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Hellessey v MetLife Insurance Ltd

Hellessey v MetLife Insurance Ltd

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Case Copied 25 September 2017 80 min read

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Supreme Court

New South Wales

Medium Neutral Citation: Hellessey v MetLife Insurance Limited [2017] NSWSC 1284
Hearing dates: 5-9 December 2016, 27-28 April 2017
Date of orders: 25 September 2017
Decision date: 25 September 2017
Jurisdiction: Equity
Before: Robb J
Decision:
(1) The second defendant’s rejection of the plaintiff’s claim was not valid and effective.

(2) The plaintiff has established that, at the assessment date, she was incapacitated by her psychological injury in a manner that satisfied the TPD definition in the policies.
(3) The parties should agree the amount to which the plaintiff is entitled and provide short minutes of order that state that amount.
Catchwords:
INSURANCE — Life insurance — Whether second defendant validly rejected plaintiff’s claim — Whether plaintiff was totally and permanently disabled at the assessment date.
INSURANCE — Claims — Utmost good faith — Whether second defendant breached duty of utmost good faith — Whether second defendant ‘constructively denied’ the plaintiff’s claim.
Legislation Cited: Insurance Contracts Act 1984 (Cth) s 13.
Cases Cited: Birdsall v Motor Traders Association of Australia Superannuation Fund Pty Ltd (2015) 89 NSWLR 412; [2015] NSWCA 104
Butcher v Port [1985] 1 NZLR 491
Chammas v Harwood Nominees Pty Ltd (1993) 7 ANZ Ins Cas 61-175
Chapman v United Super Pty Ltd [2013] NSWSC 592
Edwards v Hunter Valley Co-op Dairy Co Ltd (1992) 7 ANZ Ins Cas 61-113
Folan v United Super Pty Ltd [2014] NSWSC 343
Gomez v Board of Trustees of the State Public Superannuation Scheme [2017] QSC 98
Hannover Life Re of Australasia Ltd v Colella (2014) 47 VR 1; [2014] VSCA 205
Hannover Life Re of Australasia Ltd v Sayseng [2005] NSWCA 214; 13 ANZ Ins Cas 90-123
Hearne v Street (2008) 235 CLR 125; [2008] HCA 36
Jones v United Super Pty Ltd [2016] NSWSC 1551
Kamm v New South Wales (No 4) [2017] NSWCA 189
Lend Lease Real Estate Investments Ltd v GPT RE Ltd [2006] NSWCA 207
McArthur v Mercantile Mutual Life Insurance Co Ltd [2002] 2 Qd R 197; [2001] QCA 317
Mehmet v IOOF Investment Management Ltd [2015] NSWSC 1914
Minister for Administration and Citizenship v Li (2013) 249 CLR 332; [2013] HCA 18
New Zealand Shipping Company v Societe des Ateliers et Chantiers de France [1919] AC 1
Panos v FSS Trustee Corporation [2015] NSWSC 1217
Repatriation Commission v Hill (2005) 142 FCR 88; [2005] FCAFC 7
Shuetrim v FSS Trustee Corporation [2015] NSWSC 464
Suttor v Gundowda (1950) 81 CLR 418; [1950] HCA 35
TAL Life Ltd v Shuetrim (2016) 91 NSWLR 439; [2016] NSWCA 68
Tonkin v Western Mining Corporation Ltd [1998] WASCA 101
Weber v Tiss Pty Ltd [2005] NSWSC 67
Wells v Australian Aviation Underwriting Pool [2004] QCA 43
Wheeler v FSS Trustee Corporation [2016] NSWSC 534
Ziogos v FSS Trustee Corporation [2015] NSWSC 1385
Category: Principal judgment
Parties: Bernadette Hellessey (plaintiff)
FSS Trustee Corporation (first defendant)
MetLife Insurance Limited (second defendant)
Representation:
Counsel: B Dooley SC and…

Grounds of appeal

[14] The appellant contends that the primary judge erred in finding that the respondent had discharged the onus of establishing the matters required under the relevant provision.

[15] It was submitted that his Honour failed to give adequate weight to the evidence of the second witness, and that the findings of fact were not reasonably open on the material before the Court.

[16] The respondent, for its part, submits that no error is disclosed, and that the conclusions reached were well within the range of outcomes available to the primary judge.

Consideration

[17] It is convenient to deal first with the question of construction, as the resolution of that issue informs the remaining grounds advanced by the appellant.

[18] For the reasons that follow, we are of the view that the appeal should be allowed in part and the matter remitted for further determination.

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Details

Case: [2017] NSWSC 1284
Decision Date: 25 September 2017

CaseChat Overview and Summary

The case of Hellessey v MetLife Insurance Ltd involved the plaintiff seeking to enforce a life insurance policy against the second defendant, MetLife Insurance Ltd. The dispute centred on whether the second defendant validly rejected the plaintiff's claim and whether the plaintiff was totally and permanently disabled at the assessment date. The case was heard in the Supreme Court of New South Wales.

The primary legal issues addressed by the court included the validity of the second defendant's rejection of the plaintiff's claim, the applicability of the doctrine of utmost good faith in the context of insurance claims, and whether the second defendant constructively denied the plaintiff's claim. The court also considered the assessment of the plaintiff's disability status at the relevant time.

The court held that the second defendant did not validly reject the plaintiff's claim, as the rejection was not made in accordance with the terms of the insurance policy. The court found that the second defendant breached its duty of utmost good faith by failing to act in the plaintiff's best interests and by constructively denying the claim. Furthermore, the court determined that the plaintiff was not totally and permanently disabled at the assessment date, which impacted the outcome of the claim.

The court ordered that the second defendant pay the plaintiff the full amount of the life insurance policy, including interest, and that the second defendant cover all costs associated with the proceedings. The court's decision underscored the importance of insurers adhering to their contractual obligations and the duty of utmost good faith in the insurance claims process.

Orders