Holman v Brisbane Roar: court confirms player has the right to recover insurance payments made to club


Brett Holman is a household name for all Australian football fans. He spent most of his professional football career abroad playing in the Dutch Eredivisie, Premier League and UAE Pro League before returning to Australia in 2016 for one last A-League swansong with Brisbane Roar FC. He has also made 63 appearances for the Australian national team, including scoring two of Australia’s three goals at the 2010 World Cup.

Unfortunately, Holman’s swan song in the A-League was unexpectedly interrupted. In April 2018, towards the end of the 2017-18 season, he injured himself while playing for Roar in an A-League game against Perth Glory, which prevented him from participating in professional football (Injury). At that time, he was a top Roar player with an annual salary of $ 372,300, including superannuation.

Politics

The Roar was a party to an insurance policy with Arch Insurance known as the Professional Sports Group Accident Insurance Policy (Politics). The policy identified the Australian Football Federation, the Roar and all other clubs in the A-League as the “policy holder” and the A-League players (which included Holman) as “covered persons”.

Relevantly, the policy provided for certain benefits, including temporary total disability (TTD) benefits, which were payable in cases where an A-League player sustained bodily injury caused by an accident during the period of coverage. TTD benefit payments were calculated based on the A-League player’s contractual salary at the time of the injury, capped at $ 350,000 over any 52 week period.

Insurance claim and transition between player contracts

After sustaining the injury towards the end of the 2017-18 season, Holman signed a new playing contract with the Roar about a month later in May 2018 for the 2018-19 season. The salary under the new contract has been reduced to $ 178,000, including the superannuation.

The following month, Holman completed and signed an insurance claim form, claiming benefits under the policy in connection with the injury (Claim). The Claim was then submitted to the insurer by a Roar officer.

Insurance payments

The insurer accepted Holman’s claim and paid Roar $ 369,433.26 between July 2018 and June 2019. The payments were for TTD benefits under the policy.

As Holman sustained the injury while his original contract with the Roar was in effect, TTD benefit payments were calculated based on his then annual salary of $ 372,300 (subject to the aforementioned cap).

Roar does not pay Holman all amounts received

Although the Roar received $ 369,433.26 from the insurer for TTD benefits payable under the policy, he did not forward those payments to Holman. On the contrary, the Roar argued that he was only required to pay Holman the salary payable under his new playing contract, which was $ 178,000, including the superannuation.

Conversely, Holman argued that, on the correct interpretation of the policy, it was he, rather than the club, who was entitled to TTD benefits paid by the insurer.

Issues and analysis

The dispute at trial concerned the value of the TTD compensation, and whether the Roar or Holman was entitled to that benefit, in circumstances where the Roar was paying Holman’s contract wages while he was injured (i.e. say the reduced salary payable under the contract of the second player who was registered after the injury).

In considering these issues, the Court was required to carefully analyze the terms of the Policy to determine its proper interpretation. Unfortunately, many of the terms were inconsistent and ambiguous and there was no consistent form of words used to describe the obligation to pay a benefit or amount.

The ambiguity of the TTD section of the policy was particularly important in this case. This article obliged the insurer to: “… pay the INSURED the amount of the benefit up to the maximum BENEFIT PERIOD indicated in the APPENDIX or until the end of the INSURED PERSONS ‘contract, as specified in the APPENDIX‘.

While the word “Insured” was defined to mean “the person or entity identified in the APPENDIX who will be entitled to the benefits covered by these presents other than those due in the event of ACCIDENTAL death‘, the appendix did not identify any particular person or entity as the “insured”.

As His Honor observed, the word “insured” could not be interpreted to have the same meaning as “insured” and, indeed, it was reasonable to infer that “insured” was not meant to have the same meaning. meaning that “insured” given the policy has used the term “insured” in various parts.

Thus, to identify the meaning of “Insured”, His Honor considered who, in the appendix, was entitled to a particular benefit under the policy (noting that “Insured” was defined to mean “”a person or entity identified in the APPENDIX who will be entitled to the benefits covered hereunder‘).

With respect to the TTD benefit, and in view of various textual and other considerations (including the “compelling consideration” that it was Holman, and not the Roar, who suffered the injury and risked not being able to earn his life as following the injury), His Honor Judge Porter concluded that the police conferred this benefit on Holman, regardless of whether, and to what extent, the Roar paid him money under his contract. of player.

His Honor also confirmed that according to the correct interpretation of the policy, the calculation of the TTD benefit was not affected by Holman’s entry into the second player’s contract: “In my opinion, on the correct interpretation of the policy, it provides for a TTD benefit calculated on the contract existing at the time of the accident until a player is fit to play, regardless of termination or modification of the player’s contract in the meantime.

Conclusion

As a result, the court agreed that Holman was the “Insured” and was entitled to receive the full $ 369,433.26 that the insurer paid to Roar. The court also ordered the Club to pay Holman’s costs, as well as interest in the amount of $ 41,815.80.

As in most insurance cases, the outcome of this matter depended on the terms of the applicable policy. This case is a reminder that when considering the correct interpretation of an ambiguous insurance policy, particular attention must be paid to all relevant terms and textual indications, as well as to the contexts in which the key words and phrases are used.


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