What to Do If Your TPD Claim Is Rejected

8 August 2023 | TPD Claims

If your TPD claim is rejected, it is important not to lose hope. Super insurers often deny first-time claims, and a rejection is not the final word on your right to Total and Permanent Disability compensation.

TPD Compensation Lawyers can discuss your options if you receive notice of rejection. Appealing the denial of your benefit can be challenging, but we have the experience and knowledge to fight for your full entitlement.

Was your TPD claim rejected? Call TPD Compensation Lawyers at 03 9966 7188 today for a FREE consultation.

Why Was My TPD Claim Rejected?

Superfund insurers may cite a number of reasons for rejecting a TPD claim. Some of the most common include:

  • Not meeting the threshold for Total and Permanent Disability under the policy (i.e., own occupation, any occupation, or activities of daily living).
  • Inadequate medical evidence.
  • Lodging a claim before the end of the waiting period (usually 3–6 months).
  • Failure to meet work history requirements.
  • The policy is cancelled or inactive.

None of these reasons for rejection are unassailable. For example, disputes concerning your work capacity may be countered through additional medical evidence. Insurance companies may also make mistakes in assessing your eligibility and/or interpreting the terms of the policy.

Unfortunately, insurers have the upper hand in these scenarios. They work with these policies day-in, day-out, while you are likely making a claim for the first time. Add to this the fact that up to 60% of TPD claims are rejected, and it is easy to see why claimants become frustrated with the process of obtaining Total and Permanent Disability compensation.

What Should I Do If My TPD Claim Is Rejected?

Rejection of your claim does not necessarily mean the matter is closed. You have the right to appeal an adverse decision and pursue the TPD entitlement you deserve. The first thing you should do is seek knowledgeable legal counsel. An experienced lawyer can evaluate your claim and discuss your legal options.

How Do I Appeal a TPD Claim?

Thoroughly understanding why your TPD claim was rejected is the first step of a successful appeal. You should have received a letter from the insurance company outlining its decision to reject your claim. Share this document with your TPD lawyer, as well as any information you submitted to the super insurer when lodging your claim.

Once your lawyer has reviewed the Total and Permanent Disability insurance policy, the details of your claim, and the rejection notice, there may be several options for appealing or disputing a TPD claim that has been rejected:

1. Submitting Additional Medical Evidence

If the insurer denies your claim on medical grounds, it may be necessary to present additional and/or more specialised evidence of disability. By undergoing additional medical examinations and providing the practitioners’ reports to the insurance company, you may be able to convince the insurer to review the decision and—ideally—find that you do in fact qualify for Total and Permanent Disability.

2. Lodging a Formal Complaint

Disputes between insurers and claimants are not uncommon. But if the dispute is accompanied by unacceptable delays, lack of clear communication, unresponsiveness, and other issues on the part of the provider, it may be worth filing a formal complaint with the insurance company and going through the internal dispute resolution process.

Super funds have 45 calendar days to respond to formal complaints. While this does not guarantee a favourable reappraisal of your claim, lodging a complaint can help the process move forward. 

3. Making a Complaint to the AFCA

The Australian Financial Complaints Authority, or AFCA, is responsible for investigating and resolving complaints involving financial firms (including insurance companies and superannuation funds). If the insurer’s internal dispute resolution procedures prove ineffective, making a complaint to the AFCA may be an effective alternative.

Usually, the AFCA will first try to bring the parties together informally with the goal of negotiating a settlement. If a settlement cannot be reached, the AFCA will make a determination in the matter. With disputes involving super insurers, the AFCA’s determination is binding on both parties.

4. Taking the Matter to Court

Going to court may seem like a daunting prospect. However, commencing litigation against the insurer may be necessary if other avenues do not result in the resolution of your claim.

A qualified TPD lawyer can prepare your case for court and handle any courtroom proceedings on your behalf. From referral of the matter to mediation to hearings before a magistrate, your lawyer will protect your rights and interests and strive to obtain a favourable result.

TPD Claim Rejected? Contact Our Lawyers Today

Getting word that your claim for Total and Permanent Disability cover is truly disheartening. You were likely depending on the TPD benefit to pay for medical care, make up for lost income, and manage other expenses. Fortunately, the super insurer’s rejection is not carved in stone. TPD Compensation Lawyers can help you dispute the decision.

We handle claims on a No Win, No Fee basis. This means you pay no fees unless your claim is approved, a settlement is reached, or the court finds in your favour.

If your TPD claim was rejected, contact TPD Compensation Lawyers for a FREE consultation. Our firm serves clients throughout Australia.