Hannover Life Re of Australasia Limited v Sayseng

[2005] NSWCA 214

NSW Court of Appeal

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Interrogate

Catchwords

1. Insurance
2. › Group life insurance
3. › Total and permanent disablement
4. › Insurer's duty of good faith and fair dealing
5. › Whether duty owed to employee not party to insurance contract
6. › Whether duty breached by failure to disclose adverse material to employee
1. Insurance
2. › Group life insurance
3. › Insurer's opinion as condition of liability
4. › Procedural fairness in forming opinion
5. › Whether insurer required to give claimant opportunity to respond to adverse reports
1. Contract
2. › Privity of contract
3. › Exception to privity doctrine in insurance context
4. › Trident General Insurance Co Ltd v McNiece Bros Pty Ltd
5. › Whether incremental extension to employee under group superannuation policy where insurance indirectly benefits employee
1. Superannuation
2. › Trust deed
3. › Total and permanent disablement benefit
4. › Dual conditions of entitlement
5. › Opinion of trustee and satisfaction of policy definition
6. › Whether proceedings against trustee should be deferred pending determination of insurer's liability

Quick Take

An insurer under a group life insurance policy held by a superannuation trustee owes a duty of good faith and fair dealing to the employee-member whose claim depends on the insurer's opinion, even though the employee is not a party to the policy and cannot rely on ss 13 or 48 of the Insurance Contracts Act 1984 (Cth). This duty requires the insurer to disclose adverse expert reports and surveillance material to the employee and provide an opportunity to respond before forming its opinion. Failure to do so vitiates the insurer's opinion, and the court may itself determine the question of total and permanent disablement.