Standley v Onepath Life Ltd - [2020] NSWSC 848

Supreme Court

New South Wales

Medium Neutral Citation: Standley v Onepath Life Ltd [2020] NSWSC 848
Hearing dates: 16 March 2020
Date of orders: 29 June 2020
Decision date: 12 June 2020
Jurisdiction: Equity
Before: Rein J
Decision:
See [64]

Catchwords:
INSURANCE – Life insurance – Accident and sickness – Plaintiff sued defendant insurance company over its decision in 2017 to deny him cover under a total and permanent disability (“TPD”) policy following a motor vehicle accident (“MVA”) in 2015 – The policy provides cover to a life insured if, as a result of illness or injury, the life 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” – The TPD policy defines “Own Occupation” as the most recent occupation in which the life insured was engaged prior to the date of disability – Plaintiff claimed to be physically and psychologically incapable of returning to his own occupation as a call centre manager following the MVA – Defendant refused cover on the basis that the plaintiff, whilst injured to some degree, was still physically capable of returning to his own occupation and that the plaintiff’s claimed psychological problems arose after the relevant date of assessment (being three months after he stopped working); at trial, the defendant did not challenge the plaintiff’s evidence as to his psychological condition, on the basis that it arose after the date of assessment and was therefore irrelevant – Held: the plaintiff exaggerated the physical requirements of his occupation as a call centre manager and was not physically incapable of returning to his own occupation for the whole of the three month period in question (February to May 2016) or thereafter. However, the Court accepted the plaintiff’s unchallenged evidence that by September 2017 he was suffering from a psychological condition that rendered him unlikely ever to return to his own occupation. In so holding, the Court held that the three month period of absence from work (at the end of which the life insured’s likelihood of returning to work is to be assessed) did not have to be the first three month period during which the life insured was absent from work; a later three month period of absence could be used for purposes of the assessment, provided the assessment was made as at the end of a three month period during which he was incapable of working. The plaintiff was therefore entitled to compensation for the defendant’s breach of contract in refusing to cover him under the TPD policy.

Legislation Cited:
Nil

Cases Cited:
Hannover Life Re of Australasia Ltd v Jones [2017] NSWCA 233
Mason v Demasi [2009] NSWCA 227
TAL Life Ltd v Shuetrim [2016] NSWCA 68; (2016) 91 NSWLR 439
Wallaby Grip Ltd v QBE Insurance (Australia) Ltd [2010] HCA 9

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 Standley v Onepath Life Ltd

Details

AGLC: Standley v Onepath Life Ltd [2020] NSWSC 848
Case: [2020] NSWSC 848
Decision Date: 12 June 2020

CaseChat Overview and Summary

In Standley v Onepath Life Ltd, the plaintiff sought to enforce a total and permanent disability insurance policy issued by the defendant insurance company, Onepath Life Ltd. Following a motor vehicle accident in 2015, the plaintiff alleged that he was physically and psychologically incapable of returning to his occupation as a call centre manager, and therefore entitled to cover under the policy. The defendant refused to pay the claim on the basis that the plaintiff was still physically capable of returning to his occupation and that his psychological condition arose after the relevant date of assessment.

The key legal issue before the Court was whether the plaintiff was entitled to cover under the TPD policy. The policy provided cover if the life insured had been absent from and unable to engage in their own occupation for three consecutive months and was disabled to such an extent that they were unlikely ever again to be able to engage in their own occupation. The definition of "own occupation" was the most recent occupation in which the life insured was engaged prior to the date of disability. The Court had to determine whether the plaintiff satisfied the requirements of the policy, particularly the three month period of absence from work and the likelihood of being able to return to work at the end of that period.

The Court held that the plaintiff was not entitled to cover for the period from February to May 2016 because he was not physically incapable of returning to his own occupation during that time. However, the Court accepted the plaintiff's evidence that by September 2017 he was suffering from a psychological condition that rendered him unlikely ever to return to his own occupation. The Court found that the three month period of absence from work did not have to be the first three month period during which the life insured was absent from work; a later three month period of absence could be used for purposes of the assessment, provided the assessment was made as at the end of a three month period during which he was incapable of working. The Court therefore held that the plaintiff was entitled to compensation for the defendant's breach of contract in refusing to cover him under the TPD policy.

Orders