Byrnes-Reeves v QSuper

Case [2025] QSC 285

SUPREME COURT OF QUEENSLAND

CITATION:

Byrnes-Reeves v QSuper [2025] QSC 285

PARTIES:

RILEY KYNAN BYRNES-REEVES

(plaintiff)

v
QSUPER BOARD PTY LTD
A.C.N 657 707 009
(First Defendant)
AND
AUSTRALIAN RETIREMENT TRUST PTY LTD
ACN 010 720 840 AS TRUSTEE OF THE AUSTRALIAN RETIREMENT TRUST, ART LIFE INSURANCE LTD
ACN 607 345 853
(Second Defendant)
AND
ART LIFE INSURANCE LTD
ACN 607 345 853
(Third Defendant)

FILE NO:

BS 15425/23

DIVISION:

Trial Division

PROCEEDING:

Claim

ORIGINATING COURT:

Supreme Court at Brisbane

DELIVERED ON:

3 November 2025

DELIVERED AT:

Brisbane

HEARING DATES:

2-3 June 2025; 4-7 August 2025

JUDGE:

Wilson J

ORDER:

1.   The claim is dismissed.

2.   The question of costs is adjourned to a date to be fixed.

CATCHWORDS:

SUPERANNUATION – BENEFITS – MATTERS AFFECTING ENTITLEMENT TO AND PAYMENT OF BENEFITS – where the plaintiff brought a claim against the defendants for superannuation on the basis of a total and permanent disability – where the plaintiff additionally claims interest and costs – whether the plaintiff’s injuries were pre-existing – whether any injuries rendered the plaintiff totally and permanently disabled

Superannuation Industry (Supervision) Regulations 1994 (Cth) r 1.03C

Superannuation (State Public Sector) Deed 1990 (Qld) s 69(1)

Hannover Life Re of Australasia Ltd v Jones [2017] NSWCA 233

MetLife Insurance Ltd v Hellessey [2018] NSWCA 307

MetLife Insurance Ltd v MX [2019] NSWCA 228

Panos v FSS Trustee Corporation [2015] NSWSC 1217

Tal Life Ltd v Shuetrim (2016) 91 NSWLR 439

Trident General Insurance Co Ltd v McNiece Bros Pty Ltd (1988) 165 CLR 107

COUNSEL:

The plaintiff appeared on his own behalf

M May for the defendants

SOLICITORS:

The plaintiff appeared on his own behalf

McInnes Wilson for the defendants

Introduction

  1. On 6 December 2023, Mr Riley Byrnes-Reeves, the plaintiff, filed a claim in the Supreme Court of Queensland, claiming:

    (a)   $200,000;[1]

    (b)   $500,000 for interest; and

    (c)   $100,000 for costs of issuing the claim and this statement of claim.

    [1]The plaintiff clarifies in his statement of claim that he particularly wants his ‘lifetime outlook payment of $200,000 which was in [his] policy, the old policy before they merged with sunsuper’.

  2. The first defendant was the trustee of the fund, ‘QSuper’, until 28 February 2022. The second defendant is the current trustee of the fund, and the third defendant is the insurer.

  3. On 13 July 2017, the plaintiff commenced employment at Riviera Boats[2] as a labourer. The plaintiff’s employment at Riviera is the crux of his TPD claim, as this is where the plaintiff claims that he sustained injuries that prevented him from future employment.

    [2]           Rivmar Pty Ltd.

  4. The plaintiff’s case is that he is entitled to his claim because he has a total and permanent disability due to mental health and spinal issues. 

  5. Although the plaintiff is not a party to the insurance contract, the third defendant accepts that, if a benefit is payable, then the plaintiff can sue for it directly.[3]

    [3]By reason, for example, of the principles in Trident General Insurance Co Ltd v McNiece Bros…

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Details
AGLC
Byrnes-Reeves v QSuper [2025] QSC 285
Case
[2025] QSC 285
Decision Date

CaseChat Overview and Summary

In Byrnes-Reeves v QSuper, the plaintiff, Riley Byrnes-Reeves, sought a total and permanent disability (TPD) benefit from QSuper, a superannuation fund, based on his mental and physical conditions. The dispute centred on whether Byrnes-Reeves' injuries were pre-existing, which would exclude him from receiving the TPD benefit under the terms of the insurance policy. The Federal Court was tasked with determining the validity of Byrnes-Reeves' claim.

The court had to decide whether Byrnes-Reeves' medical conditions met the criteria for a TPD benefit as defined in the insurance policy. Specifically, the court needed to ascertain if Byrnes-Reeves' conditions were due to an illness or injury with signs or symptoms that existed prior to the commencement of the insurance coverage on 26 October 2017, and whether these conditions rendered him unable to work in a job for which he was qualified. Additionally, the court considered whether Byrnes-Reeves had proven his claim beyond the insurer's initial assessment.

The court found that the insurer's assessment, QInsure, had correctly determined that Byrnes-Reeves' conditions were related to pre-existing illnesses or injuries. The court noted that Byrnes-Reeves' mental and physical conditions had signs and symptoms that existed before the insurance coverage began. Therefore, the court upheld the insurer's decision that Byrnes-Reeves was not entitled to a TPD benefit. The court dismissed the plaintiff's claim and adjourned the question of costs to a later date.

Orders

Orders of the court

1. The claim is dismissed.

2. The question of costs is adjourned to a date to be fixed.

Background

Background to the litigation

Full text does not contain this section.

Evidence

Evidence Before The Court

Full text does not contain this section.

Decision

Reasons for decision

With respect to his mental and physical conditions, Dr Wong stated the following in that letter: “What is the prognosis regarding his mental condition? His condition is likely to be a long term and probably permanent for him. He is stable on his current medication regime, however his anxiety symptoms are very easily triggered.”What is the prognosis regarding his physical condition?Riley’s hyperemesis is likely to persist because diagnoses 1-5 and 7 are likely to persist.”The insurer’s decision On 23 June 2021, QInsure stated that, in their opinion, the plaintiff’s TPD claim is not payable:“After reviewing all the available information, this decision has been made because: ·The information received indicates that Riley Byrnes-Reeves Insurance Policy is subject to a Pre-Existing Exclusion Period Clause ·The medical information received indicates that the Total and Permanent Disablement was related to an illness or injury, the signs or symptoms of which existed prior to the date the cover commenced.However, the information received supports Riley Byrnes-Reeves has a permanent incapacity as defined in the SIS Regulations.” QInsure’s final decision on 1 November 2022, was: “On 23 June 2021, QInsure advised Maurice Blackburn Lawyers that our assessment was finalised and assessed Riley Byrnes-Reeves as having a Total and Permanent Disablement Claim with a Date of Disablement 8 May 2019.Riley Byrnes Reeve’s disablements were assessed as relating to an illness or injury the signs and symptoms of which existed prior to the date the cover commenced being 26 October 2017, there was no entitlement to a Total and Permanent Disablement Benefit payable. On 23 June 2021, QInsure also assessed Riley Byrnes Reeves as having a Permanent Incapacity; therefore he was entitled to access his preserved benefits that he held in his superannuation account. Therefore, after consideration of all the medical evidence supplied by Riley Byrnes-Reeves and obtained by QInsure and applying the definitions and clauses of the Insurance Policy, QInsure maintain the decision made on the Statement of reasons dated 23 June 2021 that no benefit is payable.” QInsure set out in the final decision the voluminous material that it relied on to assess the plaintiff’s claim.[7] [7]A medical certificate from Dr A Razack dated 22 August 2017; An email to Rivmar from Mr Byrnes- Reeves dated 13 September 2017; An Employment Separation Certificate from Rivmar Pty Ltd dated 23 September 2017; A referral letter from Dr A Razack dated 18 October 2017; An Employment Separation Certificate from TouchPoint HCM Solutions Pty Ltd dated 4 June 2018; A medical report from Dr M Katz dated 24 July 2018; A referral letter from Dr J Cliffe dated 10 September 2018; A confidential medical report from Dr G Patrick dated 20 October 2018; A referral letter from Dr G Patrick dated 24 October 2018; A CT of the plaintiff’s Cervical and Thoracic Spine from Dr M Ryan dated 18 February 2019; A medical form from Dr M Bersin dated 13 June 2019; A GP Mental Health Treatment Plan from Dr T Islam dated 25 June 2019; A referral letter from Dr J Wong dated 20 February 2020; A Total and Permanent Disability (TPD) Benefit Claim (Part C) – Doctor’s Statement from Dr J Wong (undated); A Total and Permanent Disability (TPD) Benefit Claim (Part A) – Member’s Statement from Mr R Byrnes-Reeves dated 20 May 2020; A medical report from Dr J Mahapatra dated 1 March 2021; A medical report from Dr J Wong dated 29 April 2021; A medical opinion from Dr H Siddle dated 7 May 2021; A medical report from Dr J Wong dated 16 December 2021; The Statement of Reasons from QInsure dated 23 June 2021; The Internal Dispute Statement of Reasons from QInsure dated 23 September 2021; The Internal Dispute Statement of Reasons from QInsure dated 14 October 2021; The medical opinion of Dr H Siddle dated 12 August 2022; The medical opinion of Dr S Goode dated 12 August 2022; A response to procedural fairness including attachments previously provided to QInsure dated 31 August 2022.The plaintiff’s position

Ratio Decidendi

Legal Principle Established

However, I will briefly deal with the next stage of the process, because, in my view, it also has no merit.The second step: reconsideration afresh whether the plaintiff is entitled to a TPD benefit If I concluded that the plaintiff passed the first step required to establish his claim (which I have not), then the second step requires me to reconsider on the evidence before the Court, whether the plaintiff is entitled to a TPD benefit. That will require consideration of whether the plaintiff has proven that: (a) “solely because of an Illness or Injury, the Insured Person has been absent from work and … the Insured Person is unlikely ever to be able to work again in a job for which the Insured Person is reasonably qualified by education, training or experience that they have acquired or could reasonably be expected to be able to acquire in the future within a suitable rehabilitation/retraining program” (before 1 October 2019 when the plaintiff’s cover expired); and(b) whether any such Illness or Injury is “related to” a Pre Existing Condition, being “an Illness or Injury the signs or symptoms of which existed prior to” 26 October 2017. As to onus, in Panos v FSS Trustee Corporation [2015] NSWSC 1217, Robb J stated: “[281] The court is required to make the determination on the basis of the conventional adversarial approach. It is for the applicant to support his or her case by the necessary evidence. The Insurer ceases to have any positive obligation to assist the applicant in the presentation of his or her case.[282]Importantly, the court has no expertise that permits it to make expert determinations of questions that cannot properly be decided without appropriate expert opinion evidence, without that evidence being provided. The entitlement of the court to draw its own conclusions based upon primary medical records is likely to be significantly restricted. The court is likely to require the assistance of appropriate expert evidence to make findings about the significance of primary medical facts and records. [283]There is likely to be a real risk, when the question that requires determination passes from whether the Insurer has made a proper determination, to whether the court itself should find that the criteria for the entitlement to the TPD benefit have been satisfied, that evidence provided by the applicant to support a favourable determination of the claim by the Insurer may no longer suffice, when the question must be determined by the court.” In considering this stage of the process, I have taken into account all of the evidence that was before me, which included the evidence from the plaintiff and his mother. It is clear that the plaintiff suffers from many debilitating conditions and has endured many difficulties. The plaintiff, at times, struggled during the hearing, but persevered. He, at all times, was respectful and polite to the Court. However, as I have stated, the issue is not whether the plaintiff suffers from medical conditions. The relevant issue is whether these conditions satisfy the terms of the insurance policy. Mental health