An insurer has been ordered to pay a total and permanent disablement benefit after the industry ombudsman said it was not satisfied that a labourer “was reasonably suited to work as an information officer”.

The complainant stopped working as a stonemason’s labourer in January 2021 after suffering a serious right-foot injury in a workplace accident and subsequently developing psychiatric conditions.

His employment history included manual labour, pick-packing, delivery driving, hospitality and work in family businesses.

AIA Australia declined the TPD claim, arguing the man had the capacity to work as an information officer. It said any gap in the man’s computer skills could be addressed through a short course or on-the-job training.

If there is a "real chance" a disabled claimant will return to "suitable work" within their education, training and experience, they will not satisfy the TPD definition.

AIA relied on case law that suitable work may extend beyond the claimant’s exact pre-injury roles and can involve some minimal retraining.

But the Australian Financial Complaints Authority rejected the argument, finding the proposed role did not have a “real and meaningful connection” to the man’s education, training and experience.

AFCA said that while he had some customer-facing experience, this did not show he had the skills or experience required for an information officer role involving customer enquiries and complaints, computer systems and administrative work.

“The proposed information officer role is materially different from any of the complainant’s previous occupations and would require more than minimal retraining” it said.

AFCA noted that while the man’s GP “accepted the role was physically suitable because it was sedentary, he said the complainant would need upgraded IT skills and would need to be retrained entirely before moving into work that did not involve manual labour”.

His psychologist identified problems with attention, concentration and memory, as well as other difficulties that could affect his ability to learn and perform a new role.

AFCA also dismissed the relevance of some of the claims on the man’s online employment profile, which referred to qualifications and work as a life coach, hypnotherapist and neurolinguistic programming practitioner.

“The employment assessment report found it was unlikely that he had actually worked in these roles. I accept that conclusion and have not treated those roles as part of his experience or occupational history relevant to the assessment of his TPD claim”, AFCA said.

Read the full ruling here.