AFCA Orders AIA to Pay Truck Driver's TPD Benefit After 10-Year Dispute

The case centers around a truck driver who sustained a spinal neck injury in 2013, leading to the termination of his employment in January 2015. In 2017, he lodged a TPD claim through his superannuation fund. AIA denied the claim, contending that medical evidence suggested the driver could undertake other commercial driving roles, such as bus or light delivery jobs, aligned with his education, training, and experience.

However, AFCA's assessment found that the driver, now 59 years old and unemployed for ten years, had no realistic capacity for alternative employment. The authority noted that many medical reports did not adequately consider the relevant TPD definition or were obtained for purposes other than the TPD claim. A pivotal report indicated that while the driver could work, the extensive restrictions made it unlikely for him to secure another role.

AFCA's determination stated: "There is no persuasive evidence that there was a real prospect, and not merely some theoretical prospect, that suitable work would be available." Consequently, AIA has been ordered to pay the TPD benefit along with interest from 2020, marking the period from which it was deemed unreasonable to withhold payment.

This ruling underscores the critical importance of thorough and fair assessments in TPD claims, especially for individuals in physically demanding professions like trucking. It highlights the necessity for insurers to consider the practical employability of claimants, taking into account their age, work history, and the realistic availability of suitable employment opportunities.

For professionals in the transport and logistics industry, this case serves as a reminder of the complexities involved in TPD claims and the importance of seeking expert advice when navigating such processes. Ensuring comprehensive documentation and understanding the specific definitions and criteria set forth by insurers can significantly impact the outcome of a claim.

In conclusion, the AFCA's decision reinforces the obligation of insurers to conduct fair and realistic evaluations of TPD claims, ensuring that individuals who are genuinely unable to return to work receive the support they are entitled to.