A truck driver whose total and permanent disability claim was rejected will have his case reassessed under a complaints ombudsman ruling.

Zurich declined the $36,000 claim under a superannuation-held policy, citing a rehabilitation counsellor’s report in April 2021 stating the man could take on jobs that did not require heavy lifting.

The driver’s medical conditions include systemic mastocytosis that may have caused, at least in part, his severe osteoporosis, the Australian Financial Complaints Authority ruling says.

The man’s treating doctors said he must avoid strenuous work and one, an endocrinologist, said he should not do heavy manual work because his osteoporosis was likely to be semi-permanent, depending on response to treatment.

The claimant rejected the rehabilitation counsellor’s finding that he was suited for other driving jobs such as delivery work, bus driving and trucking without heavy lifting, but did not explain why.

AFCA says the counsellor, identified as Mr H in the ruling, is an expert on work but is not a doctor.

“He cannot give a reliable opinion on whether the complainant’s medical condition will allow him to work as a bus driver, transport allocator or light delivery driver,” the authority says.

The ombudsman says Zurich has not provided Mr H’s report to the claimant’s doctors and sought their opinions on whether he is suited to the work listed.

“Putting the relevant medical questions to the treating doctors is a routine part of claims assessment – taken by all insurers in almost all cases,” AFCA says. “The insurer must ask the treating doctors about the complainant’s fitness for that work and then make a fresh decision on the claim … the insurer has an obligation to properly investigate the claim and to make a decision based on reliable evidence.

“It should not reject a claim based on the opinion of Mr H, who is not a medical expert, on a medical question.”

Click here for the ruling.