Compare Life Insurance :: News
SHARE

Share this news item!

Horse Accident Claim Rejected: A Deeper Look into Trauma Insurance

Horse Accident Claim Rejected: A Deeper Look into Trauma Insurance

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.

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:

Insurance News

Allianz Australia Penalised for Misleading Travel Insurance Information Allianz Australia Penalised for Misleading Travel Insurance Information
24 Feb 2026: Paige Estritori

In a significant ruling, the Supreme Court of New South Wales has imposed fines totaling $16.8 million on Allianz Australia Insurance and its subsidiary, AWP Australia, for disseminating misleading information about their travel insurance products between 2016 and 2018. This decision underscores the critical importance of transparency and accuracy in the insurance sector. - read more
Survey Highlights Alarming Number of Australians Travelling Uninsured Survey Highlights Alarming Number of Australians Travelling Uninsured
24 Feb 2026: Paige Estritori

Recent research conducted by the Insurance Council of Australia (ICA) and the Department of Foreign Affairs and Trade (DFAT) has unveiled a concerning trend: approximately 14% of Australian travelers embark on international journeys without any form of travel insurance. This statistic has prompted industry leaders to urge Australians to reconsider the importance of securing adequate coverage before traveling abroad. - read more
Surge in Medical Claims Among Australian Travellers Highlights Importance of Comprehensive Insurance Surge in Medical Claims Among Australian Travellers Highlights Importance of Comprehensive Insurance
24 Feb 2026: Paige Estritori

In 2024, medical incidents emerged as the leading cause of travel insurance claims among Australian travelers, 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
Australian Homeowners Confront Steep Rise in Insurance Premiums Australian Homeowners Confront Steep Rise in Insurance Premiums
24 Feb 2026: Paige Estritori

Over the past five years, Australian homeowners have experienced a significant 51% increase in home insurance premiums. This surge has placed a considerable financial burden on property owners nationwide, with Darwin residents facing the highest costs. - read more


Life Insurance Articles

Strategies to Use Life Insurance in Funding Shareholder Agreements Strategies to Use Life Insurance in Funding Shareholder Agreements
Shareholder agreements lay the cornerstone for stable business relationships and continuity in Australia. Acting as a contract among business owners, these agreements set forth the expectations, rights, and obligations of all parties involved. They are particularly vital in delineating clear paths for dispute resolution, succession planning, and the transfer of ownership shares under varied circumstances, including the untimely death or departure of a shareholder. - read more
How Income Protection Insurance Can Safeguard Your Financial Future 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
Protecting Your Future: A Simple Approach to Life and Disability Insurance Protecting Your Future: A Simple Approach to Life and Disability Insurance
Welcome to the crucial conversation about safeguarding your future through life and disability insurance. Many of us ponder the distant horizon of life's 'what ifs,' but are we truly prepared? The reality is that our financial security can be drastically affected by unforeseen events—a serious illness or a sudden disability that prevents us from working. That's where life and disability insurance come into play, serving as critical safety nets that can keep us afloat during tough times. - read more
Securing Your Family's Future: How Life Insurance Offers Peace of Mind Securing Your Family's Future: How Life Insurance Offers Peace of Mind
Life is a tapestry of precious moments, each framed by the inevitable uncertainty that the future holds. The awareness that our paths are peppered with unpredictability can often cast a shadow of concern, affecting how we cherish the present. For many, the well-being of family remains the cornerstone of life's purpose, driving the need for a foundation that offers stability and reassurance in the face of life's unexpected challenges. - read more


Start Here !
life insurance
Apply now for your free Insurance assessment and price comparisons!

Start Here

Life Cover Amount:
Postcode:


All quotes are provided free and without obligation. We respect your privacy.
Knowledgebase
Coinsurance:
A percentage of the cost of a covered healthcare service that you pay after you have paid your deductible.