Total and Permanent Disability (TPD) claim denials happen and though it has improved since a damning ASIC report in 2016, there’s still a long way to go. 

Total Permanent Disability (TPD) Insurance provides policyholders with protection in the case of permanent disability, injury or illness that prevents them from returning to work. A denial can have consequences for policyholders and their families, from their financial well-being to their health. 

Here, we’ll tackle the most common reason for claim denials and showcase how to navigate the process and avoid TPD insurance claim denial. From the necessary documentation to the supporting evidence, we can help you safeguard your rights. 

Common Reasons for TPD Claim Denials 

There are several common reasons for Total Permanent Disability Insurance claims denials; it’s a complex process, and these denials show the need for attention to detail when filing your claim. 

Insufficient Evidence 

One of the most common reasons for a claims denial is a lack of medical evidence to support your claim. Whether you have a private policy or it’s Total Permanent Disability in super, the insurance companies need comprehensive documentation to clearly demonstrate how your illness, injury or disability impacts your ability to work. It’s important to collate all the medical records, reports from specialists, and diagnostic tests. A TPD lawyer can help you gather everything you need to make your case. 

Policy Exclusions

Policies vary, and if yours is TPD Insurance in super, it might not cover you as securely as a private policy. For example, your policy may cover only your job, which means the insurance company doesn’t need to pay out because you could work elsewhere. 

Additionally, some policies will include an exclusion regarding pre-existing conditions. Every policy will outline timelines and deadlines for filing claims, and if you don’t adhere to them as laid out, the insurance company can refuse your claim. 

Failure To Meet the Definition 

If you do not meet the definition of a total and permanent disability as detailed in your TPD policy, the insurance company can refuse your claim. 

Navigating the TPD Claim Process 

If you don’t have a private TPD policy, you should check with your super fund to determine your level of Permanent Disability Work Cover. 

  • Find your TPD policies; you may have many from different jobs because TPD is often included in super. You will have a super fund for every job you’ve held, which means you are likely to have a TPD policy with each of those. 
  • If you do have several policies, your next step is to determine which of the TPD policies are still valid. 
  • Check with your valid policies to see if your injury, illness or disability is eligible to claim. 
  • Some policies cover you if you are unable to work in your job, and some will only cover you if you’re unable to work in any job. You want the one that is most likely to provide you with the highest payout. 
  • You need to gather all of your evidence because when you submit your application it should be thorough. 
  • There’s more to it than completing a form. The supporting evidence builds your case. It’s your explanation as to why your claim is valid, and a lawyer can guide you through it. 
  • While many insurers are changing the wording of policies to prevent multiple claims, check with your lawyer to determine whether you are eligible to claim TPD through multiple policies should you have them. 

Tips to Avoid TPD Claim Denials 

You can follow up with the insurer to avoid delays and ensure the assessor has all the relevant information. This move alone could prevent a claim denial. 

To avoid a claim denial, be sure to thoroughly read each of your policies and provide thorough, accurate information to support your claim. Regular medical checks can also help support your case. It’s also important to follow the treatment suggestions your medical team makes. You should start documenting your limitations the moment you notice issues, and promptly notify your insurer. 

Ultimately, the best course of action is to call a lawyer before you officially begin the TPD claim process because an expert can help you ensure you have everything in order before you submit your claim. 

Legal Recourse After TPD Claim Denial 

If your claim has been denied, you can appeal. Every insurer has a different appeals process to follow, so you need to understand the process before you proceed, and a lawyer can help you with that. 

Reviewing the rejection letter for details about why your claim was denied. The appeals process can be even more complex than the initial claims process, so find a trustworthy, experienced lawyer to help you handle the appeal process. 

Final Thoughts 

Filing a TPD Claim sounds like a straightforward process, but the supporting evidence can make or break your claim. 

A reputable lawyer can help you successfully navigate the claims process, from finding the right policy to collating the evidence to filing a successful claim. A lawyer can be a game-changer when it comes to the success of filing your TPD Insurance Claim. 

At AJB Stevens, we are TPD claim specialists; we can help you navigate the process from start to finish to ensure you receive the lump sum payment you’re entitled to. If you’ve already filed your claim and received a denial, we can help you with the appeals process. Contact AJB Stevens today.