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:
| Insuregroup's Remarkable Growth Reflects Surge in Truck Insurance Demand 24 Jan 2026: Paige Estritori Insuregroup, a specialist insurance brokerage serving Australia's transport and logistics sector, has recently announced a significant milestone: processing over 10,000 insurance policies since its inception, with a 25% increase in policy volume over the past year. This growth underscores the escalating demand for comprehensive truck insurance solutions tailored to the unique needs of Australian freight operators. - read more |
| Envest Group Unveils TLI Underwriting: A New Era for Heavy Motor Fleet Insurance 24 Jan 2026: Paige Estritori Envest Group, a prominent player in Australia's insurance sector, has announced the launch of TLI Underwriting, a new agency dedicated to providing specialised insurance solutions for heavy motor fleet operators. This strategic move aims to address the unique challenges faced by larger transport businesses in Australia. - read more |
| AFCA Delivers Ruling After Trucking Company's Claim Denied 24 Jan 2026: Paige Estritori The Australian Financial Complaints Authority (AFCA) has recently ruled against a trucking company after it was found to have misrepresented its insurance history and operational details when obtaining a policy from NTI. This case underscores the critical importance of transparency and accuracy when securing insurance coverage in the transport industry. - read more |
| Australian Insurers Achieve Record Profits Amid Rising Premiums 24 Jan 2026: Paige Estritori In 2024, Australia's insurance industry reported an after-tax profit of $6.1 billion, a figure that is three times higher than the five-year average of $2 billion. This substantial increase is attributed to a combination of factors, including significant premium hikes and a reduction in severe weather events. - read more |
| The Essential Role of Income Insurance in Your Financial Plan An income insurance policy, often referred to as income protection insurance, is a financial safety net designed to provide you with a steady income stream if you're unable to work due to illness or injury. It ensures that you can still support yourself and your family, even when unforeseen medical conditions prevent you from earning a salary. This policy typically covers a percentage of your pre-tax income, helping to alleviate the financial burden during recovery periods. - read more
|
| The Essential Guide to Travel Insurance for Australians on a Working Holiday in Canada Welcome to your guide to embark on an amazing journey from Australia to the breathtaking landscapes of Canada on a working holiday. This adventure presents an inviting blend of work and travel, allowing you to immerse yourself fully in Canadian culture while supporting your explorations financially. - read more
|
| Top Insurance Policies Every Working Adult Should Consider Insurance is an essential component of achieving financial stability. In life, unexpected events such as illnesses or accidents can pose serious financial challenges. Without adequate preparation, these can disrupt your finances significantly, making recovery even more complicated. This is where the crucial role of insurance becomes apparent. - read more
|
| Why Income Protection Insurance Matters for Every Australian Earner The unpredictable nature of life can often leave us vulnerable to financial uncertainty, especially when it comes to our ability to earn an income. Whether due to illness, injury, or unexpected job loss, the loss of income can have a devastating impact on our financial stability and quality of life. This is where the importance of insurance in financial planning becomes evident. - read more
|
The individual or entity who owns the insurance policy.