Horse Accident Claim Rejected: A Deeper Look into Trauma Insurance
Horse Accident Claim Rejected: A Deeper Look into Trauma Insurance
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
Share this news item:
| Medical Emergencies Lead Australian Travel Insurance Claims in 2024 28 Nov 2025: Paige Estritori In 2024, medical incidents emerged as the leading cause of travel insurance claims among Australian travellers, accounting for more than 40% of all claims handled by nib Travel. This trend underscores the critical importance of securing comprehensive travel insurance to mitigate the financial risks associated with medical emergencies abroad. - read more |
| QBE Insurance Faces Market Challenges with Slower Premium Growth 28 Nov 2025: Paige Estritori QBE Insurance Group, Australia's largest insurer by market value, recently reported a slowdown in premium rate growth, leading to a significant decline in its share price. The company's global average premium rate increased by only 1.5% in the nine months leading up to September 30, 2025, a decrease from the first-half pace. This deceleration is primarily attributed to slower growth in business property insurance prices. - read more |
| EQT's Bid to Acquire AUB Group: Implications for the Insurance Sector 28 Nov 2025: Paige Estritori In a significant move within the Australian insurance industry, Swedish private equity firm EQT has extended a takeover offer for AUB Group, valuing the company at A$5.25 billion. This proposal includes a price of A$45 per share, representing a 25.1% premium over AUB's last closing price. Following the announcement, AUB shares surged up to 11% to A$39.95, though they remained below the offer price. - read more |
| Australian Insurers Report Record Profits Amid Market Dynamics 28 Nov 2025: Paige Estritori Australia's general insurance industry has reported a return on equity (ROE) of 19% for the 2025 financial year, marking the highest in a decade. This impressive performance is attributed to a combination of factors, including benign weather conditions, strong investment gains, and the continued flow-through of premium increases. - read more |
| How Much Life Insurance Do You Really Need? A Family's Guide to Assessment Life insurance is one of those cornerstones of financial planning that often gets overlooked. Yet, the importance of life insurance in safeguarding your family's future cannot be overstated. It's a robust financial instrument that provides peace of mind, knowing that your loved ones will be financially secure in the event of your untimely passing. This introductory section lays the groundwork for understanding why life insurance is pivotal in your family's financial health. - read more
|
| The Single Parent’s Guide to Securing Your Child’s Financial Future Single parenting brings with it a mosaic of responsibilities and challenges, not least of which is securing a stable financial future for your child. The rollercoaster of raising a child alone often means that planning for the future can take a back seat to the day-to-day demands of parenting. Unexpected illnesses and injuries can compound these challenges, causing stress to multiply and plans to go awry. - read more
|
| How Income Protection Insurance Can Safeguard Your Financial Future Income Protection Insurance is a type of insurance policy designed to provide you with a substitute income if you are unable to work due to illness or injury. This form of insurance essentially acts as a financial safety net, ensuring that you can continue to manage your living expenses even when your regular earnings have been disrupted. - read more
|
| Finding Accidental Coverage When Comprehensive Income Protection Isn't an Option Income protection is an integral part of maintaining your financial security, especially in the event that unforeseen illnesses or injuries prevent you from working. Enabling you to receive a percentage of your regular income, this type of insurance provides a safety net, ensuring that you can continue to cover your living expenses and financial obligations whilst recovering. - read more
|
An additional insurance policy that provides extra liability coverage beyond the limits of the insured's primary policies.