We are a proud member of the Financial Services Online network!
Connect with us on your favourite social media platform for the latest financial news, views, tips, tricks, resources and information.
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
| Stolen Bag Saga: Travel Insurance Dispute Highlights Policy Loopholes 07 Oct 2024: Paige Estritori A recent travel mishap has brought attention to travel insurance policy nuances, as a traveler successfully claimed $6,300 after his bag was taken by a tuk-tuk driver during an overseas trip. - read more |
| Calls for Transparency Surge as Disclosure Debate Continues 04 Oct 2024: Paige Estritori In the evolving landscape of insurance broking, the push for greater transparency surrounding broker remuneration has gained renewed momentum. Amidst ongoing assessments of the Insurance Brokers Code, the Code Compliance Committee has vocally advocated for a reinstatement of mandatory remuneration disclosures to small business clients, with a strategic focus on refreshing trust through clarity. - read more |
| icare Ushers in Major Changes Starting Next Week 01 Oct 2024: Paige Estritori Commencing on October 8, icare is gearing up for significant structural changes aimed at streamlining operations and boosting efficiency. This initiative comes in response to a comprehensive Operational Expenditure Review conducted by NSW Treasury, which outlines 14 pivotal findings to help reduce the state's insurer's service costs by 5%. - read more |
| Horse Accident Claim Rejected: A Deeper Look into Trauma Insurance 01 Oct 2024: Paige Estritori 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. - read more |
| AI Set to Transform Claims Processing 01 Oct 2024: Paige Estritori Expect significant improvements in the insurance claims process through the adoption of artificial intelligence (AI) within the next five years, predicts Willem Paling, Executive Manager of Analytics and AI at IAG. According to Paling, local markets are poised to embrace innovations already seen in Europe, the US, and northeast Asia. - read more |
| A Beginner's Guide to Public Liability Insurance: Protecting Your Business Imagine you own a cozy café where people flock for their morning coffee and a slice of solace. Now picture a customer slipping on a wet floor and sustaining an injury. Incidents like this, as unfortunate as they are, can occur in any business setting and often result in legal claims that can be financially draining. This is where public liability insurance becomes a cornerstone for safeguarding your business. - read more
|
| The Role of Public Liability Insurance in Protecting Hospitality Venues Public liability insurance serves as a critical safety net for event organizers, often seen as a robust shield safeguarding against potential financial repercussions arising from unforeseen incidents. In the dynamic atmosphere of events, where a multitude of variables come into play, this insurance plays a fundamental role in ensuring the stability and continuance of the host's operations. - 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 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
|
| 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
|
|
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
|
|
|
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
|
|
|
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
|
|
Protect Your Construction Business: The Importance of Adequate Liability Coverage Operating within the construction industry involves managing an intricate web of risks and liabilities daily. Public liability insurance stands as one of the core safeguards to protect businesses from potential financial pitfalls that may arise from these risks. - 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
|