We are a proud member of the Financial Services Online network!
Connect with us on your favourite social media platform for the latest financial news, views, tips, tricks, resources and information.
The incident occurred on October 16 of the previous year, leading to a significant pelvic fracture for the claimant, followed by surgery a few days later. The woman has stated that her day-to-day activities have been severely affected as a result.
Currently, she is undergoing physiotherapy and taking medication to improve her mobility. Her orthopaedic surgeon, identified as Dr NJ, has reported that she exhibits "debilitating symptoms affecting her left leg and foot."
Despite these symptoms, Dr NJ remarked that it might take 18 to 24 months to see improvement, and confirmed that predicting a permanent condition is complex at this stage.
Clearview Life Assurance refused the claim, citing that their policy's "loss of independent existence" clause necessitates a permanent inability to perform at least two daily activities independently.
In June, the complainant's general physician noted that she requires crutches for mobility and is incapable of handling tasks such as shopping, laundry, food preparation, or housecleaning.
The claimant also stated she suffers from cognitive impairment and has not shown any nerve recovery since the incident. She contends it would be unreasonable to assume her condition will improve over time.
The Australian Financial Complaints Authority (AFCA) acknowledged the severity of her disability but indicated that the current medical advice suggests she could eventually recover.
"Dr NJ is in the best position to opine on the permanence of the disability, given his specialty and ongoing treatment of the complainant," AFCA noted. "He has said it's 'too early to declare a permanent condition' and has outlined the further testing and treatments that are in progress and planned."
Nonetheless, AFCA's decision leaves the door open for the claimant to present new medical evidence at a future point that might confirm the permanence of her disability.
"It may be possible for her to demonstrate with subsequent medical evidence that her disability is permanent," AFCA said. "However, based on the current evidence, I am not convinced her disability is permanent or irreversible."
This case offers a critical view into the complexities and challenges associated with trauma insurance claims and highlights the necessity for clear and definite medical proof in establishing the permanence of a condition.
Published:Tuesday, 1st Oct 2024
Source: Paige Estritori
| Calls for Transparency Surge as Disclosure Debate Continues 04 Oct 2024: Paige Estritori In the evolving landscape of insurance broking, the push for greater transparency surrounding broker remuneration has gained renewed momentum. Amidst ongoing assessments of the Insurance Brokers Code, the Code Compliance Committee has vocally advocated for a reinstatement of mandatory remuneration disclosures to small business clients, with a strategic focus on refreshing trust through clarity. - read more |
| icare Ushers in Major Changes Starting Next Week 01 Oct 2024: Paige Estritori Commencing on October 8, icare is gearing up for significant structural changes aimed at streamlining operations and boosting efficiency. This initiative comes in response to a comprehensive Operational Expenditure Review conducted by NSW Treasury, which outlines 14 pivotal findings to help reduce the state's insurer's service costs by 5%. - read more |
| Horse Accident Claim Rejected: A Deeper Look into Trauma Insurance 01 Oct 2024: Paige Estritori An individual who sustained serious injuries from a horse riding accident has been denied a trauma insurance payout, as authorities concluded that there is insufficient proof that her condition is irreversible. - read more |
| AI Set to Transform Claims Processing 01 Oct 2024: Paige Estritori Expect significant improvements in the insurance claims process through the adoption of artificial intelligence (AI) within the next five years, predicts Willem Paling, Executive Manager of Analytics and AI at IAG. According to Paling, local markets are poised to embrace innovations already seen in Europe, the US, and northeast Asia. - read more |
| RAC Justifies Record Earnings Despite Premium Inflation 30 Sep 2024: Paige Estritori Amid escalating premium prices, Western Australia’s leading general insurer, the RAC, stands firm in defending its newfound financial success. - read more |
| Understanding Liability Insurance: A Must-Read for Australian Business Owners As a business owner in Australia, navigating the complexities of insurance is crucial to safeguard your enterprise against unforeseen events. Liability insurance emerges as a cornerstone of a sound risk management plan, protecting you financially when held responsible for accidents, injuries or negligence. Its importance cannot be understated, as it serves not only to defend your business assets but also to ensure peace of mind in a climate of continually evolving liabilities. - read more
|
| Why Every Business Needs Public Liability Insurance Welcome to our comprehensive guide on public liability insurance. If you run a business, you've probably heard this term thrown around quite often. But what exactly is public liability insurance? - read more
|
| Reducing Your Risks: Public Liability Coverage Tips for Trade Professionals For tradesmen and trade professionals, venturing into the world of business comes with its set of challenges and risks. Among the myriad of precautions to consider, one critical safeguard stands out for its ability to protect both the tradesperson and their clients: Public Liability Insurance. This form of coverage is not just a safety net; it is a cornerstone of a responsible business practice within the trade industry. - read more
|
| Understanding the Role of Public Liability Insurance in Business Disaster Planning For Australian business owners, planning for unforeseen disasters is not just prudent; it's an essential aspect of sustaining operations amidst challenges. Recognizing the importance of comprehensive strategies, including robust insurance cover, can make all the difference in business longevity and legal protection. As we navigate the complexities of running a business, it's imperative to have a safeguard against mishaps that could otherwise jeopardize our hard-earned success. - read more
|
| The Cost of Safety: How Much Public Liability Insurance Does Your Australian Business Need? As a business operating in Australia, understanding the ins and outs of public liability insurance is not just recommended, it's essential. This type of insurance serves as a safeguard, protecting your business against the financial repercussions of lawsuits and claims arising from third-party injuries or property damage due to your business operations. In a world where one unintended mishap can lead to costly legal battles, public liability insurance stands as your first line of defense. - read more
|
|
|
The Cost of Safety: How Much Public Liability Insurance Does Your Australian Business Need? As a business operating in Australia, understanding the ins and outs of public liability insurance is not just recommended, it's essential. This type of insurance serves as a safeguard, protecting your business against the financial repercussions of lawsuits and claims arising from third-party injuries or property damage due to your business operations. In a world where one unintended mishap can lead to costly legal battles, public liability insurance stands as your first line of defense. - read more
|
|
|
Why Every Business Needs Public Liability Insurance Welcome to our comprehensive guide on public liability insurance. If you run a business, you've probably heard this term thrown around quite often. But what exactly is public liability insurance? - read more
|
|
|
Understanding the Role of Public Liability Insurance in Business Disaster Planning For Australian business owners, planning for unforeseen disasters is not just prudent; it's an essential aspect of sustaining operations amidst challenges. Recognizing the importance of comprehensive strategies, including robust insurance cover, can make all the difference in business longevity and legal protection. As we navigate the complexities of running a business, it's imperative to have a safeguard against mishaps that could otherwise jeopardize our hard-earned success. - read more
|
|
Proven Strategies for Slashing Your Business Liability Insurance Costs Welcome to our comprehensive guide on public liability insurance, an essential safeguard for businesses across Australia. Navigating the complexities of liability insurance can be a daunting task for many business owners, but it’s a critical component of your business protection plan. If incidents such as accidents or property damage occur, liability insurance is the barrier that stands between your business and financial calamity. - read more
|
|
The Importance of Public Liability Insurance in the Australian Labour Hire Industry The Australian labour hire industry has seen a significant rise in recent years, and with this growth, comes new and unique risks that companies in this industry must be prepared to navigate. One such risk is the potential for accidents or damages to occur in the workplace, which is where public liability insurance comes in. This article will explore the definition of public liability insurance and why it is so important for labour hire companies in Australia. - read more
|