Business 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
Author: Paige Estritori

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

Share this news item:

Insurance News

IAG's Strategic Expansion: 90% Acquisition of RACQ Insurance

24 Mar 2026: Paige Estritori

Insurance Australia Group (IAG) has announced the acquisition of a 90% stake in RACQ Insurance for $855 million. This strategic move is expected to bolster IAG's gross written premiums by approximately $1.3 billion, reinforcing its position in the Australian insurance market. - read more

Suncorp's Impressive 89% Profit Increase in H1 2025

24 Mar 2026: Paige Estritori

Suncorp Group has reported a remarkable 89% increase in net profit for the first half of 2025, with earnings per share reaching A$86.56. This substantial growth reflects the company's strong performance in the Australian insurance sector. - read more

Gallagher Bassett's Mobile Case Managers Enhance NSW Workers' Compensation

24 Mar 2026: Paige Estritori

Gallagher Bassett has introduced mobile case managers in New South Wales, aiming to enhance workers' compensation services by providing on-site support to injured workers. This initiative builds upon a successful model implemented in South Australia over the past decade. - read more

Australian Insurers Face Challenges in Cyber and AI Risk Readiness

08 Mar 2026: Paige Estritori

Recent findings from the PwC Insurance Banana Skins Survey have raised concerns about the preparedness of Australian insurers in managing emerging risks, particularly those associated with cyber threats and artificial intelligence (AI). The survey, which gathered insights from 698 insurance executives across 42 territories, including 37 from Australia, indicates that Australian insurers scored 6.6% lower on the Preparedness Index compared to their global counterparts. - read more

Rising Insurance Premiums Pose Challenges for Australian Businesses

08 Mar 2026: Paige Estritori

Businesses across New South Wales are grappling with substantial increases in insurance premiums, prompting calls for urgent reforms to alleviate financial pressures. According to Business NSW's latest Business Conditions Survey, nearly 80% of businesses have experienced double-digit hikes in insurance costs over the past year, with one in three reporting increases of 30% or more. These surges significantly outpace the annual inflation rate of 2.5%, placing an undue burden on the business community. - read more

Click for more Insurance News

Business Insurance Articles

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

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

The Importance of Cyber Security: Protecting Your Small Business

Cyber security refers to the practices and technologies designed to protect computers, networks, programs, and data from unauthorized access, attacks, or damage. It's a crucial aspect of modern business operations, and understanding its importance is vital for all businesses, especially small ones. - read more

The Importance of Adequate Insurance Coverage for Your Small Business

For small businesses, navigating the intricacies of sustainability is a critical task that can be made more manageable through the prudent use of business insurance. Understandably, many small business owners prioritize immediate operational concerns over seemingly discrete matters like insurance. However, as we will explore, insurance is not a mere formality—it's a vital backbone to enduring success. - read more

Common Insurance Mistakes Small Business Owners Should Avoid

Running a small business in Australia comes with its unique set of challenges and risks. One crucial aspect that every small business owner must consider is liability insurance. Liability insurance is designed to protect businesses from various claims and lawsuits that can arise in the course of their operations. Whether it's a customer slipping and falling in a store or a disgruntled employee filing a lawsuit, having the right insurance can provide a financial safety net. - read more

Knowledgebase

Subrogation:
The process by which an insurance company seeks to recover the amount paid to the policyholder from a third party responsible for the loss.

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.