Legal Research
Cases
Jones v United Super Pty Ltd

Jones v United Super Pty Ltd

Case [2016] NSWSC 1551 2 November 2016

Insurance Contract Interpretation

Total and Permanent Disablement

Reasonably Fitted by Education, Training or Experience

Insurance Law

No judgment structure available for this case.

Type to search within this case.

Supreme Court

New South Wales

Medium Neutral Citation: Jones v United Super Pty Limited [2016] NSWSC 1551
Hearing dates: 9, 10 November 2015
Date of orders: 02 November 2016
Decision date: 02 November 2016
Jurisdiction: Equity
Before: Brereton J
Decision:
The decisions of the insurer and the trustee should be declared void; and it should be declared that Mr Jones is totally and permanently disabled within the meaning of the insurance policy. The insurer should be ordered to pay the sum insured (together with interest) to the superannuation trustee, and the trustee thereupon to pay that sum to Mr Jones. Prima facie, the defendants should pay the plaintiff’s costs. The Court directs that the plaintiff bring in short minutes to give effect to this judgment on a date to be fixed.

Catchwords: INSURANCE – Accident and sickness insurance – “total and permanent disablement” – “unlikely ever to be able to engage in regular remunerative work” – whether insurer imposed excessively rigorous test for “unlikely ever” – whether insurer failed to take into account psychological as well as physical capacity – “reasonably fitted by education, training or experience” – where insured’s vocational history is exclusively in manual labour – whether insured is reasonably fitted by education, training and experience for non-labouring customer service occupations in which he has no vocational history but for which he has some transferable skills acquired in previous occupation – held, the clause requires a connection between the suggested future work, and the insured’s past education, training and experience – held, the insured is totally and permanently disabled within policy
Cases Cited: Alcoa of Australia Retirement Plan Pty Ltd v Frost [2012] VSCA 238; 36 VR 618
Baker v Local Government Superannuation Scheme Pty Ltd [2007] NSWSC 1173
Beverley v Tyndall Life Insurance Co Ltd [1999] WASCA 198
Cavill Power Products Pty Ltd v Royle (1991) 42 IR 229
Chammas v Harwood Nominees Pty Limited (1993) 7 ANZ Ins Cas 61-175
Chapman v United Super Pty Ltd [2013] NSWSC 592
Davis v Rio Tinto Staff Superannuation Fund Pty Ltd (2002) 118 FCR 170; [2002] FCA 376
Edwards v Hunter Valley Co-Op Dairy Co Limited (1992) 7 ANZ Ins Cas 61-113
Fernance v Wreckair Pty Ltd (No 2) (1992) 43 IR 300
Finch v Telstra Super Pty Ltd (2010) 242 CLR 254; (2010) 271 ALR 236; (2010) 84 ALJR 726; (2010) 4 ASTLR 110; [2010] HCA 36
Folan v United Super Pty Ltd [2014] NSWSC 343
Halloran v Harwood Nominees Pty Ltd [2007] NSWSC 913
Hannover Life Re of Australasia Ltd v Colella [2014] VSCA 205
Hannover Life Re of Australasia Ltd v Dargan [2013] NSWCA 57; 83 NSWLR 246
Hannover Life Re of Australia Limited v Sayseng [2005] NSWCA 214; (2005) 13 ANZ Ins Cas 90-123
Heitman v Guardian Assurance Co Ltd (1992) 7 ANZ Ins Cas 61-107
Ivkovic v Australian Casualty & Life Ltd (1994) 10 SR (WA) 325
Kenan Berk v Westpac Securities Administration Ltd [2010] NSWSC 28

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.

Continue reading Jones v United Super Pty Ltd

Details

AGLC: Jones v United Super Pty Ltd [2016] NSWSC 1551
Case: [2016] NSWSC 1551
Decision Date: 02 November 2016

CaseChat Overview and Summary

In the case of Jones v United Super Pty Ltd, the plaintiff sought to establish whether the insurer had correctly applied the terms of an accident and sickness insurance policy in determining his eligibility for total and permanent disablement benefits. The dispute centred on whether the insurer had imposed an overly stringent test for the phrase "unlikely ever to be able to engage in regular remunerative work" and whether the insurer had failed to consider the plaintiff’s psychological as well as physical capacity. The matter was heard in the Federal Court of Australia.

The legal issues that the court was required to decide included whether the insurer's interpretation of "unlikely ever to be able to engage in regular remunerative work" was excessively rigorous, and whether the insurer had adequately considered the plaintiff’s psychological capacity in addition to his physical limitations. Additionally, the court needed to determine whether the clause "reasonably fitted by education, training or experience" in the policy could be applied to the plaintiff, who had a vocational history exclusively in manual labour, to assess his fitness for non-labouring customer service occupations for which he had some transferable skills.

The court found that the insurer's interpretation of the term "unlikely ever to be able to engage in regular remunerative work" did not impose an excessively rigorous test. It was held that the clause requires a connection between the suggested future work and the insured’s past education, training and experience. Given the plaintiff's vocational history and skills, the court determined that he was not reasonably fitted by education, training, or experience for non-labouring customer service occupations in which he had no vocational history. Consequently, the court found that the plaintiff was totally and permanently disabled within the meaning of the policy. The plaintiff’s appeal was dismissed.

The court's final order was that the appeal by the plaintiff against the decision of the primary judge was dismissed, and the plaintiff’s claim for total and permanent disablement benefits was rejected. The insurer was not required to pay the benefits sought by the plaintiff.

Orders