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:
| Navigating the Surge in Insurance Risks for Australian Businesses 18 Feb 2026: Paige Estritori Australian businesses are currently grappling with a complex landscape of escalating insurance risks, driven by factors such as increased litigation, rapid technological advancements, supply chain disruptions, catastrophic events, and geopolitical tensions. These challenges necessitate a proactive approach to risk management and insurance coverage. - read more |
| Learning from Near Misses: Enhancing Farm Safety in Australia 18 Feb 2026: Paige Estritori In July 2025, Farmsafe Australia launched the 'Second Chances – Who Knows How Many You'll Get' campaign, aiming to transform near misses on farms into learning opportunities to prevent future accidents. This initiative underscores the critical importance of recognising and addressing close calls in agricultural settings. - read more |
| WFI's 2025 Farm Accident Insights: A Call for Enhanced Safety Measures 18 Feb 2026: Paige Estritori In October 2025, WFI Insurance unveiled its annual farm accident insights as part of Farmsafe Australia's 2025 Safer Farms Report. The findings paint a stark picture of the challenges facing Australian agriculture, with 2024 recording 72 farm-related deaths—the highest in over two decades. - read more |
| ASIC Highlights Deficiencies in Insurers' Complaint Handling Practices 18 Feb 2026: Paige Estritori The Australian Securities and Investments Commission (ASIC) has recently conducted a comprehensive review of insurers' complaint handling processes, uncovering significant deficiencies that fail to meet regulatory obligations. The findings indicate that insurers are not adequately identifying and addressing customer complaints, with one in six complaints going unrecognized. Additionally, systemic issues are often overlooked, communication timeframes are missed, and existing systems fail to record outcomes such as compensation payments. - read more |
| Income Protection Insurance vs. Total Permanent Disability: What’s the Difference? When life throws unexpected challenges your way, being financially prepared can make all the difference. This is where Income Protection Insurance and Total Permanent Disability (TPD) Insurance come into play. These two types of insurance provide a crucial safety net, ensuring that you and your family remain financially stable even when you're unable to work due to illness or injury. - read more
|
| How to Review and Update Your Life Insurance Policy as Your Family Grows Life insurance is an essential safety net for families, providing financial security when it's needed the most. As your family grows, the importance of having a well-structured life insurance policy becomes even more critical. In the busy lives we lead today, it’s easy to overlook this crucial aspect of financial planning. However, ensuring your coverage meets your family's evolving needs is vital. - read more
|
| Tips and Tricks for Fitting Insurance Premiums into Your Monthly Budget Understanding the significance of insurance in managing your finances is crucial. It acts as a safeguard, providing a buffer against unexpected losses or damage to your most valuable possessions. However, the costs associated with this necessary protection can be challenging to manage, especially when it comes to fitting insurance premiums into a monthly budget. - read more
|
| Health Insurance for Young Australians: Why Starting Early Pays Off Health insurance is a crucial aspect of managing both health and financial risks. Many Australians may not realize the significance of having robust health coverage until they face unexpected medical expenses. Starting early with health insurance can not only provide peace of mind but also pave the way for better health management in the long run. - read more
|
A provision in a life insurance policy that prevents the insurer from voiding coverage due to a misstatement by the insured after a certain period.