Australia: Was the PTSD of a police officer a total and permanent disability or was the insurer right to reject her claim? Which case won?

Last Updated: 11 September 2019
Article by Christopher Morris

The Facts

Police officer quits police force suffering PTSD and depression

A police officer worked for NSW Police and was involved in a number of traumatic events before ultimately quitting the police force.

After leaving the force, the officer was diagnosed with post-traumatic stress disorder (PTSD) and depression. Owing to her illness, the officer did not return to any kind of employment.

Terms of officer's life and TPD insurance policy

The officer's life insurance provider was obliged to compensate the officer if she could prove, to the satisfaction of the insurer, that she was so incapacitated as to be "unlikely ever" to return to employment.

Over the course of several years, the officer's treating psychiatrist assessed her and wrote several reports regarding her progress. Initially he expressed some hope the officer would be able to return to work. In his later reports he expressed the view that treatment had been ineffective and that the officer's condition was unlikely ever to improve.

Insurer engages private investigators to conduct surveillance

Following the officer making a claim, the insurer began conducting its own investigations and commissioning its own medical reports.

The insurer had private investigators follow the officer and observe her activities. Investigators learned that the officer had been in conflict with some of her fellow police officers, which may have been a factor in her decision to quit the force. Investigators also witnessed her engaging in various normal activities, including playing netball, attending dog shows, and smiling with friends in photos which were posted to her Facebook page.

The investigators observed the officer engaging in volunteer work at a public school. They found that her involvement with that school increased over time, to the point that she became president of the P&C Committee. The insured also became involved in organising a fete and a number of fundraisers.

Vocational assessments determine suitability for other employment

The insurer required the officer to submit to "vocational assessments" to determine which other occupations she might be able to work in, despite her condition.

Those reports asserted that the officer may be capable of working in a variety of different jobs, including insurance officer, welfare officer, office manager, security officer, control room and alarm monitoring, and insurance investigator.

Insurer engages its own psychiatric expert

The insurer had the officer examined by a different psychiatrist that it had selected.

The psychiatrist agreed that the officer did suffer from PTSD and depression. However, the insurer's psychiatrist also noted that the officer regularly abused alcohol, on occasions drinking up to two bottles of wine per night. The psychiatrist suggested that the officer had an alcohol abuse disorder which was exacerbating the consequences of her PTSD and depression and that her marriage breakdown may also have been a factor.

The psychiatrist concluded that there were good prospects of her recovering if she undertook available treatment for the alcohol abuse and depression with a combination of anti-depressants. The insurer's psychiatrist took the view that the officer had never been appropriately treated.

Insurer refuses claim after lengthy delay

After several years, the insurer eventually wrote to the officer, stating that her activities were inconsistent with the claimed disability and that she had failed to prove to its satisfaction that she was unlikely to be able to work again in any capacity.

The matter proceeded to litigation.

case a - The case for the insurer

case b - The case for the officer

  • Our investigators have shown that the officer undertakes a variety of normal activities and her Facebook account shows her regularly smiling and socialising with friends. These facts are inconsistent with her claims of total and permanent disability.
  • The vocational assessments that we organised for the officer identify several potential areas of future employment for her.
  • Our expert psychiatrist says there are other treatments available to the officer for her condition and that she has not availed herself of any of those treatments.
  • Indeed, our psychiatrist says the officer's marriage breakdown and alcohol abuse have contributed to her condition. Those are factors she can overcome.
  • The terms of the relevant insurance policy require an assessment to take place six months after she ceased employment. Medical reports from her own expert psychiatrist from around that period say that she might one day return to work.
  • The officer is exaggerating her condition; the evidence demonstrates that treatment options remain available to her and that she could work in a variety of occupations.
  • The court should find that we are entitled to reject the officer's claim under the contract of insurance.
  • I was advised by my treating psychiatrist that it was good for me to get out of the house and to try to perform normal social activities. I have followed that advice in an effort to improve my condition.
  • The expert evidence shows that undertaking occasional normal activity does not in any way prove that a person suffering from my psychiatric conditions will ever be capable of employment.
  • The insurer's expert psychiatrist runs a medico-legal practice and has not actually treated any patients for the last ten years. He has had little experience in treating police officers with PTSD and his opinion is far less reliable than that of my treating psychiatrist.
  • All other recent psychiatric reports confirm that after five years of unemployment I am "unlikely ever" to work again in any capacity.
  • My separation from my husband occurred after the deterioration of my mental health and was therefore not a factor in my illness. Abstaining from alcohol for significant periods has not resulted in any improvements in my condition, so this is also not a factor.
  • Contrary to the view of the insurer's expert psychiatrist, there is no reliable scientific evidence that combining anti-depressant medication would be effective in my case. Indeed, it can be dangerous to do so and there are risks of significant side effects.
  • Over the period of several years after I made my claim, the insurer consistently failed in its duty to act in good faith. It withheld its various investigation, psychiatrist and vocational assessment reports from me and only notified me of its determination shortly before the date set for the court hearing, which has made it difficult for me to properly respond.
  • I paid insurance premiums to the insurer diligently over many years and the court should order that the insurance company now pay my legitimate TPD claim.

So, which case won?

Cast your judgment below to find out

Christopher Morris
Workers compensation
Stacks Collins Thompson

The content of this article is intended to provide a general guide to the subject matter. Specialist advice should be sought about your specific circumstances.

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