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:
| Federal Court Denies Truck Driver's Insurance Appeal 25 Feb 2026: Paige Estritori In a recent legal development, the Federal Court of Australia dismissed an appeal by Bradley Henschke, a logging truck driver, concerning his insurance claim against the Australian Retirement Trust. The court's decision, delivered on February 12, 2026, underscores the critical importance of active insurance coverage for workers in high-risk occupations. - read more |
| Heightened Road Risks Amid Holiday Freight Traffic Surge 25 Feb 2026: Paige Estritori As the Australian summer holidays approach, insurers and transport specialists are raising alarms about increased road risks due to the convergence of peak freight activity and heightened passenger vehicle travel. This period traditionally sees a surge in both freight movements and family road trips, leading to congested roads and a higher potential for accidents. - read more |
| InfoAgent Launches Advanced Vehicle Data Services for Heavy Trucks 25 Feb 2026: Paige Estritori Australian vehicle data provider InfoAgent has unveiled two innovative services designed to deliver accurate and detailed information for heavy commercial trucks and trailers. These services aim to address critical challenges in industries such as insurance, roadside assistance, fleet management, and logistics by simplifying processes and enabling better decision-making. - read more |
| Rising Insurance Premiums: A Growing Concern for Australians 25 Feb 2026: Paige Estritori In recent times, Australian consumers have been grappling with substantial increases in insurance premiums, prompting widespread concern and scrutiny. Reports indicate that some policyholders have experienced premium hikes ranging from 30% to 50%, with certain cases witnessing even more significant surges. This trend has raised questions about the affordability and transparency of insurance pricing in the country. - read more |
| Illness and Your Finances: Strategies for Continuous Income Flow When illness strikes, the impact on your finances can be as significant as on your health. Maintaining continuous income flow during such times is crucial for financial stability. - 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
|
| Smart Insurance Solutions to Protect Your Financial Future In today’s unpredictable world, insurance plays a critical role in safeguarding your financial future. From unexpected medical bills to protecting your home and business, the right insurance can be a safety net that helps you navigate life’s uncertainties. - read more
|
| Income Safety Net: How to Choose the Right Income Protection for Your Lifestyle In the face of life's unpredictable twists and turns, few things are as disconcerting as the possibility of suddenly losing your ability to earn an income due to illness. Such events are often unexpected and can have significant financial repercussions that interrupt not only your flow of daily life but also compromise your future plans. - read more
|
A specific type of property insurance that covers losses and damage caused by flooding.