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
Source: Paige Estritori

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

Share this news item:

Insurance News

The Financial Perils of Travelling Uninsured: A Wake-Up Call for Australians

12 Mar 2026: Paige Estritori

Recent research has unveiled a concerning trend: 14% of Australian travellers embark on international journeys without any form of travel insurance. This statistic is even more alarming among younger travellers under 30, with nearly one in four opting to travel uninsured. Such decisions expose individuals to significant financial risks, especially when unforeseen events occur abroad. - read more

IAG CEO Predicts Ongoing Insurance Premium Rises

12 Mar 2026: Paige Estritori

Insurance Australia Group (IAG) has reported a significant 91% increase in net profit for the first half of the 2025 financial year, reaching $778 million. This surge is largely attributed to favourable weather conditions and a reduction in claims. Despite this positive financial performance, IAG's CEO, Nick Hawkins, has indicated that insurance premiums are expected to continue rising, albeit at a slower pace than in previous years. - read more

ICA Unveils Strategy to Combat Rising Motor Insurance Costs

12 Mar 2026: Paige Estritori

The Insurance Council of Australia (ICA) has released a comprehensive report titled 'Motor Insurance Policy Paper - A Roadmap for Reducing Rising Premiums,' calling for urgent and coordinated action to address the systemic cost drivers behind escalating motor insurance premiums. The report highlights that comprehensive motor insurance premiums have increased by 42% since 2019, reaching an average of $1,052 per year in 2024. - read more

APRA Data Reveals Steady Performance in General Insurance Intermediaries

12 Mar 2026: Paige Estritori

The Australian Prudential Regulation Authority (APRA) has released its latest bi-annual report on intermediated general insurance, providing insights into market activity for the six months ending June 2025. The data indicates a stable performance among general insurance intermediaries, with total premiums invoiced through intermediaries reaching $21.5 billion. Of this, $17.6 billion was placed with APRA-authorized general insurers, $2.6 billion with Lloyd’s underwriters, and $1.3 billion with unauthorized foreign insurers. - read more

Click for more Insurance News

Business Insurance Articles

Professional Indemnity vs Public Liability: What's the Best Choice for Your Small Business?

As a small business owner, understanding the intricacies of liability insurance is pivotal to safeguarding the fruit of your hard work. Insurances such as professional indemnity and public liability are not just safety nets; they are vital components that can mean the difference between bouncing back and closing down following unforeseen legal hurdles. - read more

Public Liability Insurance Claims: What to Expect and How to Prepare

When it comes to navigating the complex waters of insurance, understanding public liability insurance claims is crucial for businesses and individuals alike. Public liability insurance serves as a safeguard, protecting against the financial repercussions that arise from accidents or injuries that occur on your premises or through your operations. In this introductory section, we will delve into the essence of public liability insurance and underline its significance. - read more

The Importance of a Custom Risk Management Plan: A Guide for Australian Entrepreneurs

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

The Cost of Being Uninsured: Why Every Australian Small Business Needs Liability Coverage

Welcome to the complex world of running a small business in Australia where navigating through liability risks is as crucial as managing daily operations. This article is crafted to illuminate why every Australian small business needs liability coverage — a shield to protect against potential financial catastrophes. - read more

Start Here !

Knowledgebase

Reinsurance:
Insurance that an insurance company purchases from another insurance company to mitigate risk.

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.