Weber v Tiss Pty Ltd & Ors [2005] NSWSC 67
- Case Study
- 18 Feb 2015
LIFE INSURANCE – life insurance – plaintiff was member of superannuation fund – trustee of fund effected insurance policies with second defendant (insurer) – totally and permanently disabled (TPD) benefit payable if insured proved to the satisfaction of insurer that he or she was so incapacitated as to be “unlikely ever” to return to employment for which he or she was reasonably qualified by education, training or experience – plaintiff sought declarations that the insurer constructively denied her claims under policies by not having made any decision until certain dates, and that decisions themselves were void and of no effect - insurer conducted investigations and commissioned medical reports – plaintiff had little opportunity to put forward evidence and had no access to materials gathered by the insurer until a procedural fairness letter was sent – whether rejection of plaintiff’s claim reasonable – consideration of evidence until date of determination necessary – reasonableness in weight given to varied opinions of medical experts considered – HELD Insurer failed to act reasonably and accordingly, rejection of claim invalid – whether there was breach of good faith and fair dealing by the insurer – considered insurer’s refusal to share materials gathered on the plaintiff with her – considered unnecessary delay by the insurer in determining claim and inadequate opportunity for plaintiff to put her case forward despite onus on her to prove satisfaction of TPD definitions – HELD constructive denial by insurer established – court to determine whether the insured entitled to TPD claim – assessment of varied opinions in multiple expert medical reports as to significance of plaintiff’s disabilities – consideration of alcohol abuse and marital breakdown – HELD neither were intervening factors - HELD plaintiff satisfied definition of TPD in policies and entitled to receive TPD benefits