The pain just goes on
Disability insurance refusal goes to court
AN insurance company is refusing to pay out a disability claim to a Gold Coast man whose condition means he has to use a toilet up to 60 times a day.
Domenic Mete has taken Sunsuper to court after it declined to pay the Biggera Waters man’s Total and Permanent Disability (TPD) insurance of $85,000.
Documents lodged with the Superannuation Complaints Tribunal allege Mr Mete’s doctor said his problem of a “pouch dysfunction” was not caused by previous medical conditions.
Mr Mete previously suffered from bowel cancer and ulcerative colitis.
In one document, Gold Coast University Hospital consultant surgeon Dr Gregory Nolan wrote: “I would like to clarify, Mr Mete’s pouch dysfunction is not due to ulcerative colitis, colorectal cancer or the previous ileostomy... I support his TPD application.”
Mr Mete, 53, alleges Sunsuper’s rejection has caused him considerable stress, leading to depression and financial hardship.
Mr Mete said he had surgery in 2014 to remove his bowel and colon, to get rid of the cancer and relieve the colitis.
He spent 2015 in rehabilitation before feeling well enough to return to work as a teacher in October 2016.
He took out a TPD policy that month with Sunsuper and one month later, began paying weekly premiums.
Mr Mete was having up to 20 bowel movements a day, but within three months after beginning work at Careers Australia, these increased to about 40. He was forced to stop working by December 2016.
Sunsuper said Mr Mete’s condition was pre-existing.
“We appreciate that this is a difficult time for Mr Mete,” a Sunsuper spokesman told the Bulletin.
“We’ve reviewed the updated medical evidence supplied and also arranged confidential doctor-to-doctor discussions with Mr Mete’s doctor.
Our discussions with Mr Mete’s GP support that his conditions were pre-existing prior to joining Sunsuper and we therefore remain of the view that Mr Mete does not meet the eligibility requirements of his policy.
“Out of respect for Mr Mete’s privacy, we do not believe it is appropriate to provide further details.”
Mr Mete said the decision could force him out of his home.
“I have to go to the Salvos, to St Vincents because I have no money,’’ he said.
“It does my head in … this is my life now. It’s extremely unfair. I’m tired of the pain and the suffering, that’s why this story is important.
“I know Sunsuper is not the answer to all my problems but it will help me get back on track,” he said.
Mr Mete said he expected to hear back from the tribunal within six months.
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