Guide to Common TPD Claim Errors
The Top 6 Common Mistakes When Making a TPD Claim
Making TPD claims can seem daunting for some people, but with the right legal advice, it doesn’t have to be. In this article, we will explore the six common mistakes people make when filing a TPD Claim. By being aware of these mistakes, you can avoid them and have a smoother (and potentially faster) claim process.
Superannuation funds or insurers will look for errors in your claim to seek to deny or minimise your benefit payout. Large insurers do this work every day, and this is likely to be your first attempt at a TPD Claim. Remember that most people only get one chance at making a successful insurance claim.
Below you will find some common errors for people who have never had a TPD claim before.
1. Bad advice from your insurer
If you’ve ever had to claim your TPD insurance, the process can be complicated and frustrating. But it’s important to remember that your insurer is not always acting in your best interests. Here are a few pieces of bad advice that your insurer may give you to try and save money.
For instance, they may tell you that you can’t claim because of a pre-existing medical condition or that your policy didn’t cover your injury. They may also try to downplay the extent of your injury, illness, or other tactics to convince you to settle for less.
To ensure your chances of success and maximise your entitlements, you should have an experienced TPD Insurance Lawyer look over your case. Give yourself the best opportunity for getting the outcome you want.
2) Not understanding how Total and Permanently Disability is defined.
When you hear the phrase: Total and Permanently Disabled, you probably think you must be seriously incapacitated to make a successful TPD claim. These words are a bit misleading. Generally, to get a TPD payout, you must show you cannot work in your regular occupation (or one fitting your training and experience) due to the impacts of a physical injury, illness, or mental health condition.
Unfortunately, there is no single definition of TPD that insurers universally accept. The absence of a universal description can make it very difficult for claimants to determine whether they meet the criteria for TPD benefits. TPD is usually defined as an inability to work due to a physical or mental disability.
Your physical or mental condition does not have to have been acquired because of your work or workplace. A long list of injuries and medical conditions quality for TPD Insurance Claims. Some of the common medical conditions are:
- Cancer
- Heart Attack
- Stroke
- Alzheimer’s
- Dementia
- Major Organ Transplants
- Major Burns Injuries
- Arthritis
And mental health conditions like:
And physical conditions such as:
- Back, Neck and Head Injuries
- Loss of Limb
- Paralysis
If you are unsure whether you meet the definition of TPD, it is essential to speak with a qualified & experienced TPD lawyer who can help you navigate the claims process. Aussie Injury Lawyers provide a free comprehensive case evaluation.
3. Understanding your dates
If you’re making a Total and Permanently Disabled (TPD) claim, it’s essential to understand the key dates that will affect your claim. Here are some key dates to consider:
- The date of your injury or illness: Your TPD claim must be lodged within two years of the date of your injury or illness.
- The date of your injury or illness is the date from which your TPD claim starts. All other dates will be based on this date.
- You must have been away from work for at least three months before you can make a claim.
- The date you stopped working: If you’re making a TPD claim due to redundancy, you’ll need to show that you are medically unfit for your previous job. You’ll need to provide evidence from a medical professional confirming that you cannot return to work.
- The date you started receiving income replacement benefits: If you’re receiving income replacement benefits from another source (e.g., workers’ compensation, sick leave), this may affect the date your TPD benefit starts.
Keep these critical dates in mind when lodging your TPD claim to ensure that your claim is processed smoothly.
If you’re unsure about any of these dates, it’s best to speak with a law firm specialising in Superannuation and Insurance Claims.
4) Incorrectly filling in your claim form
Experienced TPD lawyers know how to fill in and submit an effective TPD claim form with all the necessary evidence for your insurer to decide promptly. Common mistakes arise when people don’t understand why they are being asked certain information or give too much or too little detail (or the wrong detail). These errors can slow down processing time instead of speeding it up as intended. This can lead to delays, or worse – denying your claim or reducing your payout.
Our legal team will support you throughout every step. Our job isn’t just about winning your case but ensuring you meet or exceed your insurers’ expectations for claim submission.
5) Conflicting medical assessments
If you’re claiming Total and Permanent Disability (TPD) benefits, one of the critical assessments will be your medical condition. To be successful, you will need to provide a medical report from your treating doctor. However, in some cases, the insurance company may also request information from an independent medical examiner (IME). If the two reports conflict, it can make it difficult to determine whether you meet the criteria for TPD benefits.
The IME report will likely be given more weight than your treating doctor’s report. Your IME assessment is supposed to be unbiased. However, this doesn’t mean that the IME report will always be given more weight.
You could be assessed unfairly in these circumstances:
- Your insurers’ doctors met with you for a short period
- The insurers’ doctors have a limited understanding of your condition
- Your insurers’ doctors has the wrong details in your report
Each case is different, and it’s ultimately up to the insurance company to decide which report they find more convincing. If you’re in this situation, getting advice from a qualified TPD lawyer who can help you understand your options is important.
6) Submitting documents piece by piece
Insurers use a common tactic to slow down or even deny your claim by requesting documents one at a time. For example, you submit the initial paperwork, and then they ask for:
- your tax records
- and then your Medicare files
- and then your Centrelink records
- and then your medical reports
- and then your clinical reports
To minimise this, you should submit as many of your supporting documents as possible to prevent them from slowing down the process.
Ensure all requests for information are in line with what’s reasonable and necessary. Your lawyer can provide advice on your legal options in this situation.
Get Expert Legal Advice for TPD Claims
If you have an illness or injury impacting your ability to work and are making a TPD claim, it’s essential to avoid these common mistakes. By working with an experienced lawyer who specialises in insurance claims, you can be sure that your application is accurate and has the best chance of being approved. Don’t let your claim be denied – get started today!
