MetLife Insurance Limited v MX

[2019] NSWCA 228

NSW Court of Appeal

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Interrogate

Catchwords

1. Insurance
2. › Accident and sickness insurance
3. › Benefits for disablement
4. › Total and permanent disability
5. › Education, training and experience clause
6. › Insurer's duty to act reasonably and fairly in forming opinion
7. › Whether insurer's process of consideration undertaken reasonably and fairly
8. › Whether insurer's reasons for decision were adequate
1. Insurance
2. › Accident and sickness insurance
3. › Benefits for disablement
4. › Total and permanent disability
5. › Reconsideration of claim
6. › Whether insurer's prior decision was an irrelevant consideration on reconsideration
7. › Whether insurer required to approach reconsideration without reference to earlier decision
1. Insurance
2. › Accident and sickness insurance
3. › Benefits for disablement
4. › Total and permanent disability
5. › Evaluation of medical evidence
6. › Whether insurer acted reasonably in preferring one body of medical opinion over another
7. › Whether insurer required to weigh significance of claimant's evidence about activities and functioning

Quick Take

When an insurer reconsiders a TPD claim, its prior decision and the reasons previously furnished form part of the relevant context and are not irrelevant considerations; however, the insurer must still undertake a reasonable and fair process of consideration that explains why it prefers one body of medical opinion over another and weighs the significance of the claimant's own evidence about their activities and functioning.