If you’ve been injured at work and make a claim for Total and Permanent Disability (TPD) benefits, you may feel anxious and uncertain about what to do next if your claim is rejected.
Don’t worry; we’re here to help. This blog post provides a step-by-step guide on what to do if your TPD claim is rejected, including how to appeal the decision and your other legal options.
We understand this process is daunting, but we trust this article provides clarity and peace of mind. Please feel free to share it with anyone else who might be in a similar situation.
What is the success rate for TPD claims in Australia?
According to APRA statistics for life insurance claims and disputes, Australia’s average rate of denied TPD claims ranges between 20% and 30%. Mental health claims tend to have a higher rejection rate as it is generally more challenging to meet the TPD definition for a mental illness.
Why are TPD claims rejected?
Unfortunately, TPD claims can be rejected for a variety of reasons. Common reasons for claim rejection include:
• Medical evidence that does not meet the insurers’ requirements
• There was a misunderstanding between you and your insurer about the coverage of your permanent disability TPD insurance policy.
• Insufficient evidence
• The insurer believes the claim is fraudulent or unsubstantiated
• The insurance company obtained medical evidence saying you don’t have an injury or illness that qualifies as a total and permanent disability
• Not meeting work history requirements
No matter the reason for the rejection, you have options and should not feel helpless. We trust this step-by-step guide will give you a clearer understanding of what to do if your TPD claim has been rejected.
3 Options to Reverse the Insurer’s Decision
When you want a successful outcome, we recommend you speak with a specialist TPD lawyer to understand the reasons for a denied claim and the best strategy for winning your TPD benefit. Generally, there are three options for changing the insurer’s decision:
- Ask the super funds internal dispute team for a review of your case
- Lodge an external review with an independent party like the Australian Financial Complaints Authority (AFCA)
- Take action in court
Reverse a Denied TPD Claim with Aussie Injury Lawyers
Undoubtedly, an approved TPD payout helps cover medical expenses and other daily living costs so you can live comfortably with a total permanent disability. So, seek legal advice to reverse the insurer’s decision.
Aussie Injury Lawyers will help you have a successful TPD claim on a 100% no win, no fee basis. Pay when you win and nothing if you lose. With a 99% success rate, you can rely on our expertise in the TPD claim process to secure your lump sum payment. Call Now: 1300 873 252
More about denied insurance claims >
Strict Time Limits to Appeal a Rejected TPD Claim
If your TPD claim has been rejected, please know that there are strict time limits for appealing the insurer’s decision. Time frames vary depending on the insurance company and super fund policies. So, if you are considering disputing a rejected TPD claim, please immediately seek urgent legal advice.
TPD claim is rejected? Don’t panic; you have options
Don’t panic if your Total and Permanent Disability (TPD) claim is rejected. There are still options to help you successfully access your TPD benefit. In this situation, your best strategy is to seek urgent legal advice after a rejected claim so you know all your rights and options.
By getting clear and informed urgent legal advice, you will understand your situation better and be able to make a more informed decision about how to have a successful tpd claim.
First, request a copy of the rejection letter from the insurer
For denied TPD claims, you start the appeals process by requesting a copy of your rejection letter from the insurance company. Sometimes, this document is available from your superannuation provider.
This step will ensure you understand why your claim was rejected and allow you to gather other relevant documents, such as medical records, assessments, and other relevant policy documents.
Being informed about the life insurance industry’s regulations and procedural guidelines is key to making an accurate TPD insurance claim. Understanding why your claim information wasn’t accepted is essential for further pursuing the claim process.
Once you have the letter, review it carefully to identify the reason for the rejection
When you receive a TPD insurance rejection letter, it’s important to take the time to review it carefully. Most TPD claims involve complex policies, and it can be difficult to understand why your claim was denied at first glance. Understanding the TPD claim policy and its application in your particular circumstances is helpful.
Knowledge of the life insurance industry can also give you valuable insight that may be beneficial when appealing the decision. Take the necessary time to review your TPD insurance rejection letter, think through the TPD claim policy, and explore the options before taking further action, such as submitting an appeal.
If you disagree with the insurance company’s decision, you can file an appeal
If you’ve found yourself in a situation where you’ve been denied or rejected for an insurance claim, don’t despair. You can file an appeal and increase the possibility of a successful claim.
This step is particularly important when claiming benefits from an employer-provided plan through a superannuation fund. You could be owed compensation. While the appeal process can be intimidating, having hope and faith will give you the backing you need to get your TPD benefit. Stick with it, and your efforts may eventually bring positive results.
About The Australian Financial Complaints Authority
One option for reversing the insurer’s decision and accessing your TPD entitlements is to file a formal complaint with the Australian Financial Complaints Authority (AFCA). This independent body aims to help clients resolve complaints against financial institutions and super funds. Usually, they will attempt to settle a complaint through informal channels like mediation.
When you hire a TPD lawyer to represent your interests, they will manage the complex process of an APRA appeal on your behalf.
The appeals process can be complex, so it’s important to seek professional help.
Navigating the appeals process can be hard work and requires much effort. Different requirements per jurisdiction and the complexity of the law mean that you may benefit from professional help. An accredited specialist in the respective jurisdiction can take over your case, ensuring you have all relevant evidence to support an appeal, including medical evidence, if necessary. Dealing with legal paperwork on top of an illness or injury can be daunting and challenging to manage alone. Make sure you get the help you need!
TPD Claims and Mental Health
The Unique Challenges of TPD Claims for Mental Health Conditions
Mental health claims can be particularly challenging when it comes to getting a TPD payout. The complexity of a mental illness, combined with the subjective nature of diagnosis and treatment, can make it difficult to establish a clear case for an approved TPD claim.
Common challenges to winning a mental health TPD claim include:
• Getting sufficient medical proof to support the claim.
• The symptoms of a mental illness change frequently (e.g. bipolar disorder), making it challenging to show a consistent permanent disability.
• Insurers often dispute the severity of the mental illness, saying you are still capable of working or you haven’t had sufficient treatment for recovery.
To win a mental health TPD claim, you often need comprehensive and compelling medical reports. Hence, your best chance of winning a TPD payout is to work with a lawyer with extensive experience in handling TPD claims related to mental illness.
Seek Urgent Legal Advice From an Experienced TPD Lawyer
When a total permanent disability stops you from working, it’s crucial to access the financial resources available through your super fund. Likewise, if your TPD claim is rejected, you must seek legal advice to reverse the insurer’s decision. With over 100 years of combined legal experience in disability insurance claims, our TPD lawyers have the expertise to deliver a successful outcome. Our 99% win rate proves this.
Thankfully, Aussie Injury Lawyers offers free advice on a 100% no-win, no-fee basis. So, if your TPD claim has been rejected, contact us now for practical legal help with the complex process of securing a TPD payout. Call Now 1300 873 252
Rejected TPD Claim FAQs
What percentage of TPD claims are successful?
According to SuperRatings, about 70% of TPD claims have a successful outcome in Australia annually. Your chance of a successful claim is considerably higher with Aussie Injury Lawyers, who have a 99% success rate.
What can I do if my insurance claim is rejected?
There are three ways to challenge a rejected insurance claim:
- Internal dispute process starting with a formal complaint
- External dispute process with the Australian Financial Complaints Authority
- Court proceedings
What medical conditions qualify for TPD?
Depending on the terms of your TPD policy, any injury or illness that prevents you from working in your usual occupation could make you eligible to claim TPD insurance benefits.
