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.

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:

Insurance News

Clear

APRA Intervenes to Freeze Unjustified Premium Increases in Commercial Auto Insurance

09 Jun 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. This intervention aims to protect independent transport operators and logistics enterprises from immediate financial strain. - read more

Escalating Claims Costs Impact Trucking Insurance in Australia

25 May 2026: Paige Estritori

The Australian trucking industry is currently grappling with a significant rise in insurance claims costs, leading to increased premiums and prompting operators to reassess their risk management strategies. This trend mirrors global patterns where the financial repercussions of truck accidents have intensified over the past decade. - read more

Human Error Identified as Primary Factor in Major Truck Accidents

25 May 2026: Paige Estritori

A recent report backed by National Transport Insurance (NTI) has identified human error as the predominant cause of major truck accidents in Australia. The findings underscore the critical need for enhanced driver training and the implementation of comprehensive safety measures within the transport industry. - read more

NTI Updates Transport Pack to Support Transport Industry Amid Challenges

17 May 2026: Paige Estritori

National Transport Insurance (NTI), Australia's leading truck insurer, has recently refreshed its Transport Pack to better support the transport industry during a period marked by significant challenges. With nearly five decades of industry experience, NTI is leveraging its extensive data to offer solutions tailored to the current needs of transport operators. - read more

Australian Motor Fleets Embrace Telematics to Boost Safety and Control Costs

17 May 2026: Paige Estritori

In response to escalating insurance premiums and stringent safety regulations, Australian motor fleet operators are increasingly turning to telematics technology. This shift is particularly evident in sectors with high operational risks and compliance requirements, such as the resources industry. - read more

Click for more Insurance News