Grounds 1 and 2(d): Misconstruction of cl 4.4 of the Insurance Terms
30 Ground 1 of the Further Amended Notice of Appeal pleads:
If on the proper construction of clause 4.4, the Tribunal had no discretion to refuse or pay interest, then interest accrued on the Benefit becoming payable on 1 April 2010 the Tribunal having so found at Reasons [49].
31 This ground is at odds with the applicant's submissions, which accept that the Trustee had a discretion to pay or refuse to pay interest, and that the Tribunal was required to stand in the Trustee's shoes to determine whether the decision was fair and reasonable. It is therefore unnecessary to consider this ground further, except to say that its intention may be to raise the issue of construction of cl 4.4 of the Insurance Terms that is raised more precisely by Ground 2(d). That ground contends that, if the Tribunal had a discretion to refuse or pay interest then the Tribunal erred by:
…incorrectly construing the Trust Deed by failing to have regard to the proper construction of the words in clause 4.4 "shall become payable".
32 The applicant's argument is that the Tribunal failed to construe the words "shall become payable" in cl 4.4 of the Insurance Terms such that he was entitled to payment of the TPD benefit on 1 April 2010, when his psychiatric illness commenced, or 3 December 2010, when he ceased to be at work due to his psychiatric illness. The applicant submits that the Tribunal accepted the applicant was totally and permanently disabled when he resigned from the Queensland Police Service on 3 December 2010. He acknowledges that the Tribunal had a discretion pursuant to cl 13 of the QSuper Deed to pay interest, but argues that, as the TPD benefit became "payable" on 1 April 2010 or 3 December 2010, interest was, prima facie, payable from then. The submission continues that the Tribunal erred by failing to consider the exercise of the discretion in accordance with that prima facie position.
33 The Trustee submits that the applicant's argument focuses too narrowly upon the words "shall become payable" in cl 4.4 of the Insurance Terms and fails to construe the clause in light of cl 9.1 and the definition of "total and permanent disablement" in cl 4 of the QSuper Deed. The Trustee submits that an insured member is only entitled to payment when the Trustee is satisfied on the proof available to it that the member has suffered total and permanent disablement. The Trustee determined that it first had sufficient proof when it received Dr Nielsen's report on 16 September 2013, and paid interest from that date. The Trustee submits that there was no misconstruction of cl 4.4 of the Insurance Terms by the Tribunal.
34 The applicant's argument depends upon the proposition that an injured member is entitled to payment of the TPD benefit when, within cl 4.4 of the Insurance Terms, the sickness or injury commenced or occurred or the member ceased to be at work due to the sickness or injury, whichever is later. Such a construction was rejected by Reeves J in Aslami v Board of Trustees of the State Public Sector Superannuation Scheme as Trustee for the QSuper Fund [2019] FCA 1560, where his Honour considered a later version of cl 4.4 of the Insurance Terms. The two sentences of cl 4.4 were, by then, separated into two paragraphs, but the clause was not otherwise materially different. His Honour held:
38 The first paragraph of cl 4.4 fixes when it is that a member becomes entitled to be paid a death or TPD benefit. That is "upon" that member's death or TPD. The question whether such a TPD exists is, in turn, determined by the Trustee forming an opinion in accordance with the definition of the expression "total and permanent disablement" in cl 4. That definition requires the Trustee to form its opinion:
(a) only after obtaining advice; and
(b) obtaining that advice from not fewer than two medical practitioners; and
(c) obtaining it by reference to the question whether "the member [is] unlikely ever to be able to work again in a job for which the member is reasonably qualified by education, training or experience".
39 Furthermore, (c) above requires the Trustee to have regard to whether:
(a) the member is unlikely ever to be able to work again;
(b) in a job; and
(c) for which the member is reasonably qualified by education, training or experience.
40 The second paragraph of cl 4.4, however, deals with an entirely different issue. That is, the date from which a member's entitlement to a TPD benefit is to be calculated. That date is also determined by the Trustee but, in this instance, it is dictated ("shall be considered") by the provisions of subparagraphs (a) and (b). Those subparagraphs, it is important to note, do not focus on the member's TPD itself, but rather on the sickness or injury that caused that disablement. Accordingly, they require the Trustee to calculate the TPD benefit by reference to the latter of the following events:
(a) when the sickness that caused the disablement commenced; or
(b) when the injury that caused the disablement occurred; or
(c) when the member ceased work due to the sickness or injury that caused the disablement.
41 The timing of the formation of the opinion under the first paragraph will depend on numerous factors. First, and most obviously, it will depend upon when the member concerned makes his or her claim for a TPD benefit. Among other things, that step will likely be affected by variations in the degree and extent of the disablement concerned. Further, once such a claim is made, it will obviously take some time for the Trustee to obtain the advices of the two medical practitioners and, having obtained those advices, to form its opinion. In that process, particularly where a fluctuating condition is involved, the Trustee may also be justified in waiting to ascertain when or whether the resultant disablement becomes total or permanent. Accordingly, the Trustee's opinion about whether a member has a TPD is likely to be formed many months, if not years, after the disablement concerned first becomes apparent...
42 Because the entitlement to a TPD benefit is dependent on the Trustee forming its opinion under the first paragraph of cl 4.4, the second paragraph is not likely to come into operation until such a TPD is determined, by that opinion, to exist...However, once that opinion is formed, the potential for further delay is likely to be limited. That is so because the date from which the TPD benefit becomes payable under that paragraph is almost entirely fixed by subparagraphs (a) and (b). I say "almost entirely fixed" because it is conceivable that there may be some delay in the ascertainment of the causative effects of the sickness or injury concerned. Nonetheless, that issue will depend on past events, namely the onset of the sickness, or the occurrence of the injury, and is therefore unlikely to be affected by the sorts of delays mentioned above associated with the formation of the Trustee's opinion.
43 So, in summary, the first paragraph of cl 4.4 is directed to whether or not a TPD exists and that issue is determined by the Trustee forming an opinion in accordance with the criteria contained in the definition of the expression "total and permanent disablement" in cl 4. In contrast, the second paragraph of cl 4.4 is directed to the sickness or injury that caused the disablement concerned and fixing a date associated with the causative effect of that sickness or injury from which a TPD benefit is to be calculated. The timing of the former is not fixed by cl 4.4 and will depend, among other things, on the nature and stability of the disablement concerned. However, the timing of the latter, whilst affected by the former, is, to a large extent, fixed by the second paragraph of cl 4.4, particularly subparagraphs (a) and (b) thereof and unlikely to be associated with any significant delay.
44 For present purposes, two things follow from these conclusions about of the provisions of cl 4.4. First, the second paragraph of that clause does not fix the date upon which a member's TPD is determined to exist, but rather it concerns the date from which that member is entitled to be paid the TPD benefit once that state of affairs is so determined. It follows that the date of assessment of a member's education, training or experience for the purposes of the definition of the expression "total and permanent disablement" is not fixed by the dates or events in that second paragraph. Secondly, and relatedly, the date on which Mr Aslami "ceased to be at work" under subparagraph (b) of the second paragraph and the date he began to suffer from his sickness under subparagraph (a) therefore have no relevant bearing on the assessment of his education, training or experience for the purposes of the definition of the expression "total and permanent disablement" in cl 4 of the Trust Deed.
(Emphasis in original)
35 I respectfully agree with his Honour's analysis. The first sentence of cl 4.4 of the Insurance Terms (set out above at [26]) is directed to when it is that a member becomes entitled to be paid a TPD benefit. The entitlement does not arise until the member satisfies the definition of "total and permanent disablement" in cl 4 of the QSuper Deed. That cannot occur until, having obtained the opinions of at least two medical practitioners, the Trustee forms the opinion that the degree of disablement is such as to render the member unlikely ever to be able to work again in a job for which the member is reasonably qualified by education, training or experience. The second sentence of cl 4.4, which is expressed to operate "for the purposes of calculating a benefit", deals with a different issue, namely the date at which the benefit is to be calculated.
36 This analysis is supported by reference to cl 9.1 of the Insurance Terms. Clause 9.1 provides that the obligation to pay an amount to the insured member arises, "[u]pon receipt by the board of proof satisfactory to it that any insured member has…suffered total and permanent disablement while an insured member and of the age of such insured member". Until such satisfaction is attained, the Trustee has no obligation to pay a TPD benefit.
37 Further, under cl 9.1, the Trustee must, "pay the amount of insurance cover in accordance with clause 4 [of the Insurance Terms] at the date of…total and permanent disablement of the insured member". The amount of insurance cover to be paid is determined at the date determined in accordance with the second sentence of cl 4.4. The amount of TPD benefit diminishes with the increasing age of the member (the reason why, under cl 9.1, the Trustee must have proof of the age of the member). It may take some substantial time before the steps outlined by Reeves J at [38] and [39] of Aslami can be completed and the Trustee's satisfaction is attained. The effect of cl 9.1 and the second sentence of cl 4.4 is to preserve the amount of the benefit at the identified date. As an illustration of the operation of these provisions, the amount of the TPD benefit paid to the applicant was $1,771,200, being the amount applicable at 1 April 2010; whereas the amount applicable at the date of approval of the TPD application on 24 October 2013 would have been $1,336,500. In summary, the date identified under the second sentence of cl 4.4 of the Insurance Terms is not the date when the TPD benefit becomes payable to the member.
38 The applicant's submission is that cl 4.4 of the Insurance Terms should be construed such that he was entitled to be paid the TPD benefit on 1 April 2010, when his psychiatric illness commenced, or 3 December 2010, when he ceased work due to his psychiatric illness, so that the prima facie position is that he should be paid interest from then. However, the applicant's entitlement to be paid did not arise until 24 October 2013, when the Trustee was satisfied that the applicant had suffered total and permanent disablement. The Trustee's decision to pay interest from 16 September 2013, when it received Dr Neilsen's report, was presumably made so the applicant would not be disadvantaged by the delay between the receipt of the report and the making of the decision.
39 There was no misconstruction of cl 4.4 of the Insurance Terms by the Trustee, or by the Tribunal when affirming the Trustee's decision. Accordingly, Ground 2(d) of the Further Amended Notice of Appeal must be rejected.