Complainant loses IP benefit reinstatement dispute

A complainant who was receiving partial disability payments for depression caused by workplace bullying for more than a year until the insurer decided to stop them, citing medical information suggesting she can return to her pre-injury work capability, has lost her dispute to have the benefits reinstated.

Resolution Life Australasia had accepted the claim in June 2020 from the complainant, who lodged it in February that year under an income protection policy that she co-owns with her husband as trustees of a family super fund.

The life insurer paid her the partial disability benefits starting from January 2 2020, the date that marked the end of the 730-day waiting period.

But on September 24 last year the insurer declined her claim as by then it held the view that medical evidence showed the complainant’s claimed condition of “depression and anxiety related to workplace psychological injury‟ was not preventing her from completing the full duties of her pre-injury role.

It says its decision to cease benefits is in line with the terms and conditions of policy but the complainant wants the payments to continue.

She says her IP claim is not about whether she can return to work based on her ability and skillset, rather it is about whether she can return to a position similar to her previous role as a centre manager at the company where she suffered “psychological” injury.

She says HR at the company was aggressive and threatening, and asked her to give an estimate of when she would return to work. She had taken extended leave for an undefined period after her father died, becoming quite panicky and also suffered an acute incapacity from Miller Fisher syndrome, a rare acquired neurological disease.

The company subsequently terminated her employment in August 2018.

The Australian Financial Complaints Authority (AFCA) says the complainant has suffered a serious medical condition as a result of incidents at her previous workplace, one that has unfortunately caused significant impact to her wellbeing including her ability to work.

While she continues to suffer from these events, AFCA says the medical information suggests she is capable of performing the duties of her pre-injury role, provided it is not with her ex-employer or in another large enterprise.

“This level of capability does not meet the definition of [partial disablement] under the policy,” AFCA says.

“As a result, it would not be fair to require the insurer to continue to pay her benefits.”

Click here for the ruling.