Edington v Superannuation Complaints Tribunal

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FEDERAL COURT OF AUSTRALIA

Edington v Superannuation Complaints Tribunal [2010] FCA 504

Citation: Edington v Superannuation Complaints Tribunal [2010] FCA 504
Parties: JOSEPH DAVID EDINGTON v SUPERANNUATION COMPLAINTS TRIBUNAL and BOARD OF TRUSTEES OF THE STATE PUBLIC SECTOR SUPERANNUATION SCHEME
File number: QUD 245 of 2009
Judge: REEVES J
Date of judgment: 21 May 2010
Catchwords:

SUPERANNUATION – appeal from the Superannuation Complaints Tribunal – Tribunal affirmed decision of the Trustee of the Superannuation Fund not to pay any insurance benefit to the applicant who had been assessed as totally and permanently disabled after a workplace incident because the total and permanent disablement was related to his pre-existing medical condition

APPEALS – consideration of the role of the Tribunal – Tribunal must affirm a decision of a Trustee if it is satisfied that the decision, in its operation in relation to the complainant, was fair and reasonable in the circumstances – Tribunal not to decide for itself the correct or preferable decision – Tribunal may make its own findings of fact only for the purpose of determining whether the decision under review was fair and reasonable – fairness and reasonableness to be assessed by reference to its impact on the complainant – Tribunal must not act in a way that is contrary to law

APPEALS – Tribunal must first identify the reasoning process that the Trustees employed to reach their decision – Tribunal did not consider how the Trustees treatment of the different medical histories affected the cogency of the Trustees reasons and whether it was fair and reasonable for the Trustee to accept one opinion but not others – Tribunal did not consider whether it was fair and reasonable for the Trustee to use different reasoning process to come to the same conclusion as Tribunal on the causation issue – Tribunal did not consider all medical evidence – Tribunal erroneously conducted a fresh review of the whole evidence – Tribunal did not properly discharge its role
Legislation: Superannuation (Resolution of Complaints) Act 1993 (Cth), ss 14, 14(2), 37, 37(1)(a), 37(5)
Cases cited:

Briffa v Hay (1997) 75 FCR 428
Colonial Mutual Life Assurance Society Limited v Brayley [2002] FCA 1333
Cameron v Board of Trustees of the State Public Sector Superannuation Scheme (2003) 130 FCR 122; (2003) FCAFC 214

Hornsby v Military Superannuation and Benefits Board of Trustees (No 1) (2003) 126 FCR 484; [2003] FCA 54

Retail Employees Superannuation Pty Ltd v Crocker (2001) 48 ATR 359; [2001] FCA 1330
National Mutual Life Association of Australia Ltd vCampbell (2000) 99 FCR 562; [2000] FCA 852
Commonwealth Superannuation Scheme Board v Dexter (2004) 142 FCR 151; [2004] FCA 1434

HEST Australia Ltd v Sykley (2005) 147 FCR 248; [2005] FCA 1381

Date of hearing: 8 February 2010
Date of last submissions: 11 March 2010
Place: Brisbane
Division: GENERAL DIVISION
Category: Catchwords
Number of paragraphs: 54
Counsel for the Applicant: M Steele
Solicitor for the Applicant: Black & Co Lawyers
Counsel for the Second…
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Details
Case
[2010] FCA 504
Decision Date

CaseChat Overview and Summary

The appeal concerns the decision of the Superannuation Complaints Tribunal regarding Mr Edington's eligibility for a total and permanent disability benefit under the QSuper Scheme. Mr Edington, who has been diagnosed with schizophrenia, claimed a total and permanent disability benefit following an incident at work where he was injured by rottweiler dogs. The Tribunal's decision under review was that Mr Edington was totally and permanently disabled due to his schizophrenia, but that his disability was related to his pre-existing condition which should have been disclosed when he joined the QSuper Scheme, and thus no insurance benefit was payable.

The legal issues before the court included whether the Tribunal properly exercised its power of review of the Trustees' decision under s 37 of the Superannuation (Resolution of Complaints) Act 1993 (Cth), and whether the Tribunal's decision was open to being quashed on the basis of errors of law or irrationality. The court had to determine whether the Tribunal's preference for the opinion of Dr Reddan over Dr De Leacy and Dr Butler was justified and whether the Tribunal's conclusion that Mr Edington's schizophrenia was the sole cause of his incapacity for work was supported by the evidence.

The court found that the Tribunal had exercised its power of review appropriately but made errors in its reasoning. The court held that the Tribunal should have considered all relevant evidence and medical opinions rather than selectively preferring one expert's opinion. The court noted that the Trustees had not considered Dr Butler's report, which was crucial to understanding the full extent of Mr Edington's injuries and conditions. Furthermore, the court held that the Tribunal's conclusion that Mr Edington's schizophrenia was the sole cause of his incapacity for work was not supported by the evidence. The court found that the Tribunal had failed to adequately consider the evidence of PTSD and other conditions diagnosed by Dr De Leacy and Dr Butler.

The court quashed the Tribunal's decision and remitted the matter to the Tribunal for reconsideration in light of the court's findings. The court emphasized that the Tribunal must consider all relevant evidence and expert opinions fairly and thoroughly, and that any preference for one expert's opinion over others must be adequately justified.

Orders

Orders of the court

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Background

Background to the litigation

The main issue in Mr Edington’s appeal to this Court is whether the Tribunal properly exercised its power of review of the Trustees’ decision under s 37 of the Superannuation (Resolution of Complaints) Act 1993 (Cth) (“the Act”).FACTUAL BACKGROUND AND PROCEDURAL HISTORY In about 1994, Mr Edington was diagnosed with schizophrenia. It is not in dispute that he continues to suffer from this condition. On 10 September 2001, Mr Edington commenced employment as a field assistant with the Department of Primary Industries (Queensland) in the Fire Ant Eradication Program. As a result of his employment, Mr Edington joined the QSuper Scheme. He acquired four insurance units effective from 10 September 2001 and a further seventeen units effective from 10 December 2001. On 2 January 2002, in the course of his employment, Mr Edington entered a property in Brisbane to inspect it for fire ants. There was some dispute about exactly how this incident occurred, but it was recorded in one of the earlier decisions in the following terms. While he was on the property, two rottweiler dogs ran towards him. To escape the dogs, he ran to the front gate and jumped over it. In the process, he fell and injured his back and his right foot. Mr Edington subsequently claimed to have suffered an injury to his right foot and either post traumatic stress disorder (“PTSD”), or an anxiety disorder, as a result of this incident. He ceased work on 8 July 2002 and thereafter applied for, and received, income protection payments from 26 July 2002 to 23 June 2003. On 12 February 2003, he applied to the QSuper Scheme for a total and permanent disability benefit. On 26 May 2003, a delegate of the Board of Trustees of the QSuper Scheme determined that, as a result of the foot injury he sustained in the dog incident, Mr Edington was not suffering from a disability that rendered him incapable of discharging his duties and he was therefore not entitled to continue to receive income protection payments after 23 June 2003. At the same time, the delegate determined that, as a result of his schizophrenia condition, Mr Edington was unlikely to ever be able to work again in a job for which he was reasonably qualified by education training and experience and he was therefore considered to be totally and permanently disabled for the purpose of retirement on the grounds of ill health. However, because the delegate concluded that the evidence did not establish that his schizophrenia condition was not related to a medical condition existing before he became a member of the QSuper Scheme, the delegate determined he was not entitled to be paid a total and permanent disability insurance benefit. On the same day as the delegate made these determinations, Ms O’Brien, the responsible Case Manager at QSuper, wrote to Mr Lane, a Human Relations Consultant in the Department of Primary Industries, advising him that:QSuper has reviewed the extent and permanency of Mr Edington’s incapacity. Sufficient medical evidence has been received to establish that he is unlikely to ever be able to work in a job for which he is reasonably qualified by education, training or experience, due to a “medical condition”. As per the QSuper trust deed and Insurance Terms, he is entitled to a total and permanent disability benefit upon termination of his employment.

Evidence

Evidence Before The Court

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Decision

Reasons for decision

Accordingly, the Trustees determined that:1.Mr Edington was totally and permanently disabled pursuant to the QSuper Trust Deed.2.Mr Edington’s disablement was related to his schizophrenia which should reasonably have been disclosed [when he joined the QSuper Scheme].THE TRIBUNAL’S DECISION In its reasons for its decision of 11 September 2009 (mentioned above), the Tribunal began by identifying the decision under review as “… that the Complainant was totally and permanently disabled (‘TPD’), but that his disablement was related to his schizophrenia which should reasonably have been disclosed had a medical statement been submitted at the time that he became a member, and that accordingly, no insurance benefit was payable”. The Tribunal then set out the extensive procedural history to the complaint (summarised above), certain facts said not to be in dispute and various provisions of the Trust Deed and Insurance Terms, including Clause 6.1 – they actually set out 6.2 of the Insurance Terms relating to the additional Insurance Terms which are almost identical: see [12] above. It then turned to analyse the evidence of all the medical experts, particularly the reports of Drs Butler, Reddan and De Leacy. It devoted some 58 paragraphs of its reasons to this analysis. The Tribunal noted Dr De Leacy had diagnosed post traumatic stress disorder (“PTSD”) as the cause of Mr Edington’s total and permanent disability and had expressed the opinion that this PTSD was solely attributable to the dog incident in 2002. On the other hand, it noted Dr Reddan had diagnosed an anxiety disorder (but rejected a diagnosis of PTSD), which was amendable to treatment and had expressed the opinion that Mr Edington’s incapacity for work related to his pre-existing schizophrenia alone. As to Dr Butler, the Tribunal noted that he was Mr Edington’s treating psychiatrist. It noted he had diagnosed an anxiety disorder; a phobia to dogs; and an injury to his right ankle (but also rejected a diagnosis of PTSD) attributable to the 2002 incident, albeit that he considered these conditions and his injury were resolved by mid 2003. It also noted that in his report dated 15 July 2004, he had expressed the opinion that these conditions and his injury were unrelated to his pre-existing schizophrenia. The Tribunal then considered the submissions the parties had made to it. It noted that Mr Edington’s legal representative stated:The Trustee’s decision turns upon the Board’s preference for the reasoning of [Dr Reddan] over the opinions of [Dr De Leacy]. Indeed, the reasons of the Trustee explicitly assert that [Dr Reddan’s] opinion was preferred because there were seemingly different versions given by the complainant to [Dr Butler] and [Dr De Leacy] with regard to the intensity of his fear of dogs. The obvious point that needs to be made is that the Trustee could not have come to a real and genuine decision about what was said to [Dr Butler] in circumstances where it did not even have [Dr Butler’s] report of 15th July 2004 before it.

Ratio Decidendi

Legal Principle Established

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