Liability Insurance :: 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: 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

0 Comments

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

Insurance News

Australian Truck Drivers Seek Relief Amid Fuel Price Surge

28 May 2026: Paige Estritori

The Australian trucking industry is confronting a severe challenge as escalating fuel prices place immense financial pressure on drivers and operators. This crisis has led to urgent appeals for major clients, including retailers and manufacturers, to share the burden to prevent widespread business closures. - read more

Easing Conditions in Australia's Commercial Insurance Market

28 May 2026: Paige Estritori

In the first half of 2026, Australia's commercial insurance market has experienced a notable softening, characterized by easing pricing across various lines and a broadening of insurer appetite. This trend is detailed in the latest Insurance Market Trends and Outlook report released by EBM Insurance & Risk on May 11, 2026. - read more

APRA Freezes Unjustified Premium Increases in Commercial Auto Insurance

28 May 2026: Paige Estritori

In March 2026, the Australian Prudential Regulation Authority (APRA) took decisive action to address significant premium hikes in the commercial auto insurance sector. Responding to widespread industry concerns, APRA issued emergency regulations to freeze unjustified baseline premium increases exceeding 25%, pending external review. - read more

Rising Mental Health Claims Lead to Surge in Income Support Access

27 May 2026: Paige Estritori

Recent data reveals a concerning trend: over 8 million Australians are now accessing some form of income support, marking an increase of approximately 2 million individuals over the past decade. This surge is predominantly driven by a rise in mental health-related claims, underscoring the pressing need for comprehensive mental health support and effective income protection strategies. - read more

Click for more Insurance News

Business Insurance Articles

How to Assess Your Risk Exposure and Select the Right Indemnity Coverage

Professional indemnity insurance stands as a pivotal safeguard for Australian professionals navigating the intricacies of liability in their work life. This form of insurance is designed to protect professionals against legal costs and claims for damages arising from acts, omissions, or breaches of professional duty in the course of their practice. Whether it's due to an honest mistake or an unforeseen error, the ramifications of such professional oversights can be financially crippling. - read more

The Importance of Documentation in Public Liability Claims

Public liability insurance is an essential part of any business's risk management strategy, especially for those operating in Australia. It's designed to protect businesses when they're found legally responsible for injury or damage to third parties due to their operations. But what happens when you need to make a claim? That's where understanding the claims process becomes vital. - read more

The Impact of Environmental Liability on Australian Business Operations

In today's ever-evolving business landscape, the significance of environmental sustainability and legal accountability is increasingly paramount. Australian enterprises, in particular, are encountering a growing need to understand and manage environmental liability. This reality not only influences corporate image but also carries substantial financial and legal ramifications. - read more

The Cost of Public Liability Coverage: Is It Worth It?

Public liability insurance is a crucial safety net for both businesses and individuals, providing protection against the financial fallout from claims of injury or damage that your business operations might cause to third parties. This type of insurance is designed to cover legal and compensation costs, safeguarding you from unexpected financial burdens. - read more

Start Here !

Knowledgebase

Liability Insurance:
A type of insurance that provides protection against claims resulting from injuries and damage to people and/or property.

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 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.