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
| Neos Recognized as Leading Income Protection Insurer in 2025 12 Feb 2026: Paige Estritori In the 2025 Life Insurance Awards presented by Money Magazine, Neos has been honored as the top provider in the Income Protection Insurance category. This accolade reflects Neos's commitment to delivering comprehensive and reliable income protection solutions to Australians. - read more |
| TAL's Health Sense Plus Now Covers Income Protection Policies 11 Feb 2026: Paige Estritori In a strategic move to make life insurance more relevant to younger Australians, TAL has expanded its Health Sense Plus program to encompass income protection policies. This initiative allows advisers to offer clients enhanced value through a straightforward preventative health engagement. - read more |
| AFCA's Ruling: Home-Based Waxing Salon Deemed a Business 11 Feb 2026: Paige Estritori The Australian Financial Complaints Authority (AFCA) recently ruled that a home-based waxing salon constitutes a business, not merely a hobby. This decision has significant implications for beauticians managing home-based operations, particularly concerning insurance disclosures and compliance. - read more |
| Insurers Push for Overhaul of Civil Liability Laws Amid Rising Premiums 11 Feb 2026: Paige Estritori The Insurance Council of Australia (ICA) has recently called for comprehensive reforms to state and territory civil liability laws, citing significant increases in public liability insurance premiums. This development is particularly relevant for beauticians and small business owners in the beauty industry, who are experiencing escalating insurance costs. - read more |
| A Guide to the Australian Income Protection Insurance Landscape Income protection insurance stands as an unsung hero in the tapestry of financial security, often overlooked but irreplaceable in its role. Designed to provide a safety net, it ensures that individuals can continue to receive a portion of their income should they become unable to work due to illness or injury. It’s about peace of mind, knowing that life's unforeseen events won't sweep the ground from beneath you. - read more
|
| Income Protection for Health Workers: What You Need to Know Income protection insurance is a crucial financial safety net designed to replace a portion of your income if you're unable to work due to illness or injury. For many, it's a vital component of a robust financial plan, offering peace of mind and stability. But why is it particularly important for healthcare professionals in Australia? - read more
|
| How to Compare Income Protection Policies When You Have a Medical History In today's ever-changing world, financial security is a cornerstone of peace of mind, particularly for Australians grappling with medical histories. Income protection insurance emerges as a pivotal solution, safeguarding not only the individual’s fiscal health but the well-being of their dependents. This introduction explores the nuances of income protection insurance and its particular significance for those with pre-existing medical conditions. - read more
|
| How to Use Insurance to Protect Your Finances and Manage Debt Financial protection and debt management are essential components of maintaining a stable financial life. Without proper safeguards, unexpected events can quickly derail even the best-laid financial plans. - read more
|