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 your life back on track, 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.

Why do insurance claims get rejected?

Although each insurance and superannuation policy will have different requirements, some common reasons for rejecting a TPD 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• The policy is no longer active – this may be because you closed your account or the account has been inactive for a long period of time;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 (each different policy will have specific criteria that you need to meet);

• Not satisfying minimum waiting periods;

• Not fulfilling work history requirements; or

• Dispute with your insurer over the evidence, or simply that you haven’t provided the right, or enough, 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.

Once you understand why the claim has been rejected, 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.

Shine Lawyers – we’re here to help

The Shine Lawyers’ Superannuation and Disability Insurance team have many years of experience in successfully helping clients through the TPD insurance claim process and achieving the outcomes they deserve. The legal journey can be complex, but our expert team will guide you through each step of the process and help you to understand your rights. We will do the hard work on your behalf so you can focus on your recovery; and will strive to resolve your case as quickly as possible.

Learn more about our client Dudley’s success story with Shine Lawyers and how we helped him get his life back on track: