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

Revolutionising Crop Insurance: DAS Unveils Cutting-Edge Data Tool Revolutionising Crop Insurance: DAS Unveils Cutting-Edge Data Tool
22 Nov 2025: Paige Estritori

Digital Agriculture Services (DAS) has introduced an innovative crop insurance solution in Australia, leveraging machine learning, automapping, and geospatial data to improve policy accuracy. This tool is designed to assist insurers, underwriters, brokers, and loss adjusters by precisely locating insured paddocks and identifying crop types, yields, and other critical details. - read more
Significant Drop in Farm Liability Claims Reflects Improved Safety Measures Significant Drop in Farm Liability Claims Reflects Improved Safety Measures
22 Nov 2025: Paige Estritori

WFI Insurance has reported a notable decrease in farm liability claims across most categories, including a 75% reduction in falls from height over the past year. This decline suggests that Australian farmers are adopting more effective safety practices, leading to fewer accidents and injuries. - read more
Insuregroup Achieves Significant Growth in Truck Insurance Policies Insuregroup Achieves Significant Growth in Truck Insurance Policies
22 Nov 2025: Paige Estritori

Insuregroup, a specialist insurance brokerage serving Australia's transport and logistics sector, has recently achieved a significant milestone by processing over 10,000 insurance policies since its inception. This accomplishment includes a 25% year-on-year increase in policy count, highlighting the escalating demand for comprehensive truck insurance solutions among Australian freight operators. - read more
ACCC Greenlights Allianz's Acquisition of RAA Insurance ACCC Greenlights Allianz's Acquisition of RAA Insurance
22 Nov 2025: Paige Estritori

The Australian Competition and Consumer Commission (ACCC) has recently approved Allianz's acquisition of RAA Insurance Holdings, a decision that has sparked discussions about the future landscape of Australia's insurance industry. This approval follows closely on the heels of the ACCC's earlier endorsement of Insurance Australia Group's (IAG) acquisition of RACQ Insurance, marking a trend towards consolidation within the sector. - read more


Life Insurance Articles

Income Insurance Claims 101: How to Get Paid Without the Stress Income Insurance Claims 101: How to Get Paid Without the Stress
Welcome to 'Income Insurance Claims 101', where we navigate the ins and outs of securing your financial wellbeing in uncertain times. As a working Australian, one of the smartest moves you can make is safeguarding your income against unforeseen events that could leave you unable to work. That's where income protection insurance enters the scene – it's not just a policy, it's peace of mind. - read more
How Life Insurance Provides Financial Security for Your Loved Ones How Life Insurance Provides Financial Security for Your Loved Ones
Life insurance is a crucial part of any comprehensive financial plan, providing peace of mind that your loved ones will be financially secure in the event of your passing. - read more
Why Income Protection Insurance Matters for Every Australian Earner 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
Income Protection Insurance: A Must-Have for Australian Adults Income Protection Insurance: A Must-Have for Australian Adults
Insurance is a crucial component of financial planning. While many Australians understand the importance of life insurance, there's another vital type of coverage that often gets overlooked: income protection insurance. - 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
Premium:
The amount paid for an insurance policy, usually on a regular basis, to maintain coverage.