A recent determination of the Superannuation Complaints Tribunal (SCT) has acted as a reminder to fund trustees of their obligation to pursue an insurance claim for the benefit of a beneficiary, if the claim has a reasonable prospect of success.
The determination saw the SCT overturning the decision of a superannuation fund and its insurer to deny a member an income protection claim on the basis that they had not fully considered the available options within the policy terms and conditions.
In particular, the SCT pointed out that while the superannuation fund member had been involved in a motor vehicle accident and had failed to meet the deadline to claim under the policy for that event, it was also open to him to claim for “sickness” resulting from the injuries.
The SCT determination said that the trustee, “had it conducted the review thoroughly, should then have turned its attention to the possibility of the policy responding to the complainant’s claim as a ‘sickness'”.
It pointed out that the policy definition of ‘injury’ mandated that: ‘[INJURY] does not include any condition which is also a SICKNESS.’
“The Tribunal, having carefully considered the facts, believes the trustee and the insurer had ample medical evidence before them at the relevant time, to have concluded that the complainant’s sciatic syndrome, as diagnosed by Mr H (the specialist doctor) was in fact a ‘sickness’ as contemplated by the policy,” the determination said.
The determination saw the superannuation fund member receive 104 weeks of income protection, equating to $47,998.08 gross.
