Terence Wong, director of T Legal, said the plaintiff in Byrnes-Reeves v QSuper [2025] QSC 285 maintained consistently that his TPD from a spinal injury was brought about by an injury sustained at his first job at a boating business.
In his submissions to the court the plaintiff said he did not blame Qsuper for his diagnosis but said “the harsh conditions undeniably worsened its effects”, claiming that while his “spine was strained beyond repair” his mental health “began to crumble in the shadows”.
“The court’s task was to assess if the insurer was open to making its decision to decline Riley’s TPD claim on the information provided to it based on the wording of the insurance policy,” Wong said.
“The plaintiff’s TPD claim was denied due to his mental health issues being a pre-existing condition prior to commencement of the TPD policy and due to his spinal issues not being a cause of his TPD, at the time his TPD policy expired because his back pain only arose some years later.”
Wong continued that the facts presented to the court stated that in 2009, the plaintiff was diagnosed with Raynaud’s syndrome and had worked various jobs since dropping out of high school on 29 March 2017 at age 18. He left his last job on 8 May 2018 after working there for 7 months.
“The plaintiff’s relevant TPD cover started on 26 October 2017, when he became a member of QSuper, and it expired on 1 October 2019,” Wong said.
“The plaintiff submitted his TPD claim form to QSuper on 10 June 2020 which initially listed his illnesses/injuries as ‘depression, agoraphobia, autism, ADHD, Aspergers, and nervous hypersensitivity’ (collectively, the ‘mental health issues’) and he identified that he first experienced this from 27 July 2017.”
He continued that QSuper requested a medical report on 24 November 2020 and the plaintiff’s claim was first declined on 23 June 2021.
On 10 August 2021 the plaintiff sought a review of the decision referring to spinal-related pain issues that were not initially stated on his TPD claim form, in his review request he stated “my diagnosis was not until 2018”.
“The plaintiff could not provide a good explanation for this omission from his TPD claim form in cross-examination,” Wong said.
“There was a further series of requests for review that were each declined on 12 August 2021, 23 September 2021, 14 October 2021 and 1 November 2022.”
Wong said the court summarised relevant principles for its investigation into whether the insurer was open to make its decisions to deny the plaintiff’s TPD claim including that the insurer must act reasonably and fairly in forming the opinion and the insurer’s opinion is not unreasonable simply because the court would form a different view.
“Additionally, the court said the insurer’s opinion will be invalidated if the process was not undertaken reasonably and fairly and an opinion that is reasonably open on the evidence can still be invalid if the insurer did not engage with the relevant evidence,” he said.
“Finally, it stated that the insurer’s opinion will be invalid if it does not answer the correct question or does not take into account relevant evidence and in deciding whether the insurer’s opinion is defective, the court should not take into account material that was not before the insurer when forming its opinion. As well, where an insurer has reconsidered a claim multiple times, the focus is usually on the last of the decisions.”
In its ruling, Wong said the court agreed with the insurer that the plaintiff’s mental health issues were a pre-existing condition citing among other things a medical report that his anxiety issues started in Year 7 and did not fall within the relevant insurance policy.
It also stated that in relation to the spinal pain-related issues there was a CT scan of the plaintiff’s spine in February 2019, which showed his relevant spinal C6/C7 bulge to be asymptomatic, and the plaintiff agreed that he still did not have any symptoms from the C6/C7 bulge later in September 2020, which was three months after he had submitted his TPD claim form and 11 months after his TPD cover expired.
“The court agreed with the insurer that the plaintiff was not TPD at the time of his claim by reason of his C6/C7 spine injury, which became worse later,” Wong said.
“It was not clear from reading the judgment why the plaintiff’s TPD cover expired on 1 October 2019 and there was no confirmation of if or when the plaintiff rolled his superannuation out from QSuper.”
He added that the QSuper website states that a member can “permanently opt in to cover” to “make sure that you are covered even if your contributions are inconsistent” (or they cease because you stopped working).
“It might have been the case that the plaintiff did not permanently opt in to his TPD cover with QSuper before it expired. If his TPD claim had been made later when his spinal condition had worsened the outcome may have been different,” Wong said.
