In this episode of P.I. Case Note, accident legal partner and personal injury lawyer Michelle Wright examines the Queensland Supreme Court’s decision in Byres-Reeves v QSuper [2025] QSC 285, which demonstrates the significant challenges of pre-existing conditions and TPD claims when mental health symptoms existed before insurance coverage commenced. The case involved Mr Byres-Reeves, who became a QSuper member on 26 October 2017 with TPD insurance coverage, but whose claim for total and permanent disability benefits was denied because his debilitating anxiety, agoraphobia, ADHD, and Asperger’s Autistic Spectrum Disorder had all manifested symptoms prior to his policy commencement date—falling within the policy’s pre-existing condition exclusion.
The Court’s comprehensive analysis reveals both the legal framework for challenging insurer TPD decisions and the practical difficulties with pre-existing conditions and TPD claims. The Court established seven key principles for reviewing insurer opinions: the insurer must act reasonably and fairly; the opinion is not unreasonable simply because the court would form a different view; the opinion is invalidated if the process was not undertaken reasonably and fairly; an opinion reasonably open on evidence can still be invalid if the insurer did not engage with relevant evidence; the opinion is invalid if it doesn’t answer the correct question or ignores relevant evidence; the court should not consider material unavailable to the insurer when forming its opinion; and where multiple reconsiderations occur, focus is on the last decision. Applying these principles, the Court found QSuper’s decisions were reasonable at each stage—Mr. Byres-Reeves’s own claim form stated he experienced symptoms since age 10 (though not diagnosed until 2018), his treating medical records confirmed treatment for psychiatric struggles from 2015-2017, and he had ceased employment with his first employer in September 2017 due to mental health before his policy commenced in October 2017. His cervical spine injury, which developed after policy commencement, did not independently satisfy the TPD definition as medical evidence indicated it would not prevent him from working in occupations for which he was reasonably qualified.
Listen for Michelle Wright’s detailed analysis of this important decision on pre-existing conditions and TPD claims and the critical timing of symptom onset versus diagnosis. If you’re considering a TPD claim and have concerns about pre-existing conditions and TPD claims, the experienced team at accident legal understands the complex policy exclusions and how insurers scrutinise medical histories. As Queensland’s trusted personal injury lawyers, we know that the timing of symptoms—not just formal diagnosis—determines whether conditions are pre-existing, and we’ll carefully review your medical records and policy terms before lodging your claim to assess your prospects of success. Contact us for a free consultation on (07) 3740 0200—we’ll provide honest advice about how pre-existing conditions may affect your TPD claim and help you gather the evidence needed to maximise your chances of approval.
