What to do if Your TPD Insurance Claim is Declined
Unfortunately, making a Total and Permanent Disability (TPD) insurance claim and receiving your benefits may not be a quick and simple process. Insurers and super funds often decline TPD claims and try to avoid paying the benefits. TPD is usually the injured or ill person’s lifeline, and after going through the ordeal of making a claim to then have it rejected can be a shattering experience. But it need not end there.
If you’ve recently tried to access your TPD insurance after suffering an injury or illness that has prevented you from returning to work in the same capacity and your insurer has denied your claim, call us immediately at PK Simpson so we can sort it out for you as soon as possible.
Some ask “can you claim TPD more than once?” The answer is yes, you can have multiple TPD claims, providing your separate funds are independent of each other.
Are you no longer able to work due to injury or illness? The good news is your superannuation fund probably owes you a lump sum payment. Call us today at PK Simpson so we can get the ball rolling and get you the TPD Insurance benefits you deserve.
At PK Simpson, we have a high success rate and our properly prepared TPD claims are accepted by superannuation fund insurance. However, it’s now increasingly common for insurers to decline a claim the first time round, only to accept it later on review. This is why you ought to challenge an insurance company if they have denied your TPD claim.
While every insurance and superannuation policy has a different requirement, TPD claims are commonly declined because the insurer:
Decides you don’t satisfy the TPD policy definitions
Has medical evidence that denies your injury or illness
Believes you can carry out some form of work
You failed to meet the working requirements before you were injured or ill (e.g you worked 30 hours a week rather than full time)
Your TPD insurance policy is no longer active
You haven’t satisfied minimum waiting periods
There’s a dispute with your insurer regarding evidence
For more than 38 years, our injury compensation lawyers at PK Simpson have helped our valued clients receive the TPD benefits they deserve.
We’ve successfully dealt with over 25,000 claims and helped thousands of people get their lives back on track.
That is our speciality!
If Your TPD insurance Claim is Denied – Don’t Give Up
If your TPD claim is declined, denied or rejected outright, don’t despair and think you’ve lost and that’s the end of the matter. Don’t let anyone tell you there’s nothing more you can do and that no further action is worth it or even possible.
Once you fully comprehend why your insurer declined your TPD claim, you have plenty of options available to you. Seek urgent legal advice from PK Simpson injury compensation lawyers to discuss your next step and find out how you can lodge a review of your insurer’s decision. We can help you:
Lodge both a personal and official complaint to your superannuation insurance provider
Submit an official complaint to the insurer’s internal dispute resolution office
Submit a complaint to the Financial Ombudsman Service
Why Should I Try to Challenge the Insurer’s Decision?
No matter what reasons your TPD insurance provider has given for declining your claim, you ought to seek urgent legal advice to find out about your options. At PK Simpson we may be able to also do the following:
Refer your super fund insurer’s the decision to the Australian Financial Complaints Authority (AFCA)
Begin court proceedings so your claim can be determined by a judge who may overturn the insurance company decision.
The importance of seeking legal advice cannot be overstated when it comes to TPD claims. The best advice is to let PK Simpson handle your case from day one of your injury or illness. Insurance companies have been known to reject TPD claims for little or no reason.
Some simply do a brief review of a file and then decide not to pay the TPD claim. Where the insurer does get medical or expert reports, they may fail to use the right professional, don’t ask the right questions or address TPD insurance policy definitions.
Call us at PK Simpson if your TPD claim has been declined and you want to know if you should challenge the decision made by your superannuation fund insurer. Phone 1300 358 057, fax (02) 92624497, email email@example.com. You can also fill in the convenient online form and we’ll get back to you pronto!
If you haven’t been able to work in your usual job for three to six months due to an injury or illness, you are likely to be classed as TPD.
Each superfund has their own TPD definition and this must be satisfied for the TPD claim to be approved. Common factors which are assessed in each claim are the members work history (education, training and experience), suitable jobs, and medical evidence.
Your TPD entitlements are set out in the contract (a.k.a. policy, or product disclosure document) you have with your insurer. Therefore, the definition of TPD will vary between policies and insurers.
Yes, you can have multiple TPD claims providing your insurance policies or super funds are independent of each other. Bear in mind that, unlike other personal injury claims, when you make a TPD claim, you do not have to prove that the illness or injury was work-related or caused by somebody else.
A successful TPD claim can never be 100 per cent guaranteed, but you are much more likely to win your claim if you contact a TPD specialist lawyer at PK Simpson to discuss your situation. There is a minimum level of evidence required to support your claim, which must be provided to your insurer and your super fund. This includes your claim form, a signed authority, certified ID, and two medical reports from your treating doctors showing that you can never return to work. These will need to be reviewed by a lawyer to ensure all the correct boxes are ticked, and that the evidence strongly supports your claim for TPD.
Often, terms and conditions specific to your policy need to be analysed in order to make sure the fund cannot decline your claim.
Superannuation funds will often require specialist reports. Superfunds do not pay for treatment throughout the claims process. However, PK Simpson pay for all medical reports needed to support your claim.
Yes, you can. People are now becoming more aware of depression and other mental illnesses, and while there’s a way to go before the stigma is lifted, we’re talking about it more often. Around one in four Australians suffer from a mental illness each year. However, insurers are wary of mental illness disability claims, and it can be quite hard to get cover. But what many people fail to recognise is that the automatic TPD insurance you have through your superannuation fund can pay out much-needed benefits and funds if you cannot work due to depression or any other mental illness.
Mental illness can often be a lingering side effect of a physical injury, even after full physical recovery.
Most claims are paid out and finalised within three to six months, but it all depends on how complicated the claim is, and how much good evidence you have about your injuries. There is also the matter of whether you fulfil all the criteria set by your insurer. This is why it’s crucial to have a specialist TPD team on your side when you make a claim for TPD for any reason.
As lawyers we will make sure your claim is assessed by the superfund in a timely manner. Delay tactics are deployed by funds to prolong and frustrate TPD claimants who are not legally represented.
Yes, you can. If you’re diagnosed with a serious cancer that has an impact on your ability to work, you may not realise you are entitled to claim insurance benefits through the insurance provided through your superannuation. These benefits may include income protection if your disablement is temporary, and TPD if your condition is long-term and serious. If your condition is terminal, you will be eligible for a terminal illness payment.
If you or anybody you know has ceased work due to illness or injury and they cannot return for at least six months they could be eligible to claim TPD benefits. Call PK Simpson specialist TPD lawyers today on 1300 358 057 or email firstname.lastname@example.org.