Total and Permanent Disablement
Abstract
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A claim for total and permanent disablement under Grooup Life insurance requires a two-stage analysis. The doctrine of privity of contract is relevant to whether a beneficiary is entitled to claim damages for breach of duty of good faith and fair dealing. Stage 1 relates to the satisfaction of insurer in accordance with a termof the policy., which may include an issue as to inconsistency between he claimant’s history and contemporaneous evidence. The second stge concerns the issue whether theclaimant's condition is within the policy's definition of 'totally and permanenty disabled.'.
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Article
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In respect of Group Life insurance a claim for total and permanent disablement requires a two-stage analysis. Because of the doctrine of privity of contract there may be an issue as to whether a beneficiary under the Groug scheme is entitled to claim damages for breach of duty of good faith and fair dealing Stage 1 of the analysis relates to the issue of the olicy's condition for satisfaction of insurer to support a claim, and particularly whether the insurer’s determination was reasonable and fair. There may be a sub-issue as to inconsistency between plaintiff’s history and contemporaneous evidence. Stage 2 then relates to the issue whether the claimant'scondition comes within the policy definition of 'totally and permanently disabled'. Burke v Metlife Insurance Ltd [2019] NSWSC 177.
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