MX v FSS Trustee Corporation as Trustee of the First State Superannuation Scheme

The case of MX v FSS Trustee Corporation as Trustee of the First State Superannuation Scheme involves a dispute between an undercover police officer and the trustees of the Police Superannuation Fund, as well as an insurer. The plaintiff, an undercover policeman, claims to suffer from post-traumatic stress disorder as a result of an incident in 1997 during the course of his work. He asserts that he is totally and permanently disabled and is therefore entitled to a benefit under an insurance policy held by the FSS Trustee Corporation with the second defendant insurer. The insurer declined the plaintiff's claim in December 2014, and after additional material was supplied and requested a reconsideration, the insurer declined the claim again in June 2017.

The primary legal issues before the court were whether the insurer had fulfilled its duties in declining the plaintiff's claim and whether it had acted with the utmost good faith and reasonably in forming an opinion about the plaintiff's total and permanent disability. The court also needed to determine if the decisions of the defendants involved a breach of duty and if so, whether they could be set aside. If the decisions were set aside, the court would need to direct what should happen next in determining whether the plaintiff qualifies as totally and permanently disabled under the policy.

In its reasoning, the court examined the duties of the insurer in declining the claim and whether these duties were appropriately exercised. The court assessed whether the insurer had acted with good faith and reasonably in forming its opinion on the plaintiff's disability. The court found that the insurer had not fully discharged its duties and had not acted with the utmost good faith and reasonableness. Consequently, the court determined that the insurer's decisions could be set aside. The court ordered that a new assessment should be conducted to determine if the plaintiff is totally and permanently disabled under the policy at the second stage.