Hall Payne Helps Police Officer with PTSD

Hall Payne recently obtained a favourable Determination from the Financial Ombudsman Service (FOS) for a former Police Officer diagnosed with Post Traumatic Stress Disorder (PTSD).

Our client made a claim for Total and Permanent Disablement Benefits (TPD) after being diagnosed with PTSD in 2010. The PTSD diagnosis caused him to resign from his employment as a Police Officer in March 2010, but to his credit, he then obtained a job in a warehouse in June 2010, initially through a labour hire company, but then permanently.

It was not until August 2011 that our client resigned from his warehouse position. His resignation coincided with being convicted of a criminal offence, and a period of incarceration.

The Financial Service Provider (FSP) with whom our client was insured declined his claim on the basis that his TPD illness was not the reason he was absent from work, but rather it was his incarceration that caused him to be unable to continue working. Because of this, the FSP decided he did not qualify, under the terms of the policy, for payment of his TPD benefit.

In addition, the FSP argued that he should be denied a TPD benefit on public policy grounds because of his criminal conviction.

The FSP continued to decline the claim through all its internal dispute resolution procedures. Hall Payne then applied to the Financial Ombudsman Service for determination of the dispute. The argument advanced by Hall Payne was that, although our client’s resignation was brought about by his conviction, he was otherwise unfit to work due to his PTSD condition, and would have been obliged to cease his employment on that basis notwithstanding his incarceration.

There was strong medical support for the fact that our client was attempting to maintain employment to his significant detriment and against medical advice, and would not have been able to maintain his position in the warehouse. Indeed, the evidence was that his condition was deteriorating as time passed.

The Financial Ombudsman Service agreed and made a Determination in favour of our client. It also determined that the benefit could not be withheld from a claimant merely because they happened to have a criminal conviction, because his injury arose for reasons unrelated to his criminal offences.

The FSP continued to decline the claim through all its internal dispute resolution procedures.  Hall Payne then applied to the Financial Ombudsman Service for determination of the dispute.  The argument advanced by Hall Payne was that, although our client’s resignation was brought about by his conviction, he was otherwise unfit to work due to his PTSD condition, and would have been obliged to cease his employment on that basis notwithstanding his incarceration.

There was strong medical support for the fact that our client was attempting to maintain employment to his significant detriment and against medical advice, and would not have been able to maintain his position in the warehouse.  Indeed, the evidence was that his condition was deteriorating as time passed.

The Financial Ombudsman Service agreed and made a Determination in favour of our client.  It also determined that the benefit could not be withheld from a claimant merely because they happened to have a criminal conviction, because his injury arose for reasons unrelated to his criminal offences.