MetLife Insurance Ltd v Hellessey

[2018] NSWCA 307

Court of Appeal

Supreme Court

New South Wales

Medium Neutral Citation:	MetLife Insurance Ltd v Hellessey [2018] NSWCA 307
Hearing dates:	24 and 25 May 2018
Date of orders:	12 December 2018
Decision date:	12 December 2018
Before:	McColl JA at [1]; Meagher JA at [2]; White JA at [65]
Decision:	Appeal dismissed with costs.
Catchwords:	INSURANCE – life insurance – benefit conditional on insurer’s satisfaction as to insured member’s total and permanent disablement – overlapping obligations requiring insurer to act reasonably and fairly in considering question under policy and determining whether it was so satisfied – insurer’s outright rejection of lay witness material significant to its reasons for discounting medical expert evidence that supported insured member’s claim – unchallenged inference from absence of rational or persuasive reasons for such rejection that insurer failed to engage with material – whether breach of obligations to act reasonably and fairly
Cases Cited:	Capital Securities XV Pty Ltd (formerly known as Prime Capital Securities Pty Ltd) v Calleja [2018] NSWCA 26 Edwards v Hunter Valley Coop Dairy Co Ltd (1992) 7 ANZ Ins Cas 61-113 Hannover Life Re of Australasia Ltd v Jones [2017] NSWCA 233 Hannover Life Re of Australasia Ltd v Sayseng [2005] NSWCA 214; (2005) 13 ANZ Ins Cas 90-123 MetLife Insurance Ltd v FSS Trustee Corporation [2014] NSWCA 281 Minister for Immigration and Citizenship v Li (2013) 249 CLR 332; [2013] HCA 18 Minister for Immigration and Water Protection v Stretton (2016) 237 FCR 1; [2016] FCAFC 11 TAL Life Ltd v Shuetrim; MetLife Insurance Ltd v Shuetrim (2016) 91 NSWLR 439; [2016] NSWCA 68 Torbey Investments Corporated Pty Ltd v Ferrara [2017] NSWCA 9
Category:	Principal judgment
Parties:	MetLife Insurance Ltd (Appellant) Bernadette Hellessey (Respondent)
Representation:	Counsel: G Watson SC, C Purdy (Appellant) BD Dooley SC, JC Lee (Respondent)   Solicitors: HWL Ebsworth Lawyers (Appellant) Slater & Gordon Lawyers (Respondent)
File Number(s):	2017/313493
Decision under appeal	Court or tribunal: Supreme Court of New South Wales Jurisdiction: Equity Division Citation: [2017] NSWSC 1284 Date of Decision: 25 September 2017 Before: Robb J File Number(s): 2015/241436

Judgment

1. MCCOLL JA: I agree with Meagher JA’s reasons and the orders his Honour proposes.

MEAGHER JA:

Overview

2. The respondent, Bernadette Hellessey, was an officer in the NSW Police Force. She claimed benefits under the First State Superannuation scheme on the basis that she was totally and permanently disabled. The appellant (MetLife) was the group life insurer under that scheme. The parties accept that the relevant terms of that superannuation scheme and the group life insurance policy are faithfully recorded by Ward JA in MetLife Insurance Ltd v FSS Trustee Corporation [2014] NSWCA 281 at [18] and [43]–[50]. Under that policy, Ms Hellessey was entitled to benefits for total and permanent disablement (TPD) if, having “been absent from” her occupation as a police officer “through injury or illness for six consecutive months”, she as the “Insured Member”:

…provided proof to [its] satisfaction that [she had] become incapacitated…