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.
Fresh attention on cyber incidents across Australian businesses is a timely warning for restaurants, cafés and takeaway operators. Hospitality venues may not always see themselves as data-heavy businesses, but modern food service increasingly depends on connected systems: point-of-sale terminals, booking platforms, delivery apps, QR ordering, loyalty databases, rostering tools and cloud accounting. - read more
Recent heavy vehicle compliance activity has again put fatigue management near the top of the risk agenda for Australian transport operators. While enforcement is usually framed as a road safety issue, it also has a direct insurance dimension. Insurers assessing truck insurance risk increasingly look beyond the vehicle itself and ask how well the business controls driver behaviour, scheduling pressure, maintenance downtime and record-keeping. - read more
APRA’s latest general insurance data has again highlighted a point many Australian tradies are already feeling at renewal time: a healthier insurance sector does not necessarily translate into simple or immediate premium relief for small businesses. While insurers continue to operate with stronger capital buffers and improved underwriting discipline, the costs sitting behind many policies remain under pressure. - read more
Fresh complaints reporting from the Australian Financial Complaints Authority has put insurance service standards back under the microscope, with claim delays, communication issues and disputed outcomes continuing to feature in the wider financial services complaints landscape. For beauty salon owners, skin clinics, nail technicians and mobile beauticians, the lesson is practical: the moment a loss occurs is not the best time to discover that records are incomplete, policy wording is unclear or a treatment has not been properly disclosed. - read more
Choosing public liability insurance is not just about comparing premiums. Australian businesses should understand policy limits, exclusions, excesses, endorsements and conditions before deciding whether a policy is appropriate for their risks. - read more
Professional indemnity insurance can help protect Australian professionals and service businesses against claims arising from alleged errors, omissions, negligence or breaches of professional duty. This guide explains what it may cover, how claims-made policies work and what to check before arranging cover. - read more
Small businesses can face liability claims from customers, clients, employees, products, advice, services and day-to-day operations. This guide explains common liability risks in Australia, how insurance can form part of a risk management strategy, and practical steps that may help business owners assess, document and manage those risks. - read more
Liability insurance is not compulsory for every Australian business, but it may be required by law, licence conditions, contracts, leases, tenders, permits or client agreements. This guide explains where requirements commonly arise and how to check what applies to your business. - read more
Start Here !
Knowledgebase
Public Liability Insurance: A very broad term for insurance covering liability exposures for individuals and business owners. It provides broad coverage, generally including all exposures for property damage and bodily injury.
No comments yet. Be the first to share your thoughts.