Life Insurance Online :: News
SHARE

Share this news item!

Horse Accident Claim Rejected: A Deeper Look into Trauma Insurance

Horse Accident Claim Rejected: A Deeper Look into Trauma Insurance

Horse Accident Claim Rejected: A Deeper Look into Trauma Insurance?w=400

The information on this website is general in nature and does not take into account your objectives, financial situation, or needs. Consider seeking personal advice from a licensed adviser before acting on any information.

An individual who sustained serious injuries from a horse riding accident has been denied a trauma insurance payout, as authorities concluded that there is insufficient proof that her condition is irreversible.

The incident occurred on October 16 of the previous year, leading to a significant pelvic fracture for the claimant, followed by surgery a few days later. The woman has stated that her day-to-day activities have been severely affected as a result.

Currently, she is undergoing physiotherapy and taking medication to improve her mobility. Her orthopaedic surgeon, identified as Dr NJ, has reported that she exhibits "debilitating symptoms affecting her left leg and foot."

Despite these symptoms, Dr NJ remarked that it might take 18 to 24 months to see improvement, and confirmed that predicting a permanent condition is complex at this stage.

Clearview Life Assurance refused the claim, citing that their policy's "loss of independent existence" clause necessitates a permanent inability to perform at least two daily activities independently.

In June, the complainant's general physician noted that she requires crutches for mobility and is incapable of handling tasks such as shopping, laundry, food preparation, or housecleaning.

The claimant also stated she suffers from cognitive impairment and has not shown any nerve recovery since the incident. She contends it would be unreasonable to assume her condition will improve over time.

The Australian Financial Complaints Authority (AFCA) acknowledged the severity of her disability but indicated that the current medical advice suggests she could eventually recover.

"Dr NJ is in the best position to opine on the permanence of the disability, given his specialty and ongoing treatment of the complainant," AFCA noted. "He has said it's 'too early to declare a permanent condition' and has outlined the further testing and treatments that are in progress and planned."

Nonetheless, AFCA's decision leaves the door open for the claimant to present new medical evidence at a future point that might confirm the permanence of her disability.

"It may be possible for her to demonstrate with subsequent medical evidence that her disability is permanent," AFCA said. "However, based on the current evidence, I am not convinced her disability is permanent or irreversible."

This case offers a critical view into the complexities and challenges associated with trauma insurance claims and highlights the necessity for clear and definite medical proof in establishing the permanence of a condition.

Published:Tuesday, 1st Oct 2024
Author: Paige Estritori

Please Note: We do not endorse any specific products or companies. Some content is sourced from third parties, including press releases, and may not be independently verified for accuracy or completeness.

Share this news item:

Rate this article

0 Comments

No comments yet. Be the first to share your thoughts.

Insurance News

New APRA Data Reinforces the Need to Review Income Protection Cover
New APRA Data Reinforces the Need to Review Income Protection Cover
29 Jul 2026: Paige Estritori
APRA’s latest life insurance performance data has put income protection back under the spotlight, with disability income products continuing to be one of the more closely watched areas of the sector. While the broader life insurance industry has been showing signs of improved stability, the update reinforces that policies designed to replace income after illness or injury remain sensitive to claims experience, pricing, and changing work and health trends. - read more
Why Severe Weather Readiness Matters for Boat Owners
Why Severe Weather Readiness Matters for Boat Owners
29 Jul 2026: Paige Estritori
Australia’s latest severe weather preparedness messaging from the insurance sector is a timely reminder that boat owners face a different risk profile to many households. Storms, flood surge, hail, cyclonic winds and marina damage can all affect vessels well before a skipper has a chance to move them. For owners in Queensland, New South Wales, Western Australia and the Northern Territory in particular, the lead-up to summer is not just a maintenance checkpoint; it is a financial protection checkpoint. - read more
What Rising Insurance Disputes Mean for Small Businesses
What Rising Insurance Disputes Mean for Small Businesses
29 Jul 2026: Paige Estritori
Recent industry reporting on the latest insurance complaints environment points to a clear message for Australian small businesses: the hardest part of insurance is often not buying a policy, but relying on it when something goes wrong. Disputes continue to arise around claim delays, declined claims, settlement amounts, policy exclusions and communication breakdowns between customers and insurers. - read more
Rising Insurance Disputes Show Why Claims Service Matters
Rising Insurance Disputes Show Why Claims Service Matters
29 Jul 2026: Paige Estritori
Australia’s latest financial dispute data has put insurance claims handling back in the spotlight, with consumers and small businesses continuing to seek outside help when problems with insurers cannot be resolved directly. The trend is a timely reminder that an insurance policy should be assessed not only on premium, but also on how clearly it explains cover, how exclusions work, and how effectively claims are managed when pressure is highest. - read more
What Cosmetic Treatment Scrutiny Means for Beauty Business Cover
What Cosmetic Treatment Scrutiny Means for Beauty Business Cover
29 Jul 2026: Paige Estritori
Australian beauty businesses offering higher-risk aesthetic treatments are facing another reminder that compliance is now a front-of-house issue, not just a back-room admin task. Recent beauty industry reporting has focused on the continued scrutiny of cosmetic injectables, skin procedures and treatment advertising, with regulators expecting clearer consent, accurate marketing and suitable clinical oversight where health-related services are provided. - read more


Life Insurance Articles

How Much Life Insurance Do You Really Need? A Family's Guide to Assessment
How Much Life Insurance Do You Really Need? A Family's Guide to Assessment
Life insurance is one of those cornerstones of financial planning that often gets overlooked. Yet, the importance of life insurance in safeguarding your family's future cannot be overstated. It's a robust financial instrument that provides peace of mind, knowing that your loved ones will be financially secure in the event of your untimely passing. This introductory section lays the groundwork for understanding why life insurance is pivotal in your family's financial health. - read more
Why Life Insurance Should Be a Priority for Every Married Couple
Why Life Insurance Should Be a Priority for Every Married Couple
When it comes to financial planning, life insurance often takes a backseat. Many married couples in Australia overlook its importance, thinking that it's not immediately necessary or that they can simply put it off for later. However, life insurance should be regarded as a cornerstone of a solid financial strategy. - read more
How Life Insurance and Estate Planning Work Together for Your Benefit
How Life Insurance and Estate Planning Work Together for Your Benefit
For many Australian families, the concept of estate planning might evoke imagery of vast wealth and complex legal documents, reserved for the very affluent. However, this misconception overshadows the universal importance of having an estate plan, which at its core, is about ensuring your loved ones are cared for and your wishes are honored upon your passing—even if you don't consider yourself wealthy. - read more
Unexpected Illness & Injury: Navigating Financial Security for Your Family
Unexpected Illness & Injury: Navigating Financial Security for Your Family
Life is an unpredictable journey filled with twists and turns that can challenge even the most prepared among us. Sudden illnesses and unexpected injuries are just some of the uncertainties that can disrupt the harmony of family life. The emotional turmoil brought on by these circumstances is often compounded by the financial strain they can cause. It's during these trying times that the true value of peace of mind becomes clear. - read more
Life Insurance Audit: Regular Check-Ups for Your Policy's Health
Life Insurance Audit: Regular Check-Ups for Your Policy's Health
Life insurance serves as a crucial safety net, guarding your loved ones against the unforeseen. Just as you would take care of your health through regular check-ups, it is equally important to ensure that your life insurance policy remains in sound condition to provide the necessary protection. - read more

Knowledgebase
Peril:
A specific risk or cause of loss covered by an insurance policy, such as fire, theft, or flood.