Applicant's Submissions
18 The applicant relied on an affidavit by Mr Dean Groundwater, a director of the law firm acting for the applicant, sworn 8 September 2014 (Ex 1) in support of his application.
19 Mr Groundwater relevantly deposed:
5. The application is based upon a number of grounds, namely:
5.1 The respondent has denied liability on the policy counts.
5.2 Adjudication of the policy counts is capable of giving rise to payment of sums certain, plus interest. By contrast the quantum in the two separate controversies in the proceedings, namely breach of the tort of good faith at common law and loss of opportunity damages for the inability to pursue patent applications, are liability and quantum issues which are at large, extensive and complex.
5.3 The preliminary adjudication of the policy counts allows the remaining questions to be litigated, or not, abiding the outcome of the separate questions.
5.4 If the applicant was unsuccessful in the particular questions which are separated there would be no cause of action arising under the tort of good faith or patent claims.
5.5 If the separate question was resolved in favour of the applicant it would open the way for negotiation of the settlement of the whole of the proceedings.
Denial of Liability
6. The applicant's proceedings are based upon a number of policies for personal income protection (IPP), business protection (BEX) and Total and Permanent Disability (TPD). The respondent has admitted the existence of the policies to which it was a party. (Paragraph 1.5 of the [Amended Statement of Claim (ASOC), Paragraph 6 Defence). The terms and conditions of the relevant policies are therefore uncontroversial …
IPP Policy
7. The income protection policy claim (IPP claim) has been particularised … (ASOC paragraph 2.4). The respondent has admitted the substance of the policy terms and conditions subject to construction argument (Defence paragraphs 13 and 14).
8. Definitions of [T]otal [D]isability as relied upon by the applicant (paragraphs 2.6 and 2.7 of the ASOC) are matters to which the respondent has pleaded a non-admission (Defence paragraphs 19 and 20). The applicant is confident that this issue will be resolved in his favour in all the policy claims by the substantial medical evidence which is within discovered documents. Extracts of this medical evidence, in various germane disciplines, as well as the various medical reports referred to in the extract, are exhibited behind TAB 2 of DG-1. There is much material and it follows a consensus of opinion, namely that the applicant has been permanently disabled from medical practice.
9. The respondent has provided discovery on two occasions in relation to this particular question. On my reading of the documents discovered on the first occasion there was no medical evidence to the effect that the definitions were not satisfied, save for some discursive commentary from a Dr Dunn, who appeared to be advising the respondent in the background. On the second discovery, on 12 June 2014, the respondent's solicitor advised:
The documents referred to in the list were overlooked when discovery was initially provided. I am instructed that the documents listed under the heading "Partner Insurance Portfolio Application" were stored under a separate administration system.
10. In the second discovery the respondent discovered the reports of Drs. Westmore (psychiatric), which was generated in Medical Board processes, and Dr Krishnan (Neurologist), which was prepared for Jenny Nicolaidis of the respondent. These opinions do not appear to suggest that the relevant policy definitions are not established. I exhibit hereto behind TAB 3 of DG-1 the report of Dr Krishnan dated 4 July 2012 and would refer specifically to paragraphs 6 and 7.
11. The respondent has denied the relief claimed under the IPP (ASOC paragraph 12.2; Defence paragraph 25).
12. Payments were initially made. On 29 July 2011 Nick Milroy of MunichRe wrote an email to Celina Ennis which said, in part:
Thanks for clarifying that for me. Please proceed with the payment of two months SIB benefit totalling $60,000.00.
13. This related to the IPP policy being two monthly payments of $30,000.00. A copy of this email is exhibited behind TAB 4 of DG-1.
14. The respondent has pleaded positive defences in respect of alleged non-disclosure which will be addressed below, as well as an exclusion clause. The applicant has filed a detailed Reply.
BEX policy
15. The applicant also claims under the practice overheads policy (BEX policy) (ASOC paragraph 2.20). The respondent has agitated construction arguments in respect of this policy (Defence paragraphs 14, 16, 18 and 28).
16. The respondent has denied the applicant's entitled under the BEX policy (Defence paragraph 33). The respondent has pleaded positive defences in respect of alleged non-disclosure which will be addressed below, as well as an exclusion clause. The applicant has filed a detailed Reply.
TPD Policy
17. The applicant also claims upon a TPD policy (ASOC paragraphs 3.3 and 3.4). These are essentially claims for specified benefits for fracture, meningitis and the like. The respondent has raised construction arguments in respect of the TPD policy (Defence paragraphs 37 and 38).
18. The applicant has alleged satisfaction of the definition of [T]otal [D]isability (ASOC paragraph 3.5). The respondent has pleaded non-admission. The matter will be attended by uncontroversial medical opinion.
19. Independently of the litigation the respondent and MunichRe have been engaged on these single benefit issues, and the medical evidence. On 13 July 2011, Nick Milroy, Senior Claims Management Officer of MunichRe, published an email to Celina Ennis which read, in part:
It would appear the IP policy does have an SIB benefit payable for a fractured skull. Clear radiological evidence supports this diagnosis. I am leaning towards admitting this benefit however this will be based upon Dr. Buchanan's response to the above query [regarding Zoloft and Lithocarb]. If he indicates that he has been suffering bipolar then we should reassess our position concerning this payment.
20. On 22 September 2011, Celina Ennis wrote an email to Nick Milroy enclosing copies of the reports of the neurologist, Dr.Graham, which said in part:
Unfortunately I didn't see Peter again after his first visit as he saw Marc Coughlan, the neurosurgeon following an episode of meningitis no doubt related to his CSF leak. And further, obviously we need to be on the look out for meningitis so that if there are any unexplained fevers, stiffness in neck, disorientation then he will require immediate treatment and CSF examination.
The MRI scan referred to within those reports recited a conclusion:
Significant neuro pneumocephalus indicating interruption of the dural lining. In this case this is most likely at the level of the right middle ear cavity. High resolution CT at the base of the skull suggested if not already performed to define the actual fracture.
Dr. John Graham further wrote:
It seems very likely that there has been major damage to the right auditory nerve.
21. The applicant has made a claim for substantial quantified benefits under the TPD policy (ASOC paragraph 3.7). The respondent has denied entitlement to those benefits (Defence paragraph 41).
Positive Defences
22. The respondent has raised positive defences essentially contending a right to avoid each of the IPP, BEX and TPD policies on the basis of non-disclosure and misrepresentation (Defence paragraphs 92 to 103). There is also reliance upon an exclusion clause.
23. The critical written documents alleged to constitute the material acts and admissions of the applicant have been discovered and are uncontroversial. The applicant has sworn an extensive affidavit in relation to the matters which arise. The respondent has caused three affidavits to be sworn, filed and served respecting the decision to underwrite the IPP, BEX and TPD policies made over a period November 2010 to 7 February 2011. The substance of the respondent's affidavit evidence is that the deponents would have declined to issue the three policies had those alleged acts and omissions on the part of the applicant not occurred. The factual controversy and the legal principles which flow there from would involve the reading of the affidavit of the applicant and a short component of the affidavit evidence of the applicant's wife, cross examination; thence the reading of the respondent's affidavits and cross examination of those officers upon the documents which have been discovered to date including relevant guidelines and protocols.
24. The opinion of Counsel is that the trial upon the separate questions would occupy approximately four to five days hearing time incorporating pre-trial directions that a structure/outline of argument be supplied by both parties; relevant authorities provided to the Court and objections to affidavit evidence be circulated inter-parties. I would also anticipate the service of a Notice to Admit Facts and Authenticity of Documents concerning issues pertaining to the relevant definitions of disability under the policy.
Quantification - BEX Policy
25. A complication of the BEX policy is that over its twelve month duration it appears that there are financial adjustment provisions which may affect the monthly entitlement. The starting point is $60,000 per month. To the extent that this controversy exists the applicant would press his plea for a declaration and anticipate further application to the Court for appointment of a referee upon this accounting exercise.
26. There are certain documents which have been produced by MunichRe upon the Court's subpoena which appear to address this matter. One is a document entitled "Accelerated Protection Business Expenses Calculator" under Tower letterhead. This appears to show acceptance of the mathematical outcome of the policy benefits. It is exhibited hereto behind TAB 5 of DG-1. "
Extensive and Complex Evidence as to Quantum and Liability
27. Parts 4, 5 and 6 of the ASOC plead that the respondent laboured under a duty in tort to act in good faith and breached same; was bound by the contractual term implied by section 13 of [the Act] as to conduct by participants to an insurance contract stipulated to be in the utmost good faith and breached same; and that conduct was relevantly unconscionable under the ASIC Act 1989. The damages which are alleged to flow from the relevant conduct are pleaded (ASOC paragraphs 4.5 to 4.30; 5.5 and 6.4) as damages essentially on two bases:
27.1 The relevant conduct caused the failure of the applicant's income vehicle, EDI, thereby depriving him of the opportunity to receive director's payments and distributions over his expected professional life; and
27.2 The relevant conduct deprived the applicant of funding to pursue patent applications which (separately from the lost income of the EDI practice), would have generated substantial financial reward to the applicant.
28. EDI failed in the second half of 2011. The locums walked out. The practice assets were taken on behalf of the major creditor. The applicant ceased lawful medical practice on 7 March 2012 after consideration of his disability and his situation by the Medical Council of NSW.
29. The evidence upon the quantum of these two separate claims, so framed, is anticipated to be very extensive and complex. The applicant has engaged with a specialist forensic accountant and a specialist patent expert in order to advance the quantification of these claims. If the applicant does not succeed upon the proposed separate questions upon policy entitlements it will follow that damages as sought in these separate claims would not arise.
30. The applicant has been in funding difficulties in co-ordinating and paying for expert opinion on these two issues. The complexity of the tort of breach of the duty of good faith is anticipated to arise from the fact that this is a developing area of law and hence compensatory damages would likewise be complex, including issues as to punitive damages. The complexity of the loss of the ability to pursue a patent in this country and in the USA is necessarily complex, as involving loss of opportunity damages.