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:
| New Legislation Prohibits Life Insurers from Using Genetic Test Results 08 Mar 2026: Paige Estritori The Australian government has enacted legislation prohibiting life insurers from using the results of genetic tests to refuse coverage or increase premiums. This landmark decision aims to eliminate genetic discrimination and encourage individuals to undergo potentially life-saving genetic testing without fear of financial repercussions. - read more |
| Australian Insurers Face Challenges in Cyber and AI Risk Readiness 08 Mar 2026: Paige Estritori Recent findings from the PwC Insurance Banana Skins Survey have raised concerns about the preparedness of Australian insurers in managing emerging risks, particularly those associated with cyber threats and artificial intelligence (AI). The survey, which gathered insights from 698 insurance executives across 42 territories, including 37 from Australia, indicates that Australian insurers scored 6.6% lower on the Preparedness Index compared to their global counterparts. - read more |
| Rising Insurance Premiums Pose Challenges for Australian Businesses 08 Mar 2026: Paige Estritori Businesses across New South Wales are grappling with substantial increases in insurance premiums, prompting calls for urgent reforms to alleviate financial pressures. According to Business NSW's latest Business Conditions Survey, nearly 80% of businesses have experienced double-digit hikes in insurance costs over the past year, with one in three reporting increases of 30% or more. These surges significantly outpace the annual inflation rate of 2.5%, placing an undue burden on the business community. - read more |
| Impact of Victorian Bushfires on Home Insurance Costs 08 Mar 2026: Paige Estritori Recent bushfires in Victoria have caused significant devastation, leading to concerns about rising insurance premiums for homeowners in affected areas. The Insurance Council of Australia (ICA) has declared the fires a catastrophic event, with over 2,600 claims already lodged. This situation underscores the financial challenges faced by residents in regions prone to natural disasters. - read more |
| Understanding Income Protection Insurance: A Comprehensive Guide for Australians Income protection insurance is an essential component of financial security for Australians, designed to provide a safety net by replacing a portion of your income if you're unable to work due to illness or injury. Despite its critical role in safeguarding livelihoods, it's often overlooked in personal financial planning. - read more
|
| Top Mistakes to Avoid When Comparing Income Protection Insurance Insurance plays a pivotal role in maintaining financial stability, especially for working adults in Australia. It acts as a safety net, offering peace of mind in the face of uncertainties. By securing an insurance policy, individuals protect themselves against potential financial disruptions caused by unexpected events. - read more
|
| Comparing Income Protection Policies: What Australians Should Look For Income protection insurance serves as a financial safety net for countless Australians, offering a replacement income when unforeseen circumstances such as illness or injury impede their ability to earn. For the self-employed and entrepreneurs who may not have the safety nets offered by corporate employment, such protection is particularly important. - 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
|
A risk associated with the nature of a particular occupation, which may affect insurance premiums.