Was the police officer’s PTSD a total and permanent disability or was the insurer right to reject her claim? Which case won?
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.