Public Liability Insurance Online :: News
SHARE

Share this news item!

Horse Accident Claim Rejected: A Deeper Look into Trauma Insurance

Horse Accident Claim Rejected: A Deeper Look into Trauma Insurance

Horse Accident Claim Rejected: A Deeper Look into Trauma Insurance?w=400

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
Author: Paige Estritori

Please Note: We do not endorse any specific products or companies. Some content is sourced from third parties, including press releases, and may not be independently verified for accuracy or completeness.

Share this news item:

Rate this article

Sign in with Google to rate

0 Comments

No comments yet. Be the first to share your thoughts.

Insurance News

Why Longer Public Liability Claims Deserve Renewal Attention
Why Longer Public Liability Claims Deserve Renewal Attention
28 Oct 2026: Paige Estritori
Fresh liability market analysis from KPMG has added an important caution for Australian small businesses: even where parts of the commercial insurance market are becoming more competitive, public liability insurance remains shaped by claims that can take time to settle, develop and fully cost. The firm's 20 October 2026 report draws mainly on APRAs National Claims and Policies Database experience to December 2024 and points to a market entering a more nuanced phase. - read more
Why Stronger Insurer Results Do Not Mean Liability Risk Has Gone Away
Why Stronger Insurer Results Do Not Mean Liability Risk Has Gone Away
16 Sep 2026: Paige Estritori
Fresh industry attention on APRA's general insurance performance data points to a healthier overall insurance sector, with stronger premium revenue, improved investment conditions and more stable underwriting outcomes across parts of the market. For small business owners, that may sound like welcome news after several years of rising premiums and tighter insurer scrutiny. - read more
Why Claims Handling Scrutiny Matters for Liability Cover
Why Claims Handling Scrutiny Matters for Liability Cover
09 Sep 2026: Paige Estritori
Fresh scrutiny of general insurance claims handling has again put the spotlight on how policies perform when customers need them most. While much of the public discussion often centres on household claims, the same service and documentation issues can become critical for small businesses facing a third-party injury or property damage allegation. - read more
What NSW Insurance Levy Reform Means for Business Cover
What NSW Insurance Levy Reform Means for Business Cover
02 Sep 2026: Paige Estritori
New South Wales’ move to shift emergency services funding away from insurance premiums has put business insurance affordability back in the spotlight. For small business owners, tradies, hospitality operators and event organisers, the change is welcome in principle: levies and taxes can add noticeably to the total cost of holding cover, especially when several policies are bundled together. - read more
Why Easing Insurance Prices May Not Mean Easier Liability Cover
Why Easing Insurance Prices May Not Mean Easier Liability Cover
26 Aug 2026: Paige Estritori
Fresh commercial insurance market commentary suggests Australian businesses may be seeing more favourable conditions in some parts of the insurance market, but that does not mean liability cover has become simple, automatic or uniformly cheaper. For small business owners, tradies, contractors, venues and event organisers, the message is clear: public-facing risk still needs careful attention. - read more
Click for more Insurance News


Business Insurance Articles

Top Mistakes to Avoid When Choosing Public Liability Coverage
Top Mistakes to Avoid When Choosing Public Liability Coverage
Public liability insurance stands as a crucial safeguard for businesses, shielding them from the financial repercussions of legal claims. These claims can arise when members of the public suffer damages or injuries in connection with a business's operations. Understanding the basics of this coverage is not just a matter of legal compliance for many businesses, but a proactive step in asset protection. - read more
The Role of Liability Insurance in Managing Contractor and Supplier Risks
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
Why Retail Store Owners Can't Afford to Skip Public Liability Insurance
Why Retail Store Owners Can't Afford to Skip Public Liability Insurance
As the owner of a retail store, you may not realize that the day-to-day interactions with customers and the public pose significant financial risks. Whether it's a customer slipping on a wet floor or a product causing harm, the threat of negligence claims is all too real. This is where Public Liability Insurance becomes not just a safety net, but a fundamental necessity for your business operations. - read more
Understanding Public Liability Insurance: A Must-Have for Aussie Businesses
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
What Is a Public Liability Insurance Certificate of Currency?
What Is a Public Liability Insurance Certificate of Currency?
A public liability insurance certificate of currency is proof that your policy is in force at a point in time. Businesses may need one for contracts, tenders, worksites, leases, events, markets or council approvals, but it is not the same as reading the full policy. - read more

Knowledgebase
Coverage:
The amount of risk or liability covered for an individual or entity by way of insurance services.

Quick Links: | Public Liability Insurance | Public Liability Insurance Australia | Business Liability Insurance | Public Liability Cover | Public Liability Insurance Quote | What Does Public Liability Insurance Cover | Compare Public Liability Insurance | Cheap Public Liability Insurance | Small Business Public Liability Insurance | Public Liability Insurance For Tradies | Public Liability Insurance Cost
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). Check our licensing details on the ASIC registers: Clark Family Pty Ltd ACR, Clark Family Pty Ltd AR, Unique Group Broker Services.
IMPORTANT: We act solely as an introducer and refer enquiries to licensed third-party brokers, insurers, and lenders. We do not provide financial product advice or credit assistance. 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 independently verify the credentials and licensing of any adviser or provider you engage. Visit the ASIC website for further information.