Life & Disability Insurance
Life and disability insurance claims are a specialised field requiring particular expertise. Such claims are subject to specific provisions under the Insurance Contracts Act and have a discrete body of evolving case law.
Moray & Agnew is one of the very few firms that has a practice dedicated to this niche area. The practice is headed nationally by Partner, Gerry Davies, a former in-house solicitor at a major life insurer.
The team’s focus is on providing high quality legal services through fully understanding developments in case law, responding to our insurer’s needs and providing reasoned recommendations.
Our team acts for a number of life and disability insurers, underwriting agencies and trustees of superannuation funds in the areas of:
- Income protection
- Total and permanent disablement (TPD)
- Group life
- Critical illness
- Personal accident and sickness
- Travel insurance.
The teams expertise lies in the following areas:
- Defending litigated claims
- Preparing submissions to the Financial Ombudsman Service (FOS) and the Superannuation Complaints Tribunal (SCT)
- Providing advice on handling and containing contentious claims
- Seeking recovery of policy benefits pursuant to offset provisions
- Policy drafting advice and interpretation.
Examples of recent matters in which our team has successfully represented their clients include:
- Defending litigated TPD claims where the plaintiff alleges that the insurer’s opinion was unreasonable
- Defending litigated claims involving policy coverage disputes, non-disclosure and misrepresentation (innocent and fraudulent) and fraudulent claims
- Defending a claim for a TPD benefit on the basis that the insured issued proceedings outside the relevant limitation period. Before litigation, FOS accepted our submissions and determined in the insurer’s favour
- Acting for five co-insurers of an income protection policy. The settlement sum was reduced by virtue of the deregistration of two other co-insurers, notwithstanding an argument that each co-insurer was jointly and severally liable to the insured
- Negotiating an early ‘walk away’ settlement in a litigated TPD claim on the basis that the member had ceased work due to accepting a redundancy
- Defending a critical illness claim where the issue was whether the insured had suffered a ‘heart attack’ in accordance with the policy definition
- Negotiating terms of settlement which include cancellation of the policy in order to obtain finality for the insurer
- Defending claims for interest which have arisen after the claims have been paid under the policy
- Defending a travel insurer in respect of substantial claim for overseas medical expenses which involved interpretation of another country’s statute of limitations
- Acting in matters which required consideration of whether the agent should be joined.
The team is praised for the depth of its capacity and ability to service insurer clients across a variety of lines, one client noting: "They have a very high volume; their real strength is that they're across all the areas that we do."
Chambers Asia Pacific, 2019