Resolution Life fights court ruling over AFCA claim decision
Resolution Life is challenging a Federal Court decision rejecting its appeal against an Australian Financial Complaints Authority (AFCA) ruling about a gratuitous payment for a total and permanent disability claim.
The insurer said in December it had acknowledged the decision by Justice Angus Steward that month and would make the payment to Gregory Teagle, who submitted the claim on his superannuation-held cover after suffering a spinal injury.
The court was not persuaded by the insurer’s contentions that AFCA “erred in law”, was “legally unreasonable”, made “jurisdictional error” and failed to provide procedural fairness in its determination on the dispute in June.
“Resolution Life confirms that it has appealed the judgment of the Federal Court of Australia,” the insurer said in a statement to insuranceNEWS.com.au on Friday.
“We are sympathetic to Mr Teagle’s circumstances, noting that the matter is taking some time for all legitimate legal avenues to be explored. As the matter is now before the Full Court of the Australian Federal Court, we are unable to provide any further comment.”
AFCA decisions are binding, but section 1057 of the Corporations Act states “a party to a superannuation complaint may appeal to the Federal Court, on a question of law” following the ombudsman’s determination.
The authority’s panel initially found in March last year that Resolution Life’s decision not to pay the total and permanent disability benefit was fair and reasonable in the circumstances, as Mr Teagle had a back condition that fell within the policy’s lumbar/sacral spine exclusion.
But Mr Teagle then raised a number of issues and the panel found in June that he had been deprived of a “meaningful” opportunity to have the exclusion reviewed, and that had a material effect on his claim. The authority determined the insurer must make a gratuitous payment to the claimant.