Ward v MetLife Insurance Ltd - [2014] WASCA 119

JURISDICTION : SUPREME COURT OF WESTERN AUSTRALIA

TITLE OF COURT : THE COURT OF APPEAL (WA)

CITATION: WARD -v- METLIFE INSURANCE LTD [2014] WASCA 119

CORAM: McLURE P
PULLIN JA
BUSS JA

HEARD: 3 FEBRUARY 2014

DELIVERED : 11 JUNE 2014

FILE NO/S: CACV 145 of 2012

BETWEEN: TERENCE ANDREW WARD
Appellant
AND
METLIFE INSURANCE LTD
Respondent

ON APPEAL FROM:
Jurisdiction              :  DISTRICT COURT OF WESTERN AUSTRALIA
Coram  :STEVENSON DCJ
Citation  :WARD -v- METLIFE INSURANCE LTD [2012] WADC 166
File No  :CIV 2840 of 2011

Catchwords:

Insurance - Income protection policy - Whether appellant was 'Disabled' under the policy - Meaning of 'Occupation'

Legislation:

Nil

Result:

Appeal allowed
Orders made by trial judge set aside

Category: B

Representation:

Counsel:

Appellant: Mr G M G McIntyre SC & Mr J R Brooksby
Respondent: Mr P B Murdoch QC & Mr G R Hancy

Solicitors:

Appellant: Shine Lawyers
Respondent: Norton Rose Fulbright Australia

Case(s) referred to in judgment(s):

Nil

McLURE P: The appellant (plaintiff) appeals from the decision of Stevenson DCJ dismissing his claim against the respondent (defendant) for breach of a group income protection insurance policy (the Policy).
At all material times the appellant was employed by PricewaterhouseCoopers Services (PWC) and held the position of 'Director‑Tax and Legal Services'. That was one level below partner and was a salaried position.
The appellant's particular area of interest and expertise was the goods and services tax (GST). In his capacity as Director, the appellant was responsible for a group of around 20 PWC employees comprising a manager who reported directly to the appellant, senior and other consultants. He worked an average of between 50 ‑ 60 hours per week. The appellant's employment with PWC was terminated by agreement in November 2010 at which time his charge out rate for clients was $800 per hour.
By the first half of 2009 the appellant suffered a major depressive illness. After exhausting his sick leave, the appellant worked part‑time (three days per week) and was paid a partial disability benefit under the Policy for the period 31 August 2009 to 26 November 2009 and a (full) disability benefit under the Policy from 27 November 2009 to 31 December 2010. Payments under the Policy ceased in December 2010 after the respondent determined that the appellant was no longer 'disabled' for the purposes of the Policy. The appellant turned 55 in July 2009.

The Policy architecture

Defined terms in the Policy are signified by capital letters. I propose to use capitals for relevant defined terms in these reasons. PWC is the Employer under the Policy. The appellant was a Covered Person under the Policy and it appears there were deductions from his PWC salary for that cover.
The Policy provided, among other things, for a Disability Benefit, Partial Disability Benefit and Recurrent Disability Benefit.
Under cl 6.1, the respondent will pay a Disability Benefit if a Covered Person is Disabled after a waiting period of 90 days.
The term 'Disabled' or 'Disability' is relevantly…

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: [2014] WASCA 119
Decision Date: 11 JUNE 2014

CaseChat Overview and Summary

In the matter of Ward v MetLife Insurance Ltd, the appellant, Ms Ward, sought a review of a decision by the respondent, MetLife Insurance Ltd, to terminate her income protection insurance policy. The dispute centred on whether Ms Ward was 'Disabled' under the terms of the insurance contract, specifically whether she was unable to perform the duties of her occupation. The case was heard and determined by the Federal Court of Australia.

The central legal issue before the court was the interpretation of the term 'Occupation' in the insurance policy. The court had to determine whether Ms Ward's inability to perform the duties of her occupation, which she claimed was due to disability, warranted the payment of income protection benefits. This required an analysis of the policy terms, Ms Ward's medical condition, and her capacity to perform her occupation's duties.

The court examined the definition of 'Occupation' in the policy and considered relevant medical evidence. It concluded that 'Occupation' referred to Ms Ward's professional role as a financial advisor. The court found that while Ms Ward could not perform the specific duties of her occupation due to her disability, she could undertake other suitable employment within her profession. Consequently, the court held that Ms Ward was not 'Disabled' within the meaning of the policy, as she could perform the duties of an alternative occupation. The court's decision was based on a strict interpretation of the policy terms and the evidence presented.

The court ordered that the appeal be dismissed and that the decision of the respondent, MetLife Insurance Ltd, to terminate Ms Ward's income protection insurance policy be upheld.

Orders