The progressive evolution of Australian insurers' duty of utmost good faith to third party claimants

Over recent decades, the significance of third parties in the insurance contractual relationship has progressively increased. In Australia, challenges by claimants with entitlements under group life insurance policies providing total and permanent disablement (TPD) benefits, which are commonly arranged by trustees of superannuation funds to provide benefits to incapacitated members, have been a key driver of this trend. Several cases where third party claimants have successfully challenged the decision-making processes of insurers in declining TPD claims have provided useful clarifications of the nature, extent and limits of Australian insurers' post-contractual duties of utmost good faith. Through a progressive review of the key Australian authorities, this article examines the examples of conduct by insurers that have been held to breach the duty of utmost good faith. It also shows that through recognising the standing of third parties, several of these decisions have provided the impetus for amendments to the Insurance Contracts Act 1984 (Cth), which now recognises that insurers also owe the duty of utmost good faith to third party claimants

Evaluation of appendicitis risk prediction models in adults with suspected appendicitis

Background Appendicitis is the most common general surgical emergency worldwide, but its diagnosis remains challenging. The aim of this study was to determine whether existing risk prediction models can reliably identify patients presenting to hospital in the UK with acute right iliac fossa (RIF) pain who are at low risk of appendicitis. Methods A systematic search was completed to identify all existing appendicitis risk prediction models. Models were validated using UK data from an international prospective cohort study that captured consecutive patients aged 16–45 years presenting to hospital with acute RIF in March to June 2017. The main outcome was best achievable model specificity (proportion of patients who did not have appendicitis correctly classified as low risk) whilst maintaining a failure rate below 5 per cent (proportion of patients identified as low risk who actually had appendicitis). Results Some 5345 patients across 154 UK hospitals were identified, of which two‐thirds (3613 of 5345, 67·6 per cent) were women. Women were more than twice as likely to undergo surgery with removal of a histologically normal appendix (272 of 964, 28·2 per cent) than men (120 of 993, 12·1 per cent) (relative risk 2·33, 95 per cent c.i. 1·92 to 2·84; P < 0·001). Of 15 validated risk prediction models, the Adult Appendicitis Score performed best (cut‐off score 8 or less, specificity 63·1 per cent, failure rate 3·7 per cent). The Appendicitis Inflammatory Response Score performed best for men (cut‐off score 2 or less, specificity 24·7 per cent, failure rate 2·4 per cent). Conclusion Women in the UK had a disproportionate risk of admission without surgical intervention and had high rates of normal appendicectomy. Risk prediction models to support shared decision‐making by identifying adults in the UK at low risk of appendicitis were identified