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What to do if your TPD claim is rejected


Have you recently been through the motions of trying to access your total and permanent disability (TPD) insurance and found out your TPD claim was rejected by your insurer?

TPD insurance can be your lifeline if you suffer an injury or illness that prevents you from returning to work in the same capacity.

If successful, your claim provides you with a lump sum payment to help get you back on your feet, and can be used for covering expenses incurred due to your loss of income, as well as any medical expenses and future care needs.

Unfortunately, making a TPD insurance claim and accessing your benefits isn't always a quick and easy process. Claims are commonly rejected as insurers and super fund providers try to avoid making payouts. However, there are a few simple guidelines you can follow to maximise your chances of a successful TPD claim.

How do you successfully make a TPD claim?

For a successful TPD insurance claim, it is important that before lodging, you ensure you meet the specific eligibility criteria laid down by your particular policy.

The basic steps to make a TPD claim include:

  1. Contact your superannuation fund to start the process of lodging a claim. Your fund will let you know the specific documentation they need to progress your claim.
  2. Once you submit your claim, you will be assigned a case manager.
  3. Your case manager assesses your claim. In some situations they may require additional documentation from you.
  4. Your insurer either accepts or rejects your claim.

Why do insurance claims get rejected?

Although each insurance and superannuation policy will have different requirements, some common reasons for rejecting a claim include:

  • The policy is no longer active – this may be because you closed your account or the account has been inactive for a long period of time;
  • Not meeting the required level of disability as defined by your policy;
  • Not satisfying minimum waiting periods;
  • Not fulfilling work history requirements; or
  • Dispute with your insurer over the evidence.

If your TPD claim is rejected – don’t give up hope

If your claim is initially rejected, don't be fooled into thinking this is the end and that no further action can be taken. There are numerous options available for seeking a review of your provider's decision, including:

  • Submitting a personal complaint to your insurance or superannuation provider;
  • Lodging an official complaint with your provider's internal dispute resolution services;
  • Sending a written complaint to the Financial Ombudsman Service; or
  • Seeking urgent legal advice.

Seeking review can be a lengthy and complex process, and is often accompanied with detailed evidential and procedural requirements.

Contact Shine Lawyers

The Shine Lawyers’ Superannuation and Disability Insurance team understands the complexities of the TPD insurance claim process, with many years’ experience in dealing with large and small insurance companies.

We know the ins and outs of what can be claimed and can often resolve your case faster, and leaving us to do the hard work on your behalf. Don’t delay, call today for an obligation free chat about your options.

Written by Shine Lawyers. Last modified: February 21, 2020.

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