AIA has to pay an injured truck driver’s total and permanent disability benefit after the industry ombudsman backed his claim.  

The driver suffered a spinal neck injury at work in 2013 and his employment ended in January 2015. In 2017 he lodged a TPD claim via his superannuation.

AIA denied the claim, saying medical evidence showed the man could do other commercial driving – such as bus or light delivery jobs – suited to his education, training and experience.  

But the Australian Financial Complaints Authority agrees with the claimant that he has no realistic capacity for other work.

In considering medical reports, it says many do not help because they comment on the complainant’s condition at a time other than the date of assessment, do not necessarily consider the relevant TPD definition, or were obtained for a purpose other than the TPD claim.

A report by one doctor said the man could work, but with so many restrictions it was unlikely he would get another role. The man is now 59 and has not worked for 10 years.

“There is no persuasive evidence that there was a real prospect, and not merely some theoretical prospect, that suitable work would be available,” AFCA’s determination says.

The insurer must pay the benefit and interest from 2020 – the date from which it was unreasonable to withhold payment.

See the ruling here.