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Policewoman wins eight-year insurance battle for TPD claim after suffering PTSD

Police Officers at scene of crime

A NSW Police officer has had to fight for eight years for her right to a Total Permanent and Disability (TPD) payment after suffering significant psychological trauma, known as “post-traumatic stress disorder” (PTSD). The case shows the legal technicalities in making such claims, writes TPD Senior Paralegal, Amy Lewis.

 

A former policewoman who suffered PTSD as a result of being exposed to a range of confronting and horrific circumstances while on the job, has been awarded a $750,000 payout under a Total and Permanent Disability (TPD) claim.

Rebecca Sandstrom took her Super fund, First State Super and their insurer, Metlife, to the NSW Supreme Court after her TPD claim was denied five years ago.

Ms Sandstrom, who was stationed in Sydney’s west in Bankstown, developed chronic post-traumatic stress disorder following several horrific cases she worked on over the span of three years.

Earlier this year, in a Supreme Court decision of His Honour Justice Slattery, Ms Sandstrom received a judgment in her favour for TPD benefits, with the claim taking over eight years to be finalised.

Background of Events

Ms Sandstrom was a young recruit when she joined the NSW Police Force in 2005 at the age of 22. In the following years of service, Ms Sandstrom was exposed to a range of confronting situations including attending at the scenes of dead and dismembered bodies as well as assisting persons who had received grievous personal injury.

In 2009, she was part of a team sent to a crime scene in Pheasants Nest, where a woman’s dismembered body had been discovered.

There were also other incidents where she had attended confronting crime scenes involving self-harm.

In 2010, she witnessed one of her colleagues being fatally shot. It was at this stage Ms Sandstrom began to experience symptoms of post-traumatic stress disorder (PTSD) which resulted in her being placed on sick leave. Ms Sandstrom has not returned to employment since 8 September 2010.

On 7 July 2011, Ms Sandstrom was formally discharged from the Police force on medical reasons.

The claim process and legal proceedings

On 1 August 2011, Ms Sandstrom initiated a TPD claim through her super fund, First State Super on the basis of PTSD and related psychological conditions. The claim was lodged with Metlife, being First State Super’s insurer at the relevant time. After four years, Metlife rejected the claim in mid-2015.

Ms Sandstrom commenced proceedings in the Supreme Court on 7 October 2015 noting that both First State Super and Metlife breached their duty of utmost good faith dealing with her claim and failed to act reasonably to form an opinion as to whether not she met the definition of TPD.

Metlife maintained that they declined the claim as the medical evidence did not support that Ms Sandtrom was “unlikely ever” to engage in work in any occupation she was qualified for by way of education, training and experience.

Metlife argued that given Ms Sandstrom’s young age, it could not conclude she would be incapable of returning to work until her likely retirement age.

The proceedings were conducted over nine days before the Supreme Court.  This involved Ms Sandstrom’s legal representatives arguing nine grounds on why Ms Sandstrom’s claim should be successful. Interestingly, when the Defendant cross-examined Ms Sandstrom, many of the questions concerned Facebook content which Ms Sandstrom had posted.

READ MORE: TPD: Can insurers use your social media posts as evidence? 

Result

After hearing the matter, His Honour Justice Slattery ordered that Ms Sandstrom is, and was, totally and permanently disabled within the meaning of the insurance policy. His Honour ordered First State Super to pay the relevant insurance amount (over $750,000) with the issue of costs and interest to be heard on a later date.

This is not the first case involving Police Officers who have been rejected for TPD benefits. Most notably, First State Super (who is the predominate super fund for NSW Police Officers) and Metlife have been involved in several court cases with Police Officers being claimants – Shuetrim v FSS Trustee Corporation; Hellessey v MetLife Insurance Ltd and Gavan v FSS Trustee & Metlife.

The case is a great win for police officers generally and recognises the difficult work-related stressors that first responders experience on a daily basis. Unfortunately, many Super funds and insurance companies deny liability on genuine claims which forces the injured person to engage lawyers and go through the court process to obtain justice.

The Super Funds and the insurers know full well that by doing this they are exacerbating the psychological injury of the claimant by denying the claim and prolonging the claim process.

Hopefully, this case will be a salient lesson to the Super funds and insurers that this conduct will not be tolerated

How can Attwood Marshall Lawyers help with a TPD claim?

Attwood Marshall Lawyers are highly experienced in TPD claims for our frontline emergency workers. If you are considering making a claim for TPD benefits, it is recommended you seek legal advice to ensure the best possible outcome. Each insurance policy is different and TPD definitions can be a complex area of law when making a TPD claim.

Read more by Amy Lewis:

TPD claims – watch out for definitions!
What is a TPD benefit? How do I make a TPD claim?
Types of life insurance and compensation claims
Why accountants must never give advice on TPD claims

For any enquiries on making a TPD claim for compensation, contact Compensation Law Department Manager Kelli Costin on 07 5506 8220, email kcostin@attwoodmarshall.com.au or free call 1800 621 071.

 

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Amy Lewis

Amy Lewis