Fund and insurer rebuked on TPD assessment

A Superannuation Complaints Tribunal (SCT) determination [D16-17\173] has sent a clear message to superannuation fund trustees and insurers that they should not rely on WorkCover Authority assessments in dealing with total and permanent disablement (TPD) claims.

A superannuation fund and its insurer earned a rebuke from the SCT for relying on WorkCover-related medical opinions rather than obtaining independent medical assessments of the fitness of an injured superannuation fund member to return to work.

Instead, the insurer and the fund had relied on the evidence provided by medical practitioners in the context of workers compensation arrangements.

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In setting aside the decision of the superannuation fund and the insurer to deny the injured member a total and permanent disablement claim, the SCT bluntly noted “that neither the trustee nor the insurer saw fit to commission an independent medical examination and a consequential vocational assessment report; choosing instead to rely upon the authority's material”.

 “The trustee and insurer would be well aware that the material was not prepared for the purpose of addressing the definitional requirements of TPD in the superannuation context,” the SCT determination said.

The SCT determined to set aside the decisions of the superannuation fund and the insurer and substituted its own decision that the member be paid a TPD benefit with interest payable to cover the almost two-year delay between the denial of the claim and the SCT decision.

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