When a superannuation trustee or group life insurer reconsiders a TPD claim after receiving substantial new medical and lay evidence, the decision-maker must engage with that new evidence and cannot simply rely on earlier adverse medical opinions without considering whether the factual assumptions underlying those opinions remain valid. An insurer must consider not just whether a claimant is theoretically physically capable of performing certain work, but also the actual likelihood of the claimant obtaining employment given their education, training and experience. A trustee that deals with a complex reconsideration request in a few minutes alongside numerous other matters, without demonstrating engagement with the new material, fails to give real and genuine consideration.
The full text is available to signed-in members, including the 22 later cases that cite this judgment.
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