Michael Burke v MetLife Insurance Limited [2019] NSWSC 177

Supreme Court New South Wales

Medium Neutral Citation: Michael Burke v MetLife Insurance Limited [2019] NSWSC 177 Hearing dates: 4–12 October 2018 Date of orders: 01 March 2019 Decision date: 01 March 2019 Jurisdiction: Equity Before: Rees J Decision: The Plaintiff's claim is dismissed. Plaintiff to pay the Second Defendant's costs. Catchwords: INSURANCE — Group life insurance — Claim for "total and permanent disablement" — "Two-stage" inquiry — Privity of contract — Whether beneficiary entitled to claim damages for breach of duty of good faith and fair dealing — "Stage 1" — Satisfaction of insurer — Whether insurer's determination "reasonable and fair"— Inconsistency between plaintiff's history and contemporaneous material — "Stage 2" — Whether plaintiff TPD within policy definition — Determination made.

CIVIL PROCEDURE — Separate determination of questions — Where appropriate — Insurance — Claim for "total and permanent disablement" — "Two-stage" inquiry.

EVIDENCE — Hearsay — Business records — COPS reports, Evidence Act 1995, s 69(3)(b), applied. Legislation Cited: Crimes Act 1900 (NSW), s 195(1)(a) Evidence Act 1995 (NSW), ss 60, 69(3)(b) Insurance Contracts Act 1984 (Cth), s 11(1) Police Act 1990 (NSW), ss 173(5), 181D Police Regulation 2000 (NSW), cl 9(1) Workers Compensation Act 1987 (NSW), ss 11A, 66, 67 Cases Cited: Averkin v Insurance Australia Ltd (2016) 92 NSWLR 68; [2016] NSWCA 122 Birdsall v Motor Trades Association of Australia Superannuation Fund Pty Ltd (2015) 89 NSWLR 412; [2015] NSWCA 104 Bradley v Voltex Group Holdings Pty Limited [2016] FCA 1230 CGU Insurance Limited v AMP Financial Planning Pty Limited (2007) 235 CLR 1; [2007] HCA 36 Edwards v The Hunter Valley Co-op Dairy Co Ltd (1992) 7 ANZ Ins Cas 61-113 Folmer v VicSuper Pty Ltd & Anor [2018] NSWSC 1503 Hannover Life Re of Australasia Ltd v Dargan (2013) 83 NSWLR 246; [2013] NSWCA 57 Hannover Life Re of Australasia v Jones [2017] NSWCA 233 Hannover Life Re of Australasia v Sayseng (2005) 13 ANZ Ins Cas 90-123; [2005] NSWCA 214 Heitman v Guardian Assurance Co Ltd & Anor (1992) 7 ANZ Ins Cs 77,483 Hellessey v MetLife Insurance Ltd [2017] NSWSC 1284 Johnson v Perez (1988) 166 CLR 351 Mason v Demasi [2009] NSWCA 227 McArthur v Mercantile Mutual Life Insurance Co Ltd [2002] 2 Qd R 197; [2001] QCA 317 MetLife Insurance Ltd v Hellessey [2018] NSWCA 307 MX v FSS Trustee Corporation as Trustee of the First State Superannuation Scheme & Anor [2018] NSWSC 923 Newling v FSS Trustee Corporation (No 2) [2018] NSWSC 1405 Paric v John Holland (Constructions) Pty Limited (1985) 62 ALR 85; [1985] HCA 58 Sargeant v FSS Trustee Corporation [2018] NSWSC 1997 Sayseng v Kellogg Superannuation Pty Ltd & Anor [2003] NSWSC 945 TAL Life Ltd v Shuetrim; MetLife Insurance Ltd v Shuetrim (2016) 91 NSWLR 439; [2016] NSWCA 68 Trident General Insurance Co Ltd v McNiece Bros Pty Ltd (1988) 165 CLR 107 Whisprun Pty Ltd v Dixon (2003) 200 ALR 447; [2003] HCA 48 Willis v Commonwealth (1946) 73 CLR 105 Ziogos v FSS Trustee Corporation as Trustee of the First State Superannuation Scheme [2015] NSWSC 1385 Texts Cited: Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Association, 5th ed., 2013) (DSM-5) Expert Guidelines: Diagnosis and Treatment of Post-Traumatic Stress Disorder in Emergency Service Workers (Harvey et al., Black Dog Institute, 2015) MMPI 2 RF Minnesota Multiphasic Personality Inventory-2 Restructured Form - Manual for Administration, Scoring and Interpretation, (Ben-Porath et al., University of Minnesota Press, 2011) Category: Principal judgment Parties: Michael Burke (Plaintiff)