The truck driver sustained a spinal neck injury at work in 2013, leading to the cessation of his employment in January 2015. In 2017, he lodged a TPD claim through his superannuation fund. AIA denied the claim, asserting that medical evidence indicated the driver could undertake other commercial driving roles, such as bus or light delivery jobs, aligned with his education, training, and experience.
However, AFCA's assessment found that the driver had no realistic capacity for alternative employment. The ombudsman noted that many medical reports did not adequately consider the relevant TPD definition or were obtained for purposes other than the TPD claim. A report from one doctor suggested the driver could work but with such extensive restrictions that securing another role was unlikely. Now aged 59 and having been unemployed for a decade, the driver faced significant barriers to re-entering the workforce.
AFCA concluded that there was no persuasive evidence of a real prospect that suitable work would be available to the driver. Consequently, the authority determined that AIA must pay the TPD benefit, including interest from 2020-the date from which it was deemed unreasonable to withhold payment.
This ruling underscores the critical role of thorough and fair assessment processes in insurance claims, particularly for individuals facing long-term disabilities. It also highlights the importance of insurers adhering to their obligations and ensuring that claimants receive the benefits they are entitled to without undue delay.
