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[2015] VCAT 1936
Victorian Civil and Administrative Tribunal
2015-12-18
Original judgment source is linked above.
Equal Opportunity Act 2010 (Vic), sections 4, 8, 44 and 47 - Disability Discrimination Act 1992 (Cth), sections 11, 29A and 46 - claim of direct discrimination in respect of the provision of services based on the inclusion of a mental illness exclusion in a travel insurance policy - claim of direct discrimination in respect of the provision of services when indemnity denied in reliance on a mental illness exclusion in a travel policy - meaning of - whether exception relating to actuarial or statistical data applies - whether defence of unjustifiable hardship applies - whether a declaration under of the (Vic) ought to be made - assessment of non-economic loss - application for costs.
Ingram v QBE Insurance (Australia) Ltd (Human Rights) [2015] VCAT 1936
Ms C Harris of counsel, instructed by Victoria Legal Aid
Mr A Naylor of counsel, instructed by Gilchrist Connell
(1) Direct discrimination occurs if a person treats, or proposes to treat, a person with an attribute unfavourably because of that attribute.
(2) In determining whether a person directly discriminates it is irrelevant -
(a) whether or not that person is aware of the discrimination or considers the treatment to be unfavourable;
(b) whether or not the attribute is the only or dominant reason for the treatment, provided that it is a substantial reason.
(1) A person must not discriminate against another person -
(a) by refusing to provide goods or services to the other person; or
(b) in the terms on which goods or services are provided to the other person; or
(c) by subjecting the other person to any other detriment in connection with the provision of goods or services to him or her.
(2) Subsection (1) applies whether or not the goods or services are provided for payment.
suffers any mental illness including dementia, depression, anxiety, panic attack, stress, bipolar, mania, schizophrenia or other nervous disorder[12]
(b) the presence in the body of organisms that may cause disease; or
(c) total or partial loss of a part of the body; or
(ii) a condition or disorder that results in a person learning more slowly than people who do not have that condition or disorder; or
(e) malformation or disfigurement of a part of the body -
and includes a disability that may exist in the future (including because of a genetic predisposition to that disability) and, to avoid doubt, behaviour that is a symptom or manifestation of a disability (my emphasis).
. . . also includes a disability which presently exists, that existed in the past and one that may exist in the future. This is designed to include persons whose disability is not yet apparent but which may occur at some time in the future.
The broad definition helps avoid genuine complaints of discrimination falling at the first hurdle - determining whether or not the person concerned is covered by the DDA. This helps focus attention on the discriminatory action rather than the person concerned.[21]
Section 47 exceptions
An insurer may discriminate against another person by refusing to provide an insurance policy to the other person, or in the terms on which an insurance policy is provided, if -
(ii) the Disability Discrimination Act 1992 of the Commonwealth; or
(i) is based on actuarial or statistical data on which it is reasonable for the insurer to rely; and
(ii) is reasonable having regard to that data and any other relevant factors . . .
This Part does not render it unlawful for a person to discriminate against another person, on the ground of the other person's disability, in respect of the terms or conditions on which:
(c) a policy of insurance against accident or any other policy of insurance;
is offered to, or may be obtained by, the other person, if:
(i) is based upon actuarial or statistical data on which it is reasonable for the first-mentioned person to rely; and
(ii) is reasonable having regard to the matter of the data and other relevant factors . . .
An insurer may discriminate against another person by refusing to provide an insurance policy to the other person, or in the terms on which an insurance policy is provided, if . . .
Our client denied cover on the basis of a mental health exclusion clause in the policy. The claimant subsequently made a claim under the [EOA] on the basis that the imposition of the exclusion was discriminatory and a breach of the statute.
Our client's primary defence is that declining cover was not discriminatory as there is actuarial or statistical data or other material that supports the declinature as being reasonable in the circumstances, or that it was reasonable to underwrite the risk conditionally.[82]
Consideration of the pre-existing condition exclusion
I am not satisfied that it is more probable than not that the data produced demonstrates that, as at December 2011 to December 2012, QBE would have suffered a loss if it could not have relied on the mental illness exclusion in respect of Ms Ingram or any other insured's claim.
. . . in this context, and the reason is that a pre-existing medical condition for mental illness, while it exists in the current policy, it is never triggered, so if you were to move to a situation where the blanket claims exclusion for mental illnesses on anxiety and affective disorders was removed, you would need to revisit the existing pre-existing medical condition as it relates to those pair - or that pair of mental illness forms
Right? Right. In order to underwrite a travel insurance policy, many of which are purchased at the click of a mouse on the Qantas site, if you were to underwrite that with a statement about pre-existing medical condition relating to substance abuse, with such a high prevalence for substance - for mental illness, there's such a high prevalence for mental illness, you would need to do some significant underwriting associated with that. It's true that many people who are suffering a mental illness are not aware of it. They don't acknowledge it. They don't get it treated.[109]
Financial impact on QBE's business and alternatives
(a) the nature of the benefit or detriment likely to accrue to, or to be suffered by, any person concerned;
(b) the effect of the disability of any person concerned;
(c) the financial circumstances, and the estimated amount of expenditure required to be made, by the first person;
(d) the availability of financial and other assistance to the first person;
(e) any relevant action plans given to the Commission under section 64.
Example: One of the circumstances covered by paragraph (1)(a) is the nature of the benefit or detriment likely to accrue to, or to be suffered by, the community.
The nature of the benefit or detriment likely to accrue to or be suffered by any person concerned
Financial circumstances and estimated amount of expenditure
The tribunal's powers to make findings and declarations
(1) Subject to this Division, each party is to bear their own costs in the proceeding.
(2) At any time, the Tribunal may order that a party pay all or a specified part of the costs of another party in a proceeding.
(3) The Tribunal may make an order under subsection (2) only if satisfied that it is fair to do so, having regard to -
(a) whether a party has conducted the proceeding in a way that unnecessarily disadvantaged another party to the proceeding by conduct such as -
(i) failing to comply with an order or direction of the Tribunal without reasonable excuse;
(ii) failing to comply with this Act, the regulations, the rules or an enabling enactment;
(iii) asking for an adjournment as a result of (i) or (ii);
(v) attempting to deceive another party or the Tribunal;
(b) whether a party has been responsible for prolonging unreasonably the time taken to complete the proceeding;
(c) the relative strengths of the claims made by each of the parties, including whether a party has made a claim that has no tenable basis in fact or law;
(e) any other matter the Tribunal considers relevant.
Ms Ingram's applications for costs[148]
[1] Particulars of defence dated 18 September 2014, paragraph 22.
[2] See section 6 of the EOA which sets out the attributes protected by the Act.
[3] Aitken & Ors v State of Victoria - Department of Education & Early Childhood Development [2012] VCAT 1547.
[4] Closing written submissions dated 20 November 2015, paragraph 98.
[5] Closing written submissions, paragraph 96.
[6] Section 13 of the EOA has the effect that discrimination is not prohibited if an exception applies to the conduct.
[7] Exhibit MD-1 to the affidavit of Mr De Luca National Manager - Sales, Distribution and Strategy with QBE (Exhibit R1).
[8] Evidence of Mr M De Luca, transcript, day 1, page 80.
[9] Policy, page 31. A claim may also be made if a business partner or employee made the cancellation necessary but that aspect of the clause is not relevant here. The term 'confinement' is not defined in the policy and was not the subject of submissions. I proceed on the basis that it does not extend to compulsory treatment of the kind regulated under the Mental Health Act 2014 (Vic) or its predecessors and so inpatient treatment for mental illness is captured by the term 'hospitalisation'.
[14] Policy page 28 and definitions pages 24 to 25.
[16] Particulars of complaint dated 28 August 2014, paragraph 20.
[17] Particulars of complaint dated 28 August 2014, paragraph 22.
[18] J Gardner, An Equality Act for a Fairer Victoria: Equal Opportunity Review Final Report, June 2008.
[20] Closing written submissions, paragraphs 19 and 20.
[23] Closing written submissions, paragraphs 68 to 70 and paragraphs 92 to 95.
[25] Reply submissions, paragraphs 10 to 14 - Slaveski v Smith [2012] VSCA 25 at paragraphs 24 and 45; Nigro v Secretary to the Department of Justice [2013] VSCA 213 at paragraph 85; and Victorian Toll & Anor v Taha [2013] VSCA 37 at paragraph 190. See also Momcilovic v The Queen [2011] HCA 34; Bare v Small [2013] VSC 129; and Kuyken v Chief Commissioner of Police [2015] VSC 204 at paragraph 78.
[26] See Project Blue Sky v ABA [1998] HCA 28; and Cooper Brookes (Wollongong) Pty Ltd v Federal Commissioner of Taxation [1981] HCA 26 per Gibbs CJ at paragraph 6.
[27] Closing written submissions, paragraph 33.
[28] Closing written submissions, paragraphs 21 to 36.
[30] [2001] FMC 15 at paragraph 15.
[31] Closing written submissions, paragraphs 96 to 100.
[33] Closing written submissions, paragraphs 88 to 90.
[34] Reply submissions, paragraphs 3 to 5.
[36] Closing written submissions, paragraphs 46 to 56.
[37] Reply submissions, paragraphs 8 to 15.
[39] See QBE Travel Insurance v Bassanelli [2004] FCA 396.
[40] Bassanelli at paragraphs 31 and 79.
[41] Closing written submissions, paragraph 112.
[44] During the hearing and in the written submissions there was argument about whether QBE was confined to the above statistics or could rely on all of the material contained in the documents annexed to Mr De Luca's affidavit. Given my findings, it has not been necessary to determine this question finally.
[45] [1982] HCA 70 - closing written submissions, paragraph 107.
[49] Transcript, day 1, pages 64, 74, 85 and 108 to 109. Also see Associate Professor Pitt's evidence regarding reliance on the blanket exclusion at transcript, day 3, page 20.
[50] Closing written submissions, paragraph 82 relying on Jones v Dunkel (1959) HCA 8.
[52] Closing written submissions, paragraph 116.
[53] Orders for expert evidence were made in the proceeding on 2 February 2015, 24 April 2015, 27 July 2015 and 26 August 2015. On each of the last three occasions, orders for costs thrown away were made against QBE.
[54] Closing written submissions, paragraphs 114 to 115.
[56] This summary is based on the parties closing written submissions which describe the case law on section 29A.
[57] Closing written submissions, paragraph 85.
[58] Closing written submissions, paragraphs 119 to 127.
[63] King v Jetstar Airways Pty Limited [2012] FCAFC 115, at paragraph 29.
[64] Reply submissions, paragraphs 16 to 34.
[65] Closing written submissions, paragraph 132.
[67] This material is taken from Exhibit R4.
[71] Closing written submissions, paragraph 117.
[72] Letter from Dr Kyng dated 26 November 2015 and letter from Ms Ingram's solicitors dated 27 November 2015.
[73] As I understand that QBE has no data for mental illness based cancellation claims, the monetary amounts used were based on the quantum of physical medical cancellation claims.
[74] Mr Dong - transcript, day 2, page 94 to 95; and Associate Professor Pitt - transcript, day 3, page 8.
[75] Transcript, day 2, pages 95 to 97.
[77] Transcript, day 2, page 76. I note that in the closing written submissions that ratio was stated as being 95% but that appears to be an error.
[80] Introductory section of report under heading 'Instructions'.
[85] Transcript, day 3, pages 27 to 28.
[89] For example, the evidence about other insurance policies was of little assistance. While some insurers had a similar exclusion, others did not. There was no evidence before me as to why the various insurers took different approaches or as to the premiums payable or the comparative benefits or terms of each. Many of the policies post-dated the relevant events. In these circumstances, I have not considered those policies further.
[90] Transcript, day 3, pages 67 to 69.
[91] Transcript, day 3, page 103 to 104.
[92] Closing written submissions, paragraph 111 to 113.
[99] Closing written submissions, paragraphs 114 to 115, referring in part to Associate Professor Pitt's evidence at transcript, day 3, pages 22 to 24.
[100] Closing written submissions, paragraphs 105 to 107.
[101] Closing written submissions, paragraph 136(d).
[102] Transcript, day 3, page 77 to 78.
[103] Transcript, day 3, pages 38 to 39.
[104] Transcript, day 2, pages 24 to 25.
[105] Closing written submissions, paragraphs 98 and 110 to 114.
[106] Closing written submissions, paragraph 136(b).
[107] Reply submissions, paragraphs 58 to 59.
[109] Transcript, day 3, pages 20 to 21.
[110] Pages 5 to 6 regarding pre-existing conditions and page 8 regarding the insured's duty of disclosure.
[112] Transcript, day 1, pages 97 to 98, 108 to 109
[113] Closing written submissions paragraphs 140 to 146.
[114] Reply submissions, paragraphs 37 to 51.
[116] Closing written submissions, paragraphs 131(b).
[117] Closing written submissions, paragraph 131(f) and 132(b).
[118] Final paragraph of the Pitt/Kyng report.
[119] Closing written submissions, paragraph 121 to 122.
[120] Closing submissions, paragraph 131(b), (e) and (f).
[121] Closing submissions, paragraph 131(d) and (f).
[122] Closing written submissions, paragraph 131(c).
[123] Francey v Hilton Hotels of Australia Pty Ltd [1997] HREOCA 56.
[125] Closing written submissions, paragraph 132.
[129] Sections 97 and 98 of the VCAT Act.
[130] Ainsworth v Criminal Justice Commission [1992] HCA 10.
[131] Closing written submissions, paragraph 132.
[132] Closing written submissions, paragraphs 156 to 170.
[133] Closing written submissions, paragraph 169(c).
[134] Per Bell J in Kracke v Mental Health Review Board [2009] VCAT 646 at paragraph 820.
[135] Per Hollingworth J in Alinta Asset Management v Essential Services Commission [2007] VSC 353 at paragraph 13.
[136] Dated 23 March 2015, paragraphs 23 to 24, 29 to 30 (Exhibit A1) and transcript pages 51 to 52 (cross-examination) and pages 52 to 53 (re-examination).
[137] Witness statement dated 23 March 2015, paragraph 19 (Exhibit A2) and transcript, page 59.
[138] Transcript, pages 51 to 52; Closing written submissions, paragraphs 172 to 175.
[139] I note that arguably QBE incorrectly distinguished the tribunal's decision in Bevilacqua v Telco Business Solutions (Watergardens) PL No 2 [2015] VCAT 693 - see paragraph 50 of the decision and paragraph 59 of the reply submissions.
[142] Reply submissions, paragraph 65.
[144] GLS v PLP [2013] VCAT 221 at paragraph 275, per Garde P referring to I & L Securities Pty Ltd v HTW Valuers (Brisbane) Pty Ltd [2002] HCA 41 per Gaudron, Gummow and Hayne JJ at paragraphs 56 to 57.
[145] Richardson v Oracle [2014] FCAFC 82, per Kenny J at paragraphs 95 to 97, including reference to the Victorian Court of Appeal's decision in Amaca Pty Ltd v King [2011] VSCA 447, an asbestos related negligence case.
[146] Tan v Xenos (No 3) [2008] VCAT 584 at paragraph 556.
[147] Closing written submissions, paragraph 147 referring to DP McKenzie's decision in Styles v Murray Meats Pty Ltd [2005] VCAT 914 at paragraph 100.
[148] Reply submissions, paragraphs 68 to 80.
[149] Closing written submissions, paragraphs 192 to 193.
[150] Transcript, day 2, pages 46 to 47.
Ingram
QBE Insurance