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 reporting on Australia's construction sector has highlighted a problem that strata communities cannot afford to treat as background noise: builder and trade contractor failures remain a live risk for apartment buildings, particularly where major repairs, defect rectification or insurance reinstatement works are required. - read more
Fresh attention on Australia's construction cost environment is a useful reminder for strata communities that insurance adequacy is not just about the premium charged at renewal. For owners corporations and body corporates, the more important question is whether the insured value of the building would still be enough to rebuild, reinstate common property and meet associated professional costs after a major loss. - read more
ASIC’s latest scrutiny of insurance in superannuation communications is a timely reminder that life cover is only valuable when people understand when it applies, what it pays, and where the gaps may sit. For employers, CFOs and HR leaders, this is not just a superannuation fund issue. It goes directly to workforce wellbeing, benefit design and the way organisations explain financial protection to their people. - read more
APRA’s latest general insurance statistics point to a sector that is in a stronger financial position than it was during the worst of recent inflation, repair-cost and catastrophe pressures. For Australian tradies, that sounds positive at first glance: a well-capitalised insurance market is better placed to pay claims, support recovery after major loss events and keep products available across higher-risk occupations and regions. - 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
Public liability insurance is designed to help protect a business when it is found legally responsible for injury or property damage suffered by a third party because of its operations. If an incident occurs, the quality of your documentation can make a major difference to how clearly the claim is assessed. - read more
In the ever-evolving landscape of Australian commerce, business insurance stands as a crucial bulwark, safeguarding enterprises against unforeseen financial perils. Recognizing this, our in-depth exploration begins with an overview of the monumental role business insurance plays for Australian companies, both large and small. It's a cornerstone for risk management, providing business owners with peace of mind as they navigate the intricacies of their industries. - 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
Endorsement: An amendment or addition to an existing insurance policy that changes the terms or scope of the original policy.
No comments yet. Be the first to share your thoughts.