What To Do If My TPD Claim Is Denied?
TPD
1 February 2023
2min read
Key Takeaways
TPD claims commonly face initial insurer declines, but many are later accepted on review. Challenge the decision through three routes: request internal review by the superannuation fund’s dispute resolution team, refer to the Australian Financial Complaints Authority (AFCA), or commence court proceedings before a judge.
• Most insurers decline based on insufficient evidence or brief file reviews without proper expert assessment
• A number of initially declined claims are later accepted by the insurer on review
• You should always consult a lawyer to discuss your options and build a stronger case
• Court proceedings can overturn the decision and secure your TPD benefit payment
In our experience, if TPD claims are prepared properly they are usually accepted by the insurers.
It is becoming more common for insurers to decline claims initially and then later accept them on review. For this reason, you should always try and challenge the insurers decision to decline your claim for TPD benefits.
A number of the claims that are initially declined are later accepted by the insurer.
Why was my TPD claim denied?
Usually the insurer will decline the claim for one of the following reasons:
- The insurer does not believe you satisfy the definition of TPD
- The insurer has obtained medical evidence that states you do not have an injury or illness
- The insurer finds that you can work in some form of employment
- You have not met the working requirements prior to the date of injury (such as working 30 hours per week prior to injury or illness)
Regardless of the insurers reason for declining your claim, you should always consult a lawyer to discuss your options as your lawyer may be able to:
- Requesting an internal review by the super funds internal dispute resolution team
- Refer the decision to the Australian Financial Complaints Authority (AFCA)
- Commence your claim in Court to be determined by a Judge,
and by doing so have the decision overturned and your TPD benefit paid.
Should I try and challenge the insurers decision?
You should always seek legal advice to see if you can challenge the insurers decision because insurers will often decline your claim based on little or no evidence. They will simply conduct a brief review of the file and determine that they will not pay your claim.
In the circumstances where the insurer does obtain evidence from a doctor or an expert, they often fail to appoint the correct expert, fail to ask the right questions, or fail to address the policy definitions of TPD.
If your TPD claim has been declined and you want to know if you can challenge the insurers decision you can complete a free case assessment here.
Disclaimer
The information contained on this article is of a general nature only and is not intended to be legal advice. The law may have changed since the information was published. There is no intention to create a lawyer-client relationship and you should always seek legal advice about your own personal circumstances.
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