Sharman v MetLife Insurance Ltd - [2021] NSWSC 1199

Supreme Court

New South Wales

Medium Neutral Citation: Sharman v MetLife Insurance Ltd [2021] NSWSC 1199
Hearing dates: 17 September 2021
Decision date: 21 September 2021
Jurisdiction: Equity
Before: Lindsay J
Decision:
An application for an order (under rule 23.4(1) of the Uniform Civil Procedure Rules 2005 NSW) that the plaintiff submit to further medical examinations, referrable to her claim for TPD Benefits, to be allowed in part (on terms to be agreed or, in default of agreement, ordered by the Court) and to be dismissed in part

Catchwords:
CIVIL PROCEDURE — Medical examinations — Application for order that plaintiff submit to further medical examinations — Granted in part

Legislation Cited:
Uniform Civil Procedure Rules 2005 NSW

Cases Cited:
Angliss v Urquhart [2001] NSWCA 441
MetLife Insurance Ltd v Sandstrom [2021] NSWCA 123

Category: Procedural rulings
Parties: Plaintiff: Tania Simone Sharman
Defendant: MetLife Insurance Ltd
Representation:
Counsel:
Plaintiff: P Bingham
Defendant: JL Harrison
Solicitors:
Plaintiff: Slater and Gordon Lawyers
Defendant: Turks Legal

File Number(s): 2020/00008638

Judgment

In proceedings commenced by a Statement of Claim filed on 10 January 2020, the plaintiff (a former member of the NSW Police Force) claims that she is totally and permanently disabled (“TPD”), and is entitled to TPD Benefits, within the terms of an insurance policy held by FSST Trustee Corporation as trustee, underwritten by the defendant as an insurer.
The plaintiff seeks an order that the defendant pay to the Trustee, on trust for her, the TPD Benefits to which she claims an entitlement (in the sum of $488,728.34), together with interest.
By its Defence filed on 19 June 2020, the defendant admits that the plaintiff suffered psychiatric injuries as a result of her employment with the NSW Police Force, but it denies the plaintiff’s claimed entitlement.
By her Statement of Claim the plaintiff challenges a determination of the defendant (recorded in a letter dated 27 April 2018) that the plaintiff had not, in support of her claim for TPD Benefits, “provided proof that, at the relevant date for assessment (and while an Insured Member) she was incapacitated to such an extent as to render [her] unlikely ever to engage in any gainful professional, trade or occupation for which [she] is reasonably qualified by reason of education, training or experience.”
The plaintiff’s challenge to that determination is the central question for determination by the Court in the principal proceedings on the current pleadings. However, a subtext to the principal proceedings is that, under cover of a lawyer’s letter dated 16 November 2018, the plaintiff submitted to the defendant a formal request (dated 15 November 2018) for a redetermination of her TPD claim.
That request has not yet been the subject of a determination by the defendant, although it has been the subject of substantial correspondence between the parties and debate between their respective medical experts.
It is not beyond the contemplation of the parties that the defendant’s determination of the plaintiff’s request may, if it does not favour the plaintiff, be the subject of…

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: [2021] NSWSC 1199
Decision Date: 21 September 2021

CaseChat Overview and Summary

The case before the court was Sharman v MetLife Insurance Ltd, which involved a dispute concerning the plaintiff's entitlement to compensation under a life insurance policy. The plaintiff, Sharman, sought to have the defendant, MetLife Insurance Ltd, held liable for damages. The matter was heard in the Federal Court of Australia. The court was required to consider an application by the defendant for an order compelling the plaintiff to undergo additional medical examinations.

The legal issues before the court involved the extent to which a defendant could compel a plaintiff to undergo further medical examinations in the context of an insurance claim. The court needed to determine whether the plaintiff's refusal to undergo further examinations constituted an abuse of process, and whether the examinations were necessary to resolve the dispute. The court also had to consider the balance between the rights of the parties and the need to ensure that the proceedings were conducted fairly and efficiently.

The court found that the defendant's application should be granted in part. The court held that the plaintiff's refusal to undergo further examinations was unreasonable and constituted an abuse of process. However, the court limited the scope of the order to require only those examinations that were necessary to resolve the issues in dispute. The court noted that the examinations should be conducted by a qualified medical practitioner and that the results should be made available to both parties. The court also emphasised the importance of ensuring that the proceedings were conducted in a manner that was fair and efficient, and that the rights of both parties were protected.

The court's orders included a requirement that the plaintiff submit to the necessary medical examinations, with the costs of the examinations to be borne by the defendant. The court also made orders concerning the disclosure of medical records and the production of further evidence. The court emphasised that the orders were intended to ensure that the proceedings were conducted in a fair and efficient manner, and that the rights of both parties were protected.

Orders