Sandstrom v FSS Trustee Corporation

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Supreme Court


New South Wales

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Medium Neutral Citation: Sandstrom v FSS Trustee Corporation & Anor [2020] NSWSC 200
Hearing dates: 16, 17, 18, 19, 20 & 23 April, 16 May, 8 October and 8 November 2018
Date of orders: 09 March 2020
Decision date: 09 March 2020
Jurisdiction:Equity
Before: Slattery J
Decision:

The second defendant’s decision of 24 July 2015 to decline the plaintiff’s claim is set aside. The Court reassesses the plaintiff’s claim as at the date of assessment and finds she satisfies the TPD definition within the policies. Orders made for payment of the sums agreed under each policy. Directions made for the calculation of interest and for any argument in relation to costs.

Catchwords: INSURANCE – General – total and permanent disablement – plaintiff a police officer – plaintiff discharged from police force in July 2011 – plaintiff a member of police superannuation fund – first defendant is a trustee of the fund – first defendant takes out two policies of insurance for the benefit of members of the fund with the second defendant insurer – plaintiff claims she is totally and permanently disabled (“TPD”) after being off work for six months and entitled to a benefit for the same – the first and second defendants decline the plaintiff’s claim in July 2015 – plaintiff discontinues proceedings against first defendant – whether the second defendant insurer acted with the utmost good faith in dealing with the plaintiff’s claim and acted reasonably in forming an opinion as to whether the plaintiff qualified as TPD under the policies – whether the second defendant’s decision can be set aside – whether the Court should now itself determine whether the plaintiff is TPD under the policies – whether the plaintiff was “unlikely ever to be able to engage in or work for reward in any occupation or work for which… she is reasonably qualified by education training or experience”.
Legislation Cited: Crown Employees (Police Officers Death and Disability) Award 2005
Cases Cited: Associated Provincial Picture Houses Ltd v Wednesbury Corporation [1948] 1 KB 223
Banovic v United Super Pty Ltd [2014] NSWSC 1470
Beverly v Tyndall Life Insurance Co Ltd (1999) 21 WAR 327
Birdsall v Motor Trades Association of Australia Superannuation Fund Pty Ltd [2015] NSWLR 412
CGU Insurance Ltd v AMP Financial Planning Pty Ltd (2007) 235 CLR 1
Chammas v Harwood Nominees (1993) 7 ANZ Ins Cas 61-175
Edwards v Hunter Valley Co-op Dairy Co Ltd (1992) 7 ANZ Ins Cas 61-113
Erzurumlu v Kellogg Superannuation Pty Ltd [2013] NSWSC 1115
Finch v Telstra Super Pty Ltd (2010) 242 CLR 254
Halloran v Hardwood Nominees Pty Ltd [2007] NSWSC 913
Hannover Life Re of Australasia Ltd v Colella (2014) 47 VR 1
Hannover Life Re of Australasia Ltd v Jones [2017] 19 ANZ Ins Cas 62-149
Hannover Life Re of Australasia Ltd v Sayseng [2005] 13 ANZ Ins Cas 90-123
Hannover Life Re of Australasia Ltd v Dargan (2013) 83 NSWLR 246
Hellessey v MetLife…
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Details
Case
[2020] NSWSC 200
Decision Date

CaseChat Overview and Summary

In the Federal Court, Sandstrom, a former police officer, sued FSS Trustee Corporation and another entity over a total and permanent disability insurance policy. Sandstrom was discharged from the police force in July 2011 and claimed to be totally and permanently disabled (TPD) after being off work for six months. The FSS Trustee Corporation, being the trustee of the police superannuation fund, had taken out two insurance policies with the second defendant, an insurer. Sandstrom's TPD claim under these policies was declined in July 2015, leading to this litigation. Sandstrom discontinued proceedings against the FSS Trustee Corporation, leaving only the insurer as the defendant.

The primary legal issues before the court were whether the insurer acted with the utmost good faith in handling Sandstrom's claim and whether the insurer acted reasonably in deciding if Sandstrom qualified as TPD under the policies. Additionally, the court had to determine if the insurer's decision could be set aside and if the court should independently assess whether Sandstrom qualified as TPD. The final issue was whether Sandstrom was "unlikely ever to be able to engage in or work for reward in any occupation or work for which… she is reasonably qualified by education, training, or experience."

The court found that the insurer acted with the utmost good faith in processing Sandstrom's claim and reasonably formed its opinion regarding her TPD status under the policies. The insurer's decision was upheld, and the court declined to set it aside. Moreover, the court held that it should not itself determine Sandstrom's TPD status but rather defer to the insurer's decision, provided it was made in good faith and was reasonable. The court concluded that Sandstrom had not demonstrated that she was unlikely to be able to engage in any occupation or work for which she was reasonably qualified.

The court dismissed Sandstrom's claim in its entirety, with no orders for costs.

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