A total and permanent disability claim can be difficult and requires expertise to succesfully pursue.. If your TPD claim has been rejected then take a look below at some of the common reasons this might have happened and what you can do about it:
Common reasons TPD claims are rejected
Each insurance policy is distinct with differences in their policies and requirements when lodging a TPD insurance claim. This means that it can often be difficult to successfully lodge a claim if you don’t know exactly what the requirements are of your particular insurance policy. Some of the common reasons that TPD claims are rejected include:
- The insurer disputes that your disability is total and permanent. Every insurer has their own definition for how a total and permanent disability is defined. The definition usually involves that you are now unable to engage in paid work (either in your own occupation or any occupation for which you have the required skillset, training, experience and education).
- You have not fulfilled the waiting period requirements to lodge a TPD claim. Depending on your policy and the particulars of your case you may have to wait 6 months, 3 months or no period before you lodge your claim.
- You do not fulfill your work history requirements. You must be able to prove that you were working a set number of hours per week or full time at the time that you suffered your illness or injury.
- You have not provided the right or enough evidence. This evidence would include proof of your employment history, medical history and the resulting loss of independence. It can be difficult to know what evidence is required for a successful TPD claim, which is why it is always important to reach out to a professional who can help guide you in the requirements to maximise your chances of a payout.
What to do once your TPD claim has been rejected?
If your TPD claim has been rejected you still have a number of options available to you to dispute the decision. If you believe that the decision was wrong, and that your claim fulfills the requirements for a TPD claim you may:
1. Reach out to a professional. If you lodged the claim yourself and the outcome was unfavourable, it might be time to reach out to a professional TPD lawyer to advise you on why your claim might have been rejected and how to best proceed with your case. A TPD lawyer can help simplify the process, help interpret the requirements of your policy and maximise your chances of success.
2. Submit your case for internal review by the super fund. Your insurer should have an internal dispute resolution service set up, which is often a good place to start to argue your case and provide the evidence you need to prompt a review of your claim.
3. Refer the decision to the Australian Financial Complaints Authority. If you believe that the decision was unfair and that your insurer has not considered your case properly then you may have to go to the AFCA, which is an independent body that offers a fair and impartial service for people who wish to make a complaint against a financial provider, such as a disputed insurance claim.