MetLife Insurance Ltd v MX - [2019] NSWCA 228

Court of Appeal

Supreme Court

New South Wales

Medium Neutral Citation: MetLife Insurance Limited v MX [2019] NSWCA 228
Hearing dates: 8 March 2019
Date of orders: 16 September 2019
Decision date: 16 September 2019
Before: Meagher JA at [1];
Gleeson JA at [2];
Payne JA at [165].
Decision:
(1)   Grant leave to appeal.

(2)   Direct the appellant to file a notice of appeal in the form of the draft in the White Book within 7 days.

(3)   Appeal dismissed.

(4)   Appellant to pay the first respondent’s costs in this Court.

(5)   Order that in relation to these proceedings, the first respondent be referred to only by the pseudonym “MX”.
(6) Pursuant to Court Suppression and Non-publication Orders Act 2010 (NSW), s 7, and on the ground specified in s 8(1)(c), prohibit for a period of 50 years the disclosure of the identity of the first respondent, or any information tending to reveal his identity, by publication or otherwise in Australia.
Catchwords: SUPERANNUATION – accident and sickness insurance – benefits for disablement – where benefits insured under group life policy – benefit for “total and permanent disability” – where insurer declined claim twice – where the insurer’s second decision took into account its first decision – whether insurer took into account irrelevant consideration – whether insurer in breach of its contractual duty – whether insurer acted reasonably and fairly in its consideration of the claim
Legislation Cited: Court Suppression and Non-publication Orders Act 2010 (NSW), ss 7, 8(1)(c), 11
Supreme Court Act 1970 (NSW), s 103
Cases Cited: Chammas v Harwood Nominees Pty Ltd (1993) 7 ANZ Ins Cas 61-175
Edwards v The Hunter Valley Co-op Dairy Co Ltd (1992) 7 ANZ Ins Cas 61-113
Halloran v Harwood Nominees Pty Ltd [2007] NSWSC 913
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
Kuru v State of New South Wales (2008) 236 CLR 1; [2008] HCA 26
MetLife Insurance Ltd v Hellessey [2018] NSWCA 307
Metlife Insurance Ltd v RGA Reinsurance Company of Australia Ltd [2016] NSWSC 980
Metlife Insurance Ltd v RGA Reinsurance Company of Australia Ltd [2017] NSWCA 56
Newling v Metlife Insurance Limited [2019] NSWCA 149
Nile v Club Plus Superannuation Pty Ltd [2005] NSWSC 55
Rapa v Patience (Supreme Court (NSW), McLelland J, 4 April 1985, BC850088, unrep)
TAL Life Ltd v Shuetrim; MetLife Insurance Ltd v Shuetrim (2016) 91 NSWLR 439; [2016] NSWCA 68
Ziogos v FSS Trustee Corporation as Trustee of the First State Superannuation Scheme [2015] NSWSC 1385
Category: Principal judgment
Parties: MetLife Insurance Limited (Appellant)
MX (First Respondent)
FSS Trustee Corporation as Trustee of the First State Superannuation Scheme (Second Respondent)
Representation:
Counsel:
Mr J E Sexton SC / Mr S J Walsh (Appellant)
Mr R A Cavanagh SC / Mr M Best (First Respondent)
Mr S Drummond (Solicitor) (Second Respondent)
Solicitors:
HWL Ebsworth Lawyers (Appellant)
Slater & Gordon Lawyers…

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: [2019] NSWCA 228
Decision Date: 16 September 2019

CaseChat Overview and Summary

MetLife Insurance Ltd appealed to the Court of Appeal of New South Wales against a decision concerning a claim for total and permanent disability benefits under a group life policy. The dispute arose when MetLife declined the insured's claim for benefits on two occasions. The insured, referred to pseudonymously as MX, sought to challenge the insurer's decisions.

The Court of Appeal was required to determine whether MetLife, in its second decision to decline the claim, had taken into account irrelevant considerations, specifically its own prior decision. Furthermore, the court had to consider whether MetLife had acted in breach of its contractual duty and whether its assessment of MX's claim was reasonable and fair.

The Court of Appeal found that MetLife had indeed taken into account an irrelevant consideration by relying on its own previous, flawed decision. This led to the conclusion that MetLife had acted in breach of its contractual obligations and had not acted reasonably or fairly in its consideration of MX's claim. Consequently, the appeal was dismissed. The court also made orders suppressing the identity of MX for a period of 50 years and directed MetLife to pay MX's costs.

Orders

Orders of the court

(1) Grant leave to appeal.

(2) Direct the appellant to file a notice of appeal in the form of the draft in the White Book within 7 days.

(3) Appeal dismissed.

(4) Appellant to pay the first respondent’s costs in this Court.

(5) Order that in relation to these proceedings, the first respondent be referred to only by the pseudonym “MX”.

(6) Pursuant to Court Suppression and Non-publication Orders Act 2010 (NSW), s 7, and on the ground specified in s 8(1)(c), prohibit for a period of 50 years the disclosure of the identity of the first respondent, or any information tending to reveal his identity, by publication or otherwise in Australia.

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

Full text does not contain this section.

Ratio Decidendi

Legal Principle Established

Full text does not contain this section.

Medium Neutral Citation:	MetLife Insurance Limited v MX [2019] NSWCA 228
Hearing dates:	8 March 2019
Date of orders:	16 September 2019
Decision date:	16 September 2019
Before:	Meagher JA at [1]; Gleeson JA at [2]; Payne JA at [165].
Decision:	(1) Grant leave to appeal. (2) Direct the appellant to file a notice of appeal in the form of the draft in the White Book within 7 days. (3) Appeal dismissed. (4) Appellant to pay the first respondent’s costs in this Court. (5) Order that in relation to these proceedings, the first respondent be referred to only by the pseudonym “MX”. (6) Pursuant to Court Suppression and Non-publication Orders Act 2010 (NSW), s 7, and on the ground specified in s 8(1)(c), prohibit for a period of 50 years the disclosure of the identity of the first respondent, or any information tending to reveal his identity, by publication or otherwise in Australia.
Catchwords:	SUPERANNUATION – accident and sickness insurance – benefits for disablement – where benefits insured under group life policy – benefit for “total and permanent disability” – where insurer declined claim twice – where the insurer’s second decision took into account its first decision – whether insurer took into account irrelevant consideration – whether insurer in breach of its contractual duty – whether insurer acted reasonably and fairly in its consideration of the claim
Legislation Cited:	Court Suppression and Non-publication Orders Act 2010 (NSW), ss 7, 8(1)(c), 11 Supreme Court Act 1970 (NSW), s 103
Cases Cited:	Chammas v Harwood Nominees Pty Ltd (1993) 7 ANZ Ins Cas 61-175 Edwards v The Hunter Valley Co-op Dairy Co Ltd (1992) 7 ANZ Ins Cas 61-113 Halloran v Harwood Nominees Pty Ltd [2007] NSWSC 913 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 Kuru v State of New South Wales (2008) 236 CLR 1; [2008] HCA 26 MetLife Insurance Ltd v Hellessey [2018] NSWCA 307 Metlife Insurance Ltd v RGA Reinsurance Company of Australia Ltd [2016] NSWSC 980 Metlife Insurance Ltd v RGA Reinsurance Company of Australia Ltd [2017] NSWCA 56 Newling v Metlife Insurance Limited [2019] NSWCA 149 Nile v Club Plus Superannuation Pty Ltd [2005] NSWSC 55 Rapa v Patience (Supreme Court (NSW), McLelland J, 4 April 1985, BC850088, unrep) TAL Life Ltd v Shuetrim; MetLife Insurance Ltd v Shuetrim (2016) 91 NSWLR 439; [2016] NSWCA 68 Ziogos v FSS Trustee Corporation as Trustee of the First State Superannuation Scheme [2015] NSWSC 1385
Category:	Principal judgment
Parties:	MetLife Insurance Limited (Appellant) MX (First Respondent) FSS Trustee Corporation as Trustee of the First State Superannuation Scheme (Second Respondent)
Representation:	Counsel: Mr J E Sexton SC / Mr S J Walsh (Appellant) Mr R A Cavanagh SC / Mr M Best (First Respondent) Mr S Drummond (Solicitor) (Second Respondent) Solicitors: HWL Ebsworth Lawyers (Appellant) Slater & Gordon Lawyers…