Ward -v- Metlife Insurance Ltd  WASCA 119
This was one of the fundamental questions being addressed at trial and the subsequent appeal in the case Ward v Metlife.
At trial, Stevenson DCJ found that Mr Ward was not disabled for the relevant period, because he did not have an “illness” as deﬁned in the Policy.
The policy we are referring to is the Group Salary Continuance plan offered by Mr Ward’s employer PriceWaterHouseCoopers (PWC) to some of it’s employees, in this case with the premiums paid by Mr Ward.
Mr Ward was employed by (PWC) as a Director in the Tax and Legal Services Group. He was responsible for around 20 direct reports, and worked between 50-60 hours a week in a specialised area of taxation law.
In early 2009, Mr Ward suffered from a major depressive illness. He took 6 weeks off work, returned to work on a part-time basis and after a period of time back he ceased duties. He claimed he could no longer face work and began receiving a full monthly payment from the policy under the Total Disability benefit. In November 2010 his employment with PWC was terminated by agreement and on 31 December 2010 Metlife determined that he was no longer “disabled” for the purposes of the policy, and it ceased payments.
At trial, the issues included whether (1) Mr Ward suffered one or two major depressive episodes; and (2) whether his major depressive disorder was in partial remission or full remission.
The experts at trial (three psychiatrists plus his treating psychologist) provided four different assessments ranging from Major depressive disorder, in remission (not recurrent) to Major depressive disorder, chronic, in partial remission to Major depressive disorder, recurrent.
The assessment provided by fourth psychiatrist at trial (Dr Spear), called by the respondent (Metlife), provided Major depressive disorder, in remission (not recurrent) as his assessment which interestingly was different to his previous assessments while payments were in dispute.
Dr Spear provided further commentary regarding Mr Ward’s personality style being ‘Type A personality’, having an ‘obsessional style’ and a ‘choleric melancholic (ie reflective) temperament’. He also described him as having ‘some narcissistic traits with a sense of egocentricity, being very self-centred and also having a very strong sense of entitlement’
I find that the plaintiff in November 2009, and at various times during the relevant period in differing degrees, experienced a collection of physical and mental symptoms which may be attributed in part to the 2009 major depressive disorder but also to his personality type. Some of the symptoms can be related to the normal aging process (loss of memory, loss of confidence). I do not accept that the symptoms relied upon are best described as ‘Major Depressive Disorder – Recurrent’ (or partially recurrent). In my view, the proper diagnosis is that the 2009 major depressive disorder is in remission.
I am not persuaded that the plaintiff’s symptoms consist of or constitute a recognisable psychiatric illness. As mentioned they do not constitute a major depressive disorder, whether recurrent or in partial remission. In my view, many of the plaintiff’s symptoms are explained by the plaintiff’s current circumstances and his personality type as set out in the medical evidence, in particular by Dr Spear
There was a 2:1 decision in favour of Mr Ward with some conflicting and important statements on the handling of such a case.
With the majority opinion, before the Court of Appeal, McLure P (with Buss J agreeing) noted that the insurer must take the insured as it ﬁnds him, and “if those personality matters underlie, intensify or delay recovery from symptoms attributable to a major depressive disorder, they are not, causally or otherwise, relevantly separate”
The High Court dismissed Metlife’s application for Special Leave
The ruling provides guidance against an insurer attempting to allocate some of a claimant’s symptoms to their personality type, without relevant evidence.
Justice Pullin’s observations on the Trial Judge’s findings were positive for future mental health claimants:
The trial judge does not identify the particular symptoms said to be attributable to the appellant’s personality type or why the other symptoms attributable to his major depressive disorder were not a disorder and therefore not an Illness…….
…….. The insurer must take an insured as it finds him or her, including their personality types and features. If those personality matters underlie, intensify or delay recovery from symptoms attributable to a major depressive disorder, they are not, causally or otherwise, relevantly separate. Moreover, there is no support in the expert evidence for allocating some (unspecified) plaintiff’s symptoms to his personality type and others to his mental illness.
To view a more in-depth analysis of this case, including the other matters in question, particularly in relation to the definition of occupation and the insurer’s ability to consider the claimants ability to perform work other than what they were doing exactly before illness or injury, click here.
To view a copy of the Court of Appeal’s decision, click here.
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