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
| How Rising Insurance Premiums Are Impacting Australian Retirees 08 Apr 2026: Paige Estritori Recent reports have highlighted a concerning trend: escalating insurance premiums are placing significant financial strain on Australian retirees. Some individuals have experienced premium increases of up to 400%, making it increasingly difficult for those on fixed incomes to maintain essential coverage. - read more |
| Regulatory Update: ASIC and APRA's Review of Life Insurance Premium Practices 08 Apr 2026: Paige Estritori The Australian Securities and Investments Commission (ASIC) and the Australian Prudential Regulation Authority (APRA) have jointly released an update on their review of life insurance premium practices. This review was initiated in response to concerns over frequent and substantial premium increases that may not align with policy terms or policyholder expectations. - read more |
| Australians Prioritise Life Insurance but Face Knowledge Gaps 08 Apr 2026: Paige Estritori Recent research indicates a growing emphasis on life insurance among Australians, with 60% now holding some form of coverage, up from 55% the previous year. This trend reflects an increased awareness of the importance of financial security. - read more |
| Surging Insurance Costs Pose Challenges for Australian Retirees 08 Apr 2026: Paige Estritori Recent reports indicate a significant increase in insurance premiums across Australia, with some policies experiencing hikes of up to 18%. This surge is placing considerable financial pressure on retirees, many of whom are on fixed incomes and find it challenging to accommodate these rising costs. - read more |
| Why Income Protection Insurance is Essential for Self-Employed Australians Income protection insurance is a type of coverage designed to provide you with a steady income if you are unable to work due to illness or injury. Unlike other types of insurance, which may focus on lump-sum payments, income protection insurance prioritises regular income replacement to help cover your everyday expenses. - read more
|
| Affordable Life Insurance: Finding the Right Fit for Your Family's Finances Life insurance is a crucial component in safeguarding your family's financial security. It offers peace of mind, knowing that your loved ones will be protected in the event of unexpected circumstances. Many Australians understand the value of having life insurance, but the task of finding a policy that fits within a family's budget can sometimes feel overwhelming. - read more
|
| Protecting Your Legacy: Estate Planning and Life Insurance for Australians When thinking about the future, it's essential to have a comprehensive strategy that ensures the well-being of your loved ones and the security of your assets. Estate planning and life insurance are two critical pillars in safeguarding your family's financial stability. Despite the complexity often associated with these topics, understanding their importance and implementing them correctly can provide immense peace of mind. - read more
|
| Top Insurance Policies Every Working Adult Should Consider Insurance is an essential component of achieving financial stability. In life, unexpected events such as illnesses or accidents can pose serious financial challenges. Without adequate preparation, these can disrupt your finances significantly, making recovery even more complicated. This is where the crucial role of insurance becomes apparent. - read more
|