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PK Simpson Blog

Why Your TPD or Disability Pension Claim Is Refused

There can be nothing worse than suffering a disability caused by an accident or by an illness. It can change your life and the lives of those you love, and it’s made all the more gut wrenching if you have to manage the fallout of your inability to continue to work full time if at all.

Becoming disabled can leave you and your family unsure about the future. Not only do disabilities have a significant impact on your day-to-day activities, they are likely to cause problems for you in the workplace. In some cases, you may never be able to return to your previous job or any other form of employment due to the severity of your condition.

No matter how or where you were injured, or whether or not it was your fault, you might not realise there are many things you can do with regard to a claim for disability, be that for a pension or a lump sum to give you the best chance of success you should consult an expert lawyer in the field. They will be able to quickly determine if your case is valid and advise you about your Life Insurance policy, Superannuation fund or Disability Support Pension, or other options to help with your claim.

However, not all insurers or Super funds pay out the claims that they receive.

Reasons for rejected claims

1. You lodged your claim too late

Some, if not all Total and Permanent Disability (TPD) policies have a time frame in which you must lodge your claim. If you fail to file it on time it is more than likely going to be refused. You might be able to argue that due to unforeseen circumstances you were unable to lodge it on time. The way to handle this is via your lawyer who will be able to discern whether or not you can still make a claim.

2. You are not able to fit the TPD classification

Your TPD has to suit the requirements of your particular policy and all insurers and super funds have their own criteria that constitutes what a TPD is. In other words, your TPD has to fit your policy’s classification, if it doesn’t your insurers might decide to reject your claim. Proving such claims can be expensive for your insurers or Super fund so they are not keen on paying out. It’s wise to have a chat with a lawyer qualified in these areas to determine if the insurer or fund’s decision is able to be questioned.

3. Your age disqualifies you

The requirements of most TPD policies is that anyone who makes a claim has to be below the age of 65 on the day they stopped work because of a TPD so even if you are insured on the day you ceased employment due to your TPD, if you were over 65 your claim may be rejected.

4. Evidence has been found to dispute your claim

It’s very common for insurers to put a tail on you and for such surveillance to gather evidence so they can dismiss your claim or make it invalid. Claimants can find this a most distressing experience, especially for someone whose claim is for PTSD or other mental disabilities that are almost impossible to detect or to be assessed physically by untrained observers.

The best way to avoid the stress is to get the help you need from an expert lawyer who can support you through the process, arrange medical examinations and reports and give you advice on your claim.

TPD Lawyers

The team of specialty lawyers at PK Simpson are highly trained when it comes to running TPD and Superannuation claims. Your first consultation is free and you’d be taken through the process and we’ll explain our ‘no win, no fee’ basis.

If you have a disability due to an accident or illness and believe you can make a claim, or just want more information, call PK Simpson on 02 8999 7700 for a chat. Or, email enquiries@pksimpson.com.au.