BACKGROUND
7 On 6 November 1999, Mr Woodward became a member of the superannuation fund of which the first appellant is trustee while employed by NESS Security Products Pty Ltd. He also thereby became covered by a Group Life Insurance Policy No K003779 issued by the insurer.
8 On 9 April 2001, Mr Woodward commenced employment with Rexel Australia Pty Ltd (Rexel). Rexel continued to make superannuation payments to the trustee on his behalf. The last contribution paid was for the period ending 30 August 2002, with the consequence that Mr Woodward's TPD insurance cover expired on 28 February 2003.
9 On 19 April 2002, Mr Woodward was involved in an accident while riding his motor cycle home from work. As a result of the accident, he claimed to have suffered injuries to his ankles, right knee and lower back. He continued to work at Rexel with the aid of painkillers and anti-inflammatory medication until he resigned on 2 August 2002, citing "back pain, ankle pain, nightmares and 'an extreme amount of pressure from management'": Woodward [2008] FCA 706 at [9].
10 In October 2002, allegedly on the advice of his general practitioner, Mr Woodward commenced employment at Mayne Armaguard. He said that the job involved very light duties and no stress. He nevertheless resigned in November 2002 as his pain was too intense, despite the use of painkillers and muscle relaxants.
11 From 13 January 2003 Mr Woodward was in receipt of a Commonwealth Disability Support Pension administered by Centrelink. In August 2003 the Commonwealth Rehabilitation Service arranged for him to work as a concreter with Northside Mini Mix. He claims he took up this placement as a result of pressure exerted by Centrelink. He resigned on 30 June 2004 and has not worked since that date.
12 The insurer received Mr Woodward's claim for TPD against the trustee, which was then known as the STA Superannuation Fund, on 29 July 2003. He claimed to have been incapacitated from 2 August 2002, which was the date he resigned from Rexel. At the time the claim was received, the trust deed defined TPD as follows:
(73) "Total and Permanent Disablement" means disablement of a Member resulting from an illness, accident or injury to the Member which commenced or occurred whilst the Member was employed and whilst a Member as a result of which -
(a) the Member has been precluded for a period of six consecutive months after the date of occurrence of such event from following any occupation for which the Member is reasonably suited by education training or experience; and
(b) the Member will, in the opinion of the Trustee after consideration of medical evidence satisfactory to it, continue to be so disabled to such an extent as to render the Member unlikely ever again to resume work in or attend to any such occupation;
and "totally and permanently disabled" shall have a corresponding meaning PROVIDED THAT where at any time all or part of the Benefit payable in the event of Total and Permanent Disablement is insured with an insurance company, the term "Total and Permanent Disablement" shall bear the meaning ascribed to it in the relevant Policy in lieu of the above definition unless the Trustee in its absolute discretion otherwise determines; …
13 This clause has been amended from time to time following the initial settlement of the superannuation fund: by a Deed of Variation dated 29 May 2001, effective 1 April 2001; by a Deed of Variation dated 27 June 2002, effective 27 June 2002; and by a Deed of Variation dated 19 December 2002, effective 26 February 2003 (Woodward [2008] FCA 706 at [81]). The learned primary judge (at [81]) did not regard the amendment, effective on 26 February 2003 as relevant. Nor do we. Evidently though, his Honour considered that the Tribunal ought to have looked to a yet later, 2005 version, of the trust deed. Quite how the definition of TPD in any such later version of the trust deed differed, if at all, from that in effect at 2 August 2002 is not apparent in the material concerning the wording of the trust deed from time to time which was before the learned primary judge. Be this as it may, it was the conception that the wrong version of the trust deed had been looked to which occasioned the quashing of the Tribunal's decision.
14 The definition extracted at [12] incorporated by reference the definition of TPD in the insurance policy. There was no suggestion by either party that this definition was materially other than in the form of the insurance policy in evidence before the Tribunal and reproduced in the appeal book. The insurance policy defined TPD as:
disablement where we are satisfied on medical or other evidence that an insured member:
(a) has been absent from employment for 6 consecutive months because of sickness or injury; and
(b) (i) is so incapacitated because of the sickness or injury that the person is prevented from ever engaging in is or her own occupation or any occupation for which he or she is reasonably suited by education, training or experience; or
(ii) has suffered the total and permanent loss of the use of:
· 2 hands; or
· 2 feet; or
· 1 hand and 1 foot; or
· the sight in both eyes; or
· 1 hand and the sight in 1 eye; or
· 1 foot and the sight in 1 eye,
where "hand" means whole hand below the wrist and "foot" means the whole foot below the ankle.
15 On 18 August 2005 the insurer rejected the claim and, after conducting an internal review, affirmed the decision on 27 September 2005. The reason given was that Mr Woodward had earned an income and demonstrated work capacity after the date from which he claimed to be totally and permanently disabled (ie 2 August 2002) and therefore did not meet the definition of TPD in the trust deed [AB 195].
16 On 3 November 2005 the trustee also rejected the claim and, upon review, affirmed the decision on 16 December 2005. The reason given was that Mr Woodward had worked after his insurance cover had ceased on 23 February 2003 and therefore did not meet the definition of TPD in the insurance policy [AB 198].
17 On 28 April 2006 Mr Woodward lodged a complaint with the Tribunal claiming that the decision of the trustee was unfair or unreasonable: see s 14 of the Act. Pursuant to s 18(1), both the trustee and insurer were named as parties.
18 When a complaint is made to the Tribunal under s 14 of the Act, the Tribunal has all the powers, obligations and discretions that are conferred on the trustee: s 37(1). Where an insurer has been joined as a party to a complaint, the Tribunal must, when reviewing the trustee's decision, also review any decision of the insurer that is relevant to the complaint and, for that purpose, has all the powers, obligations and discretions that are conferred on the insurer: s 37(2).
19 Upon reviewing the decision of the trustee or insurer, the Tribunal may affirm the decision; remit the matter to the trustee or insurer for reconsideration in accordance with the directions of the Tribunal; vary the decision; or set aside the decision and substitute another: s 37(3) of the Act. The Tribunal must affirm a decision of the trustee or insurer if it is satisfied that the decision, in its operation in relation to the complainant, was fair and reasonable in the circumstances: s 37(6).
20 The Tribunal conducted the review on the papers and, pursuant to s 32 of the Act, requested submissions from the parties. Submissions were received from the trustee and Mr Woodward. The Tribunal found that there was "little medical evidence to support the [insured's] decision to cease work due to his back condition in late 2002". It found that Mr Woodward had "resigned from his position in August 2002 for his own reasons". It found that, due to his age and the sedentary nature of his work, there was a good "possibility that he could return to some form of employment for which he is suited by education, training or experience at some time in the next 30 years" [AB 11]. The Tribunal found the decisions of the trustee and insurer to have been fair and reasonable and affirmed the decisions pursuant to s 37(6) of the Act.
21 Importantly, for the purposes of the present appeal, the Tribunal found that "the version of the superannuation fund's trust deed that is relevant in this matter is that which was in effect on the date when the [insured] ceased employment with [Rexel] (ie 2 August 2002), being the trust deed as amended to 27 June 2002". It is with respect to this finding that the primary judge found the Tribunal to have erred.
22 For the purposes of the disposition of the cross-appeal, it is also necessary to say something about another, separate TPD claim Mr Woodward made against the ANZ Super Advantage Superannuation Fund (ANZ) in 2003.
23 On 9 February 1999 Mr Woodward joined ANZ whilst employed by Bradflo Pty Ltd. He was covered by ANZ's insurance policy for TPD and death. His last insurance premium was deducted from his account on 9 September 2003 and he withdrew all of his superannuation on 26 September 2003 due to financial hardship.
24 On 6 August 2003 Mr Woodward lodged a claim for TPD against ANZ which was rejected by Tower Australia Ltd (Tower), the insurer to ANZ, on 29 August 2005 and by ANZ on 26 September 2005. ANZ and Tower both rejected the claim on the basis that Mr Woodward had continued to work until 30 June 2004 (when he resigned from Northside Mini Mix). Any entitlement to a TPD benefit could only have arisen on or from that date, by which time Mr Woodward's cover had lapsed.
25 Mr Woodward sought review of the decisions of ANZ and Tower before the Tribunal. The Tribunal held that ANZ and Tower did not have the necessary evidence to conclude that Mr Woodward did not meet the definition of TPD, as neither had sufficiently clarified the facts surrounding his accident or obtained appropriate specialist medical reports ("the ANZ decision"). The Tribunal found that the decisions operated unfairly and unreasonably in relation to Mr Woodward and remitted the matter to ANZ and Tower with directions that they obtain further evidence. It is with this latter Tribunal decision that Mr Woodward contends the decision of the Tribunal under appeal is inconsistent.