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Surprising delay tactics used by super funds


Every week hard-working Australians are contributing to their superannuation fund, giving them peace of mind that they will have a source of income at retirement and access to Total Permanent Disability (TDP) insurance should they need it. Unfortunately, people are now discovering how difficult it can be to access these protections when tragedy strikes and injury or illness leaves them unable to work.

Every day, countless Australians battle with their insurers to access the insurance benefits they desperately need in times like this - Australians just like James Duncan.

The battle continues for James Duncan

James' life was turned upside down when a bowel cancer diagnosis left him with a slim chance of survival. Unable to work and with almost no money, James moved to the Philippines, the only place he could afford to live.

He is now fighting to access his Total and Permanent Disability Insurance benefits for some form of financial security. Despite supplying everything the insurer needs, James' claim has been dragged out and delayed, leaving him frustrated, exhausted and hopeless.

Delay, deny and defend: The tactics used by insurers

When Australians are turning to their insurance providers, it's usually in a time of desperate need. Far too often they are being met with time-wasting tactics, deployed in an attempt to wear them down and abandon their claims.

Delay

Common ways insurers delay the claims process include:

  • Constant requests for different information;
  • Insisting they haven’t received documents that have been sent;
  • Transferring cases to new staff members so investigations have to restart;
  • Sending the claimant to multiple medical practitioners, also known as ‘doctor shopping’; and
  • Not answering calls or putting claimants on hold for long periods of time.

These hurdles created by insurance companies are so exhausting, genuine claims are frequently abandoned by those desperately needing support.

Deny

For those claimants that finally do get an answer, it may be either a very small offer or the claim is rejected because the illness or injury doesn’t match the exact wording on the policy. In some cases, policies even have out-dated medical definitions included, and these are used to deny valid claims.

Defend

Far too often we see insurance companies operating on a ‘take it or litigate it’ basis. They offer unrealistic or no payment amounts to those that can no longer work and need ongoing medical treatment.

The toll of TPD claims

When people are looking to make a total and permanent disability claim through their superannuation fund, they're usually in a desperate situation. No longer able to work, many have to cover the costs of expensive medical treatments and/or operations out of their own pocket.

The recent report into Australian life insurance

In late 2016, the Australian Securities and Investments Commission (ASIC) released a report summarising the findings of a review into the life insurance sector.

The ASIC report revealed that that the most poorly performing insurer (in terms of claim denials) was rejecting 37% of claims. The corporate watchdog refused to reveal the name of the company. However hours later, Westpac’s life insurance component BT Financial Group (BTFG) issued a public statement admitting they were responsible.

Appallingly but not surprising, the ASIC report indicated that some insurance operators were offering staff bonuses based on their decline rate. This is just one example of the internal infrastructure within the industry to deny claimants’ payments.

Get the help you need

If you're struggling to access your superannuation or TPD benefits, help is available. At Shine Lawyers, our superannuation and disability lawyers fight against insurance companies every day, and we're good at it. We're strong advocates for our clients and are dedicated to getting the best results possible. Get in touch today for an obligation-free consultation.

Written by Shine Lawyers. Last modified: October 16, 2019.

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