Onepath Life Ltd v Standley - [2020] NSWCA 321

Court of Appeal

Supreme Court

New South Wales

Medium Neutral Citation: Onepath Life Ltd v Standley [2020] NSWCA 321
Hearing dates: 13 November 2020
Date of orders: 10 December 2020
Decision date: 10 December 2020
Before: Macfarlan JA at [1];
Meagher JA at [2];
McCallum JA at [54].
Decision:
(1) Appeal dismissed.
(2) Appellant pay respondent’s costs.

Catchwords:
INSURANCE – life and disability insurance – where claim for total and permanent disablement – where definition required insured to be totally and permanently disabled after three month absence from “Own Occupation” – whether three month period must commence on date insured left employment – whether insured can satisfy definition due to psychological condition arising after initial three month absence from engaging in occupation
INSURANCE – claims – proof – where claim for total and permanent disablement – whether medical evidence establishes insured unable and unlikely ever again to be able to engage in “Own Occupation”

Cases Cited:
Finch v Telstra Super Pty Ltd (2010) 242 CLR 254; [2010] HCA 36
Suttor v Gundowda (1950) 81 CLR 418; [1950] HCA 35
TAL Life Ltd v Shuetrim (2016) 91 NSWLR 439; [2016] NSWCA 68
Water Board v Moustakas (1988) 180 CLR 491; [1988] HCA 12
Wilkie v Gordian Runoff Ltd (2005) 221 CLR 522; [2005] HCA 17

Category: Principal judgment
Parties: Onepath Life Ltd (appellant)
Aaron Standley (respondent)
Representation:
Counsel:
G Watson SC with K Morris (appellant)
R de Meyrick (respondent)
Solicitors:
TurksLegal
Beston Macken McManis (respondent)

File Number(s): 2020/214340
Publication restriction: N/A
Decision under appeal

Court or tribunal:

Supreme Court of New South Wales

Jurisdiction:

Equity Division

Citation:

[2020] NSWSC 848

Date of Decision:

12 June 2020

Before:

Rein J

File Number(s):

2017/377841

HEADNOTE

[This headnote is not to be read as part of the judgment]

The respondent was insured under a life and disability policy issued by the appellant. The respondent was employed as a “customer experience manager” when he sustained physical injuries as a result of a motor cycle accident in August 2015. He returned to work in October 2015. However he had to resign in February 2016 as a result of those physical injuries.

The respondent made a claim under the policy on the basis that he was totally and permanently disabled (TPD) as a result of his physical injuries. The relevant TPD definition was satisfied if, as a result of illness or injury, the insured “has been absent from and unable to engage in their ‘Own Occupation’ for three consecutive months”, and “is disabled at the end of the period of three consecutive months to such an extent that they are unlikely ever again to be able to engage in their ‘Own Occupation’”. In rejecting that claim the appellant assessed the respondent’s condition as at May 2016, that being three months after he ceased to be employed in that occupation.

The respondent claimed that the date for assessing whether he satisfied the relevant definition need not necessarily be May 2016. The…

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 Onepath Life Ltd v Standley

Details

AGLC: Onepath Life Ltd v Standley [2020] NSWCA 321
Case: [2020] NSWCA 321
Decision Date: 10 December 2020

CaseChat Overview and Summary

Onepath Life Ltd appealed to the New South Wales Court of Appeal against a decision of the primary judge in favour of the respondent, Mr Standley, who had claimed under a total and permanent disablement (TPD) policy. The dispute concerned whether Mr Standley met the definition of TPD under the policy, which required him to be totally and permanently disabled after a three-month absence from his "Own Occupation".

The Court of Appeal was required to determine two primary legal issues. First, whether the three-month period of absence from "Own Occupation" must commence on the date the insured first ceased to engage in that occupation. Second, whether the insured could satisfy the TPD definition due to a psychological condition that arose after the initial three-month absence from engaging in his occupation. The court also considered whether the medical evidence sufficiently established that Mr Standley was unable and unlikely ever again to be able to engage in his "Own Occupation".

The Court of Appeal dismissed the appeal, upholding the primary judge's finding that Mr Standley met the TPD definition. The court reasoned that the three-month period did not need to commence on the exact date Mr Standley ceased working, but rather on the date he was unable to perform his own occupation. Furthermore, the court held that a psychological condition developing after the initial three-month absence could still satisfy the definition, provided it rendered the insured unable to engage in their own occupation and unlikely ever to be able to do so again. The medical evidence was found to be sufficient to establish these conditions. Consequently, the appellant was ordered to pay the respondent's costs.

Orders

Orders of the court

(1) Appeal dismissed.

(2) Appellant pay respondent’s costs.

Background

Background to the litigation

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Evidence

Evidence Before The Court

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Decision

Reasons for decision

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Ratio Decidendi

Legal Principle Established

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Medium Neutral Citation:	Onepath Life Ltd v Standley [2020] NSWCA 321
Hearing dates:	13 November 2020
Date of orders:	10 December 2020
Decision date:	10 December 2020
Before:	Macfarlan JA at [1]; Meagher JA at [2]; McCallum JA at [54].
Decision:	(1) Appeal dismissed. (2) Appellant pay respondent’s costs.
Catchwords:	INSURANCE – life and disability insurance – where claim for total and permanent disablement – where definition required insured to be totally and permanently disabled after three month absence from “Own Occupation” – whether three month period must commence on date insured left employment – whether insured can satisfy definition due to psychological condition arising after initial three month absence from engaging in occupation INSURANCE – claims – proof – where claim for total and permanent disablement – whether medical evidence establishes insured unable and unlikely ever again to be able to engage in “Own Occupation”
Cases Cited:	Finch v Telstra Super Pty Ltd (2010) 242 CLR 254; [2010] HCA 36 Suttor v Gundowda (1950) 81 CLR 418; [1950] HCA 35 TAL Life Ltd v Shuetrim (2016) 91 NSWLR 439; [2016] NSWCA 68 Water Board v Moustakas (1988) 180 CLR 491; [1988] HCA 12 Wilkie v Gordian Runoff Ltd (2005) 221 CLR 522; [2005] HCA 17
Category:	Principal judgment
Parties:	Onepath Life Ltd (appellant) Aaron Standley (respondent)
Representation:	Counsel: G Watson SC with K Morris (appellant) R de Meyrick (respondent) Solicitors: TurksLegal Beston Macken McManis (respondent)
File Number(s):	2020/214340
Publication restriction:	N/A
Decision under appeal	Court or tribunal: Supreme Court of New South Wales Jurisdiction: Equity Division Citation: [2020] NSWSC 848 Date of Decision: 12 June 2020 Before: Rein J File Number(s): 2017/377841