Income Insurance Australia

... helping Australians to secure a prosperous future

Income Insurance Australia :: News

Share this news item!

Horse Accident Claim Rejected: A Deeper Look into Trauma Insurance

The information on this website is general in nature and does not take into account your objectives, financial situation, or needs. Consider seeking personal advice from a licensed adviser before acting on any information.

An individual who sustained serious injuries from a horse riding accident has been denied a trauma insurance payout, as authorities concluded that there is insufficient proof that her condition is irreversible.

The incident occurred on October 16 of the previous year, leading to a significant pelvic fracture for the claimant, followed by surgery a few days later. The woman has stated that her day-to-day activities have been severely affected as a result.

Currently, she is undergoing physiotherapy and taking medication to improve her mobility. Her orthopaedic surgeon, identified as Dr NJ, has reported that she exhibits "debilitating symptoms affecting her left leg and foot."

Despite these symptoms, Dr NJ remarked that it might take 18 to 24 months to see improvement, and confirmed that predicting a permanent condition is complex at this stage.

Clearview Life Assurance refused the claim, citing that their policy's "loss of independent existence" clause necessitates a permanent inability to perform at least two daily activities independently.

In June, the complainant's general physician noted that she requires crutches for mobility and is incapable of handling tasks such as shopping, laundry, food preparation, or housecleaning.

The claimant also stated she suffers from cognitive impairment and has not shown any nerve recovery since the incident. She contends it would be unreasonable to assume her condition will improve over time.

The Australian Financial Complaints Authority (AFCA) acknowledged the severity of her disability but indicated that the current medical advice suggests she could eventually recover.

"Dr NJ is in the best position to opine on the permanence of the disability, given his specialty and ongoing treatment of the complainant," AFCA noted. "He has said it's 'too early to declare a permanent condition' and has outlined the further testing and treatments that are in progress and planned."

Nonetheless, AFCA's decision leaves the door open for the claimant to present new medical evidence at a future point that might confirm the permanence of her disability.

"It may be possible for her to demonstrate with subsequent medical evidence that her disability is permanent," AFCA said. "However, based on the current evidence, I am not convinced her disability is permanent or irreversible."

This case offers a critical view into the complexities and challenges associated with trauma insurance claims and highlights the necessity for clear and definite medical proof in establishing the permanence of a condition.

Published:Tuesday, 1st Oct 2024
Author: Paige Estritori

Please Note: If this information affects you, seek advice from a licensed professional.

Share this news item:

Insurance News

Australian Life Insurers Achieve Significant Underwriting Gains in Q4 2025

23 Mar 2026: Paige Estritori

The Australian life insurance sector has reported a substantial underwriting gain of $279 million for the December quarter of 2025, a significant improvement from the $36 million recorded in the same period the previous year. This data, released by the Australian Prudential Regulation Authority (APRA), highlights a notable turnaround in the industry's financial performance. - read more

Record Profits for Australian General Insurers in 2024

23 Mar 2026: Paige Estritori

Australia's general insurance industry has reported an unprecedented after-tax profit of $6.1 billion for the year 2024, marking a significant milestone in the sector's financial performance. This figure is three times higher than the five-year average of $2 billion, according to KPMG's General Insurance Insights report. - read more

IAG Achieves 33% Increase in Insurance Profit Amid Lower Claims

23 Mar 2026: Paige Estritori

Insurance Australia Group (IAG), the country's largest insurer, has reported a 33% increase in its full-year insurance profit, reaching A$606 million for the 12 months ending June 2025. This significant growth is attributed to a combination of reduced claims expenses and strategic premium adjustments. - read more

Introducing Backd: Affordable Insurance for Casual and Contract Workers

15 Mar 2026: Paige Estritori

In a significant move to address the insurance needs of Australia's growing casual and contract workforce, TAL has partnered with global insurtech company Cover Genius to launch Backd. This innovative digital-only insurance product aims to provide accessible and affordable life and income protection coverage to workers who have traditionally faced challenges in obtaining such protection. - read more

Zurich's Home Loan Protection: Tailored Insurance for Mortgage Holders

15 Mar 2026: Paige Estritori

Zurich has unveiled its Home Loan Protection (HLP) product, a new insurance offering that combines life and income protection benefits tailored specifically for mortgage holders. This innovative cover automatically adjusts its premiums as the insured's mortgage balance decreases, ensuring that policyholders are only paying for the coverage they need. - read more

Click for more Insurance News

Life Insurance Articles

Comparing Income Protection Policies: What Australians Should Look For

Income protection insurance serves as a financial safety net for countless Australians, offering a replacement income when unforeseen circumstances such as illness or injury impede their ability to earn. For the self-employed and entrepreneurs who may not have the safety nets offered by corporate employment, such protection is particularly important. - read more

Income Protection Insurance vs. Total Permanent Disability: What’s the Difference?

When life throws unexpected challenges your way, being financially prepared can make all the difference. This is where Income Protection Insurance and Total Permanent Disability (TPD) Insurance come into play. These two types of insurance provide a crucial safety net, ensuring that you and your family remain financially stable even when you're unable to work due to illness or injury. - read more

Understanding the Process: A Beginner's Guide to Income Insurance Claims

Income insurance, an often-overlooked component of financial security, is gaining traction among Australia's burgeoning self-employed population. In an economy where traditional employment is no longer the sole path to success, this form of insurance has become a cornerstone for proactive financial planning. Touted as a safety net, it ensures that personal livelihoods and business operations remain secure in the face of adversity. - read more

How Pre-Existing Conditions Affect Your Income Protection Insurance Options

Income protection insurance is a type of insurance policy designed to provide you with a continuous flow of income in case you are unable to work due to illness or injury. It's a safety net that helps ensure you can maintain your standard of living, even when unforeseen health issues arise. - read more

Income Insurance: Common Misunderstandings that Could Cost You

When life throws unexpected challenges your way, income insurance can be a financial lifesaver. Essentially, it's a policy designed to replace a portion of your income if you're unable to work due to illness or injury. Imagine not having to worry about bills piling up while you focus on recovery. That's the peace of mind income insurance aims to provide. - read more

Start Here !

Apply now for your free Insurance assessment and price comparisons!

This website is owned and operated by Clark Family Pty Ltd (ACN 010 281 008) as Trustee for the Clark Family Trust (ABN 35 957 893 714), 43 Larch Street Tallebudgera QLD 4228. Clark Family Pty Ltd is an Authorised Representative (AR 1298860) of Unique Group Broker Services Pty Ltd (AFSL 509434) for financial product referrals and an Authorised Credit Representative (ACR 401491) of Saccasan Pty Ltd (ACL 386297). Check our licensing details on the ASIC registers: Clark Family Pty Ltd ACR, Clark Family Pty Ltd AR, Saccasan Pty Ltd, Unique Group Broker Services.

IMPORTANT: We do not provide financial product advice or credit assistance. We act solely as an introducer and refer enquiries to licensed third-party intermediaries, insurers, and lenders - with whom you can then deal directly. We may receive a fee or commission from these third parties in consideration for the referral. Before any action is taken to obtain a product or service referred to by this website, advice should be obtained (from either the third party to whom we refer you or from another qualified intermediary) as to the appropriateness of obtaining those products having regard to your objectives, financial situation and needs. Whilst we have our own process for validating the legitimacy of our referral partners, you should always verify the credentials of your financial adviser before proceeding with recommendations that they may present. Visit the ASIC website for further information.