The driver sustained a spinal neck injury in 2013, leading to the termination of his employment in January 2015. In 2017, he lodged a TPD claim through his superannuation fund. The insurer, 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 sided with the claimant, determining that he lacked a realistic capacity for alternative employment. The authority noted that many medical reports were either outdated, did not consider the specific TPD definition, or were obtained for purposes other than the TPD claim. A pivotal report suggested that while the driver could work, the extensive restrictions made it improbable for him to secure another role. 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 substantial evidence indicating a real prospect of suitable employment being available to the claimant. Consequently, the insurer was directed to pay the TPD benefit, including interest from 2020—the point at which withholding payment was deemed unreasonable.
This case underscores the complexities involved in long-term disability claims and highlights the importance of clear policy terms and thorough assessments in determining claim outcomes.
