We are delighted to welcome you to the fifth edition of the HWL Ebsworth Life Insurance Quarterly Newsletter.
With insurance lawyers in each capital city, HWL Ebsworth has one of the largest insurance practices in Australia, dedicated to assisting clients in all aspects of insurance and reinsurance. Within the national practice group we have a team of partners and lawyers who specialise in life insurance and have market-leading expertise across all Australian jurisdictions.
As part of our focus on the life insurance industry, each newsletter addresses a range of topics designed to provide industry stakeholders with an insight into legal and other developments across the nation.
In this edition we review the following topics:
Utmost good faith principles embodied in the Life Insurance Code of Practice
One of the ways the life insurance industry has responded to the increased focus on its obligations to act in good faith, and in particular claims handling procedures, is with the implementation of the Life Insurance Code of Practice (the Code).
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What’s the connection? Linking a claimant’s ETE and suitable job options
When considering the vocational options for which a claimant may be reasonably suited/fitted by reason of their education, training or experience (ETE), it is no longer permissible simply to rely on roles in which a claimant may possess some transferable skills which are relevant to that role. A reasonable connection between the proposed role and the claimant’s ETE must be identified.
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Total Permanent Disability – Insurer’s duties when faced with overwhelming evidence that a claimant is not TPD
It is well established that, where an element of the insurer’s liability under an insurance policy is expressed in terms of the opinion of the insurer, the insurer is obliged to act reasonably in considering and determining a claim for TPD1. The insurer must also consider the correct question and, in the exercise of powers affecting the interests of both the insurer and the claimant, the insurer is under a duty of good faith and fair dealing, which requires it to have due regard for the interests of a claimant2.
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What can an insurer do when it is uncertain who should receive the proceeds of a policy?
Typically, there will be little doubt about who a benefit should be paid to under a policy of life insurance. If the beneficiaries cannot be identified, payment can be made into court to discharge the insurer’s liability.
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Something fishy? When a claimant’s self reported symptoms are questionable
When a disability insurance claim becomes litigated, what is often significant, if not crucial, to the claimant being able to succeed in establishing their claim is their presenting and being accepted by the court as honest and reliable (and also, arguably, worthy of sympathy).
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Editors: Jason Stevens, Partner and Matthew Harding, Partner.
1 Hannover Life Re of Australasia Ltd v Jones [2017] NSWCA 233 at [65], TAL Life Ltd v Shuetrim [2016] NSWCA 68 at [60]-[62], Edwards v Hunter Valley Co-op Dairy Co Ltd (1992) 7 ANZ Ins Cas 61-113 at 77,536
2 Edwards, at 77,536