Business Insurance Online
Australia's leading Online Business Insurance resource
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
| Building Resilience: ICA Aligns Floods Inquiry Plan 19 Dec 2024: Paige Estritori The Insurance Council of Australia (ICA) is strategically addressing the recommendations from recent inquiries into flood responses and code of practice in its latest updates. Acknowledging the variety and complexity of the suggestions, ICA supports 78 out of the total recommendations presented, tackling them in a staged and structured manner. - read more |
| Major Acquisitions Shake Up the Australian Life Insurance Sector 18 Dec 2024: Paige Estritori In a significant move estimated at $13 billion, MLC Life Insurance and Resolution Life’s subsidiaries in Australia and New Zealand are set to merge. This development is part of an acquisition involving Nippon Life, a major player in the global insurance industry. - read more |
| Sure Highlights Coverage Gaps in Cyclone Zones 17 Dec 2024: Paige Estritori An alarming gap in insurance coverage has been spotlighted by Queensland underwriting agency, Sure, as it drew attention to underinsurance among cyclone-susceptible areas. Their comparison of coverage across the state reveals stark contrasts that could have dire consequences for residents. - read more |
| Term Life Insurance Fuels Customer Grievances 13 Dec 2024: Paige Estritori New insights from the Australian Securities and Investments Commission (ASIC) highlight that term life insurance sparked the most grievances among consumers last financial year. ASIC's newly released internal dispute resolution report indicates that 41% of the complaints were linked to term life policies. - read more |
| Car Theft Case: Ignition Key Slip Leads to Unexpected Payout 13 Dec 2024: Paige Estritori A recent ruling has shed light on an insurance predicament where a policyholder’s vehicle was taken directly from outside his house while the ignition key remained in the car. Despite this oversight, the couple involved managed to secure compensation for the incident. - read more |
| Essential Insurance Coverages You Need to Protect Your Small Business Insurance is a vital component for any small business. It acts as a safety net, helping to protect your enterprise from unexpected financial losses. Whether you run a retail shop, a consultancy, or a manufacturing unit, having the right insurance coverages can make the difference between thriving and merely surviving. - read more
|
| Key Factors to Consider When Comparing Business Insurance Options Business insurance is a vital aspect of safeguarding your company's interests and mitigating potential risks. Whether you are a small startup or a well-established organization, having appropriate insurance coverage is essential for protecting your assets, finances, and reputation. - read more
|
| The Essential Checklist: What Every Australian Business Owner Needs to Know About Insurance Cover When it comes to securing the future of your business, insurance isn't just a safety net; it's a vital tool for stability and growth. As an Australian entrepreneur, navigating the complex world of business insurance can be daunting. That's why understanding the importance of choosing the right insurance cover for your venture is critical for success. - read more
|
| Understanding Business Insurance: How to Safeguard Your Australian Small Business Welcome to the elucidative journey through the realm of business insurance and the pivotal role it plays for small businesses in Australia. In the ever-evolving business landscape, having a solid safety net is not merely an option, but a necessity to thrive amidst unforeseen challenges. - read more
|
| Business Interruption Insurance: Why It’s Crucial for Small Business Owners Business interruption insurance is a type of coverage designed to compensate businesses for lost income and operational costs when they are unable to operate due to a covered event such as a natural disaster, fire, or other incidents that disrupt business operations. - read more
|
|
|
Understanding Business Insurance: How to Safeguard Your Australian Small Business Welcome to the elucidative journey through the realm of business insurance and the pivotal role it plays for small businesses in Australia. In the ever-evolving business landscape, having a solid safety net is not merely an option, but a necessity to thrive amidst unforeseen challenges. - read more
|
|
Navigating Cyber Threats: Essential Cyber Insurance for Your Start-up Starting a new business venture is an exciting endeavor, but amid the myriad decisions start-up founders face, one must not overlook the importance of insurance. In today's digital-first world, the potential for cyber threats is a reality that can no longer be ignored by businesses of any size or sector, especially start-ups aiming to secure their future. - read more
|
|
|
Key Factors to Consider When Comparing Business Insurance Options Business insurance is a vital aspect of safeguarding your company's interests and mitigating potential risks. Whether you are a small startup or a well-established organization, having appropriate insurance coverage is essential for protecting your assets, finances, and reputation. - read more
|
|
Avoiding Underinsurance: How to Adequately Cover Your Growing Business When it comes to protecting the vitality and financial health of a growing business, insurance is a keystone. Yet, amidst the day-to-day hustle of driving your business forward, it's surprisingly easy to overlook the adequacy of your insurance policies - a misstep that can lead to the perilous state of underinsurance. In this article, we will delve into the essential knowledge and strategies to ensure your business is sufficiently covered, shielding it from unexpected setbacks and losses. - read more
|
|
Assessing the Insurance needs of your Australian Labour Hire firm As a labour hire firm, it is important to assess your insurance needs to protect your business from the risks it faces. Assessing your insurance needs involves identifying potential risks specific to your industry and taking steps to mitigate them. With the right coverage, you can protect your employees, clients, and business assets from unforeseeable circumstances, which could otherwise result in costly lawsuits or accidents. - read more
|