Horse Accident Claim Rejected: A Deeper Look into Trauma Insurance
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.
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.
A federal parliamentary inquiry into small business insurance has pushed back its reporting date from 27 October 2026 to 26 February 2027, extending the wait for recommendations on issues that directly affect many Australian trade businesses. The inquiry is examining the provision, regulation and pricing of modern insurance products for small businesses and not-for-profits, including public liability, professional indemnity, cyber cover and business interruption. - read more
A federal parliamentary inquiry into small business insurance has reportedly pushed back its final report from 27 October 2026 to 26 February 2027, extending the wait for recommendations on insurance affordability, availability and regulation. For Australian tradies and small trade businesses, the delay matters because the inquiry is examining the types of cover many operators rely on daily, including public liability, professional indemnity, cyber risk and business interruption insurance. - read more
A new Insurance Brokers Code of Practice has been launched by the National Insurance Brokers Association, putting clearer disclosure, renewal contact and client support standards on the agenda for Australian businesses that use brokers to arrange cover. The 2027 Code takes effect on 1 January 2027 and is designed to set out, in plainer language, what clients should be able to expect from subscribing insurance brokers. - read more
The Australian Financial Complaints Authority’s latest annual review has put income protection insurance back in focus, with the product again attracting the highest number of life insurance complaints in 2025-26. The figures are a useful reminder that the real value of cover is tested not at purchase, but when illness or injury interrupts a person’s capacity to earn. - read more
In the fast-paced world of entrepreneurship, the only constant is change, and with change comes the inherent realm of the unknown – risk. Australian entrepreneurs, much like their international counterparts, operate in dynamic environments where unpredictability is a staple. However, the unique economic, legal, and environmental aspects of Australia demand a more localized understanding of these risks. Acknowledging this unpredictability is the first step towards mitigating potential threats to one's business venture. - read more
Freelancers and employees can look similar in day-to-day business operations, but the legal and liability implications are different. In Australia, classification affects tax, superannuation, employment entitlements, workers compensation, workplace safety duties, insurance and contract risk. - read more
Welcome to the crucial world of risk management for Australian tradesmen. Whether you're a seasoned professional or just starting, understanding and mitigating the inherent risks in the trades industry is paramount to both the safety and sustainability of your business. This article intends to guide you through the world of risk management, emphasizing the pivotal role of liability insurance. - read more
Public liability insurance can help protect a business if a member of the public alleges injury or property damage connected with its operations. Premiums are only one part of the decision: cover limits, exclusions, excesses, risk management and claims support all matter. This guide explains practical ways Australian businesses can review their public liability insurance costs without simply stripping out important protection. - read more
Start Here !
Knowledgebase
Professional indemnity: An insurance that provides cover for liability incurred in the course of exercising a profession.
No comments yet. Be the first to share your thoughts.