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
| Understanding the Rise in Strata Insurance Premiums Amid Climate Challenges 12 Apr 2026: Paige Estritori In recent years, Australia's strata insurance market has experienced notable shifts, primarily driven by escalating climate risks and increasing claims costs. As we move through 2026, these factors continue to influence premium rates and underwriting practices, presenting challenges for owners corporations and strata managers. - read more |
| Deloitte's Vision: Navigating Australia's Insurance Landscape in 2026 12 Apr 2026: Paige Estritori As the Australian insurance sector approaches 2026, Deloitte has released a comprehensive report detailing eight pivotal predictions that are set to reshape the industry. These insights provide a roadmap for insurers to adapt and thrive amidst evolving challenges and opportunities. - read more |
| APRA Highlights Increase in Intermediated General Insurance Premiums 12 Apr 2026: Paige Estritori The Australian Prudential Regulation Authority (APRA) has released its latest statistics, indicating a notable increase in general insurance premiums placed through intermediaries. This trend reflects the dynamic nature of Australia's insurance landscape and offers insights into the sector's current trajectory. - read more |
| Deloitte's Forecast: Key Insurance Trends for Australia in 2026 12 Apr 2026: Paige Estritori As the Australian insurance landscape continues to evolve, Deloitte has released its 2026 Insurance Predictions, highlighting pivotal trends that are set to reshape the industry. These insights are particularly relevant for self-employed professionals seeking to understand how these changes may impact their coverage options and risk management strategies. - read more |
| What Does It All Mean? Navigating Life Insurance Terminology When it comes to life insurance, understanding the terminology is crucial for anyone looking to secure their family's financial future. Unfortunately, life insurance can often seem like a confusing maze of complex terms and legal jargon. - read more
|
| Protecting Your Loved Ones: The Role of Life Insurance in Estate Planning Estate planning is a process that involves the management and distribution of an individual's assets and responsibilities in the event of their passing or incapacitation. It is an essential part of financial planning that ensures your assets are managed according to your desires and your loved ones are taken care of. - read more
|
| The Savvy Consumer’s Guide to Purchasing Life Insurance in Australia As the landscape of finance and personal security evolves in Australia, the importance of being insured has never been more prominent. In a world of changing family dynamics, economic pressures, and higher living costs, life insurance stands as a bastion of support ensuring the well-being of loved ones in the event of unforeseen circumstances. The advent of the digital age has significantly shifted the manner in which Australians can shop for and secure life insurance from the comfort of their homes, offering tailored solutions with just a few clicks. - read more
|
| Breaking Down Common Income Protection Insurance Terms Income protection insurance is designed to provide financial support if you're unable to work due to illness or injury. It aims to replace a portion of your income during such times, ensuring you can maintain your lifestyle and meet financial obligations. - read more
|