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 difficult 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 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.
It’s also important to note that insurers will deny a claim if they deem it fraudulent or unsubstantiated.
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 you have a rejected TPD claim.
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. Rely on our expertise to reverse the insurer’s decision and secure your lump sum payment. Call Now: 1300 873 252
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 TPD 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 you had a rejected claim and allow you to gather other relevant documents, like 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 the exact reason 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. It is helpful to understand the TPD claim policy and its application in your particular circumstances. Understanding 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 hard to manage alone. Make sure you get the help you need!
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. Evidenced by our 99% win rate.
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 effective legal help with the complex process of securing a TPD payout. Call Now 1300 873 252
