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TPD insurance: When claims get rejected

Total and permanent disability, or 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; lost past income, lost earning capacity, any medical expenses and your future care needs can all be compensated.

However, 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 minimise your chances of having a claim rejected.

insurance-claim-form

Before you lodge 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.

Although each insurance and superannuation policy will have different requirements, some common reasons people fall ineligible include:

  • Not meeting the requisite level of disability;
  • Not satisfying minimum waiting periods; and
  • Not fulfilling work history requirements.

Be sure to read your policy carefully, and if you have any questions, contact your provider or a member of Shine Lawyers’ Superannuation and Disability Insurance team for further advice.

If your TPD claim is denied

If your claim is initially rejected, don’t be fooled into thinking this is the end of the matter. There are numerous options available for seeking 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; and
  • Sending a written complaint to the Financial Ombudsman Service.

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

If you need assistance in taking further action to access benefits under your superannuation or insurance policy, Shine Lawyers’ team of superannuation and disability insurance lawyers are available for an obligation-free consultation. They offer tailored legal advice on a ‘No Win, No Fee‘ basis to ensure you receive the full range of benefits you are entitled to under your policy.

Written by Shine Lawyers on . Last modified: March 14, 2018.

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  • Ray Graham wrote:

    Without Prejudice. We were absolutely broken hearted with Ray’s claim outcome. The paralegal went to the Melbourne Cup on settlement day & everything she advised we weren’t allowed to say according to the barrister who wasn’t familiar with our case at all. We weren’t advised our claim amount until it was final when the barrister passed it to Ray. He obviously didn’t read all the specialists reports on Shine Lawyers & also Workcover.. Our life has changed because of Ray’s brain damage & if we had of been advised re the ombudsman we definitely would have pursued the case. The paralegal had no contact with us after what she promised she would do after settlement. We could go on forever but just wanted to record how traumatised we have been since as Ray could not work at all. We know it’s done & dusted but we were definitely ripped off by Townsville Shine Lawyers & we have to wear it.

    • Shine Lawyers wrote:

      Hi Ray, thanks for getting in touch. We are sorry to hear about your experience and also sorry we could not meet your expectations at this time. We have made a note of your comments and have passed this on to the Townsville branch so they are aware of your feedback.

  • Tony schaper wrote:

    Years ago I lodged a claim to AXA insurance co. To get my TPD insurance. I was in the forces and when I was granted a Gold Card TPI vet affairs. I was told I would be eligible to claim on my TPD of my super insurance that I had paid into for years. They took 2 Years to make a decision that they would not pay me. Then when I tried to appeal they said that I had to appeal within 6 months of the injury. That was impossible.
    I am still very upset and confused why they rejected me.
    Can any one help me fight for justice,

    • Shine Lawyers wrote:

      Thanks for contacting us Tony, and I’m sorry to hear about your experience. Your situation sounds like something our superannuation and disability insurance lawyers might be able to help with. If you get in touch with our New Client Team, they will be able to gather more details from you and let you know if we can assist. You can find the contact details here: http://bit.ly/Shine-contact

  • Domenic mete wrote:

    Hi I made a claim for my tpd with sunsuper and they rejected it. The tribunal has now set a conciliation date for it to be settled. If the tribunal set a conciliation date what does this mean to me. Do have a good chance to now be paid out. Also the Gold Coast bulletin is looking at running my story because they feel I have been hard done by and have been shown little and no compassion by sunsuper. I have been severely depressed waiting to be paid out and I have nearly lost my property several times for falling behind in payments due not being able to work again. My health is getting worse each day and my finances are creating so much depression that I have thought about suicide and in one instance I was going to jump off my balcony. I was wondering can you pursue a higher payout because of their refusal to initially pay and the length of time they have taken to pay and also the depression they have caused. Is their a way to sue for unnecessary depression caused by the insurer. And should I go ahead with the newspaper story will that make it easier or open a way for a better payment. And Would shine represent me or any lawyer represent because it would create exposure for the lawyers. I’m so confused and fear I might say the wrong thing at my hearing coming up soon.

    • Shine Lawyers wrote:

      Hi Domenic, your situation sounds like something we might be able to help with. If you email your contact number to socialmedia@shine.com.au I can organise for someone to give you a call to get more details from you and discuss this further with you. ~Steph

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