TPD Claim Rejected? $400,000 Settlement…..

Liza Yar | Senior Associate

Have you recently tried to claim for your total and permanent disability insurance and your claim has been rejected?

Unfortunately, it is not uncommon for superannuation funds and their insurers to reject TPD claims as this will prevent them from paying out a lump sum to eligible members.

Superannuation funds and their insurers may reject your TPD claim for the following reasons: –

You no longer hold or at the time of their injury/illness did not have an active TPD insurance.

Your injury/illness fall beyond the insurance coverage period.

You have not provided the Super fund sufficient evidence in support of your claim.

Your circumstances simply do not match the definition of TPD set out in their applicable insurance policy.

What can you do if your claim is rejected?

Normally, before a TPD claim is rejected the insurer will send you a Procedural Fairness letter which sets out their reasons for rejecting your claim. You will be provided an opportunity to respond to this letter and make submissions before a final decision is made by them. You can prevent your claim from being rejected by simply responding to this letter and addressing the issues.

If a final decision is made by the insurer or the superannuation fund to reject your claim, you have the right to lodge a formal complaint internally with either the insurer or the super fund.

If the superannuation fund maintains their decision even after considering your formal complaint, you may make a complaint to the Australian Financial Complaints Authority (AFCA).

The above options are cost effective and an easy process of overturning the insurer’s decision about your TPD claim. Alternatively, you can start proceedings against the insurer or the fund in Court.

What Alliance Compensation and Litigation Lawyers can do for you:

We can assist you to overturn the fund’s decision about your TPD Claim and ensure you receive your insurance payout at the time you need it most. If your claim is accepted, you will have access not only to your insurance payment, but you can also have access to the fund you have in your super.

We have many years of experience in successfully challenging negative TPD outcomes and achieving great result for our clients. Our expert team will identify the real issues in dispute, reviewing the insurance policy, gathering appropriate evidence on your behalf to address the eligibility issues and resolve your claim.

One example of our successful claim: –

Our client’s TPD claim was rejected by the superannuation fund simply because the fund did not believe our client had provided them sufficient medical evidence to confirm he meets the requirement.

Initially we responded to the Procedural Fairness letter we had received from fund’s insurer, and we requested them consider our response before making a final decision. Unfortunately, the claim was rejected by the insurer.

Therefore, we gathered further medical evidence and lodged a formal complaint directly to the fund with submissions explaining why they failed to make a fair and reasonable decision. The Superannuation fund reviewed our submissions, the fresh evidence and overturn their initial decision.

As a result, our client received approximately $400,000.00 as a lump sum.

For more information contact us or call 02 8764 1776

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