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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 June 6, 2017. Last modified: September 6, 2018.

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