Public Liability Insurance Online :: News

Share this news item!

Horse Accident Claim Rejected: A Deeper Look into Trauma Insurance

The information on this website is general in nature and does not take into account your objectives, financial situation, or needs. Consider seeking personal advice from a licensed adviser before acting on any information.

An individual who sustained serious injuries from a horse riding accident has been denied a trauma insurance payout, as authorities concluded that there is insufficient proof that her condition is irreversible.

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

Please Note: If this information affects you, seek advice from a licensed professional.

Share this news item:

Insurance News

ICA Advocates for Overhaul of Civil Liability Laws to Curb Rising Insurance Premiums

24 Feb 2026: Paige Estritori

The Insurance Council of Australia (ICA) has recently released a white paper highlighting the urgent need for reforms to state and territory civil liability laws, which have remained largely unchanged for nearly 25 years. These outdated laws are contributing to significant increases in public liability insurance premiums, affecting a wide range of businesses across the nation. - read more

Liberty Adds 'Safe Harbour' Insolvency Cover to D&O Policies

24 Feb 2026: Paige Estritori

Liberty Specialty Markets has announced the addition of a company insolvency extension to its Australian directors' and officers' (D&O) liability policies. This innovative feature is designed to support companies and their directors by covering reasonable costs incurred when engaging approved advisers under the 'safe harbour' insolvency regime. - read more

APRA Reports Significant Underwriting Gains in Short-Tail Insurance

24 Feb 2026: Paige Estritori

The Australian Prudential Regulation Authority (APRA) has released data indicating a substantial underwriting profit of $1.55 billion in short-tail insurance lines for the September quarter. This marks a notable improvement in the sector's performance, with householders insurance contributing $636 million to the overall profit. - read more

NSW Court Decision Escalates Liability Risks for Construction Industry

16 Feb 2026: Paige Estritori

A recent landmark ruling in New South Wales has significantly altered the liability landscape for the construction industry. The court's decision removes the ability for developers and builders to rely on proportionate liability defences under the Design and Building Practitioners Act 2020 (DBP Act), thereby increasing their exposure to claims related to building defects. - read more

Rising Public Liability Insurance Premiums Challenge Australian Businesses

16 Feb 2026: Paige Estritori

The Australian Prudential Regulation Authority (APRA) has released its latest National Claims and Policies Database (NCPD) statistics, revealing a substantial increase in public liability insurance premiums over recent years. According to the data, premiums have risen by 40% since 2015, a rate that surpasses general inflation and places additional financial strain on businesses across the country. - read more

Click for more Insurance News

Business Insurance Articles

How to Choose the Right Public Liability Insurance Policy for Your Business

When it comes to running a business, safeguarding your financial well-being against unforeseen events is crucial. Public Liability Insurance (PLI) is designed to protect your business from the financial risks associated with claims of property damage, personal injury, or death caused to third parties due to business activities. Understanding this shield of security is the first line of defense in a world where accidents and mishaps are not just possible but often probable. - read more

Understanding Public Liability Insurance: A Must-Have for Aussie Businesses

For any Australian business, the unforeseeable mishaps that can occur daily pose potential risks not only to operational continuity but also to financial stability. At the core of a strategic risk management plan lies the essential protective layer of public liability insurance, a shield safeguarding businesses from the legal and financial repercussions of accidents and injuries that may happen on their premises, or as a result of their operations. - read more

The Business Owner's Guide to Calculating Adequate Public Liability Coverage

For any business owner, navigating the waters of legal and financial protection can be daunting. Public liability insurance is a lifeboat in this respect; by understanding its basics, businesses can better shield themselves against the unpredictable tides of liability claims. As a starting point, public liability insurance is designed to protect businesses in the event that a third party suffers an injury or property damage due to the business's operations. - read more

Navigating Public Liability Insurance for Event Organizers: A Must-Read Guide

Event organizing can be an exhilarating adventure, teeming with creativity and collaboration. However, with the buzz of activity and the gathering of crowds comes a significant responsibility to ensure the safety and well-being of attendees, staff, and the venue itself. This is where Public Liability Insurance becomes a pivotal part of an event organizer's toolkit. - read more

The Role of Liability Insurance in Managing Contractor and Supplier Risks

Engaging with contractors and suppliers is an integral facet of many business operations, fostering growth and expansion. However, with this collaboration comes inherent risks that can impact a business financially and legally, should any unexpected incidents arise. It is here that liability insurance steps in as a cornerstone of risk management, safeguarding businesses from potential pitfalls associated with these partnerships. - read more

Knowledgebase

Insurance Deductible:
That part of an insurance claim that must be paid by an insured person before the the balance is paid by the insurer.

This website is owned and operated by Clark Family Pty Ltd (ACN 010 281 008) as Trustee for the Clark Family Trust (ABN 35 957 893 714), 43 Larch Street Tallebudgera QLD 4228. Clark Family Pty Ltd is an Authorised Representative (AR 1298860) of Unique Group Broker Services Pty Ltd (AFSL 509434) for financial product referrals and an Authorised Credit Representative (ACR 401491) of Saccasan Pty Ltd (ACL 386297). Check our licensing details on the ASIC registers: Clark Family Pty Ltd ACR, Clark Family Pty Ltd AR, Saccasan Pty Ltd, Unique Group Broker Services.

IMPORTANT: We do not provide financial product advice or credit assistance. We act solely as an introducer and refer enquiries to licensed third-party intermediaries, insurers, and lenders - with whom you can then deal directly. We may receive a fee or commission from these third parties in consideration for the referral. Before any action is taken to obtain a product or service referred to by this website, advice should be obtained (from either the third party to whom we refer you or from another qualified intermediary) as to the appropriateness of obtaining those products having regard to your objectives, financial situation and needs. Whilst we have our own process for validating the legitimacy of our referral partners, you should always verify the credentials of your financial adviser before proceeding with recommendations that they may present. Visit the ASIC website for further information.