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:
| Australian Life Insurers Report Significant Profit Increase in June 2025 Quarter 26 Dec 2025: Paige Estritori The Australian life insurance sector has reported a substantial after-tax profit of $360 million for the June 2025 quarter, marking a significant increase from the $116 million recorded in the same period the previous year. This impressive growth is primarily attributed to a sharp rise in investment income and improved underwriting performance across key product lines. - read more |
| Rising Mental Health Claims Impact Australian Life Insurance Industry 26 Dec 2025: Paige Estritori The Australian life insurance industry is witnessing a significant surge in mental health-related claims, reflecting broader societal challenges and increasing awareness of mental health issues. AIA Australia, a leading life insurer, has reported that mental health claims now account for 23% of its total claims, up from 15% in 2014. This trend underscores the growing prevalence of mental health conditions and their impact on individuals' ability to work and maintain financial stability. - read more |
| Decline in Australian Life and Income Protection Insurance Premiums 26 Dec 2025: Paige Estritori Recent data indicates a notable decline in life and income protection insurance premiums across Australia, providing consumers with more affordable coverage options. According to the latest Direct Life Insurance Report from Rainmaker Information, direct life premiums have decreased by 7% since 2024. Similarly, direct income protection premiums have seen significant reductions, with average premiums for waiting periods of 30 days and 90 days decreasing by 12% and 13%, respectively. - read more |
| Club Marine Marks 65 Years of Leadership in Australian Boating Insurance 26 Dec 2025: Paige Estritori Club Marine, Australia's largest recreational boat insurer, is celebrating its 65th anniversary in 2024. Since its founding in 1959 as Marine Hull & Liability, the company has grown from a small operation in Victoria to a nationwide provider of insurance services for the country's boating community. - read more |
| The importance of Income Protection Insurance for Employees While some people might think that income protection insurance is only for self-employed individuals, this is not accurate. This type of insurance is just as beneficial for employees, because accidents and illnesses can happen to anyone at any time. Workers' compensation provides only limited coverage, and most employees don't have much more than a few weeks' sick leave accrued. Of course, if you have more than one job, the situation becomes more of a concern if you are injured at one workplace resulting in being unable to work at either. - read more
|
| The Savvy Traveller's Checklist for Affordable Travel Insurance Travel insurance is an indispensable component for any savvy traveller from Australia, playing a protective role in a myriad of situations that may occur away from home. Whether it's encountering flight delays, requiring medical assistance, or facing luggage theft, having a solid travel insurance policy can convert potential nightmares into manageable inconveniences. Yet, despite its importance, the process of finding a policy that won't break the bank is increasingly challenging. - 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
|
| Life Insurance for Entrepreneurs: Protecting Your Business and Family Life insurance is a financial product designed to provide a safety net for your loved ones and business in the event of your passing. At its core, life insurance aims to deliver financial protection by paying out a lump sum or ongoing payments to a designated beneficiary upon the insured's death. - read more
|
An amendment or addition to an existing insurance policy that changes the terms or scope of the original policy.