Have you found yourself unable to work due to an injury or illness? Are you struggling to make ends meet while dealing with the physical and emotional toll of your condition? If you have income protection or Total and Permanent Disability (TPD) insurance through your superannuation fund or insurer, you may be entitled to make a claim for benefits. However, the process can be complex, and disputes with insurers are not uncommon. In this article, we’ll explore how the Australian Financial Complaints Authority (AFCA) and an experienced compensation claim lawyer can help you navigate the claims process and fight for the benefits you deserve.
Understanding Income Protection and TPD Insurance
Now, let’s take a moment to understand what income protection and TPD insurance are, and how AFCA and your lawyer can help you.
Income protection insurance is designed to provide you with a monthly benefit, usually up to 75% of your pre-disability income, if you are unable to work due to injury or illness. The benefit is typically paid for a specified period, such as two or five years, or until you reach a certain age, depending on your policy.
TPD insurance, on the other hand, provides a lump sum payment if you become totally and permanently disabled and are unable to work again. The definition of TPD varies between policies but generally requires that you are unable to work in your usual occupation or any occupation for which you are reasonably suited by education, training, or experience.
Both types of insurance can provide a valuable financial safety net if you find yourself unable to work. However, making a successful claim is not always straightforward.
Common Disputes with Insurers
Insurers may deny income protection or TPD claims for various reasons, such as:
- Non-disclosure of pre-existing conditions: If you failed to disclose a pre-existing medical condition when applying for cover, the insurer might argue that they would not have provided cover had they known about the condition.
- Exclusions: Most policies have exclusions for certain conditions or circumstances. For example, your claim may be denied if your disability arises from a self-inflicted injury or participation in dangerous activities.
- Insufficient evidence: Insurers may argue that there is insufficient medical evidence to support your claim or that your condition does not meet the policy’s definition of disability.
- Failure to follow treatment plans: If you fail to follow recommended treatment plans or participate in rehabilitation programs, the insurer may argue that you are not mitigating your loss.
These are just a few examples of the disputes that can arise with income protection and TPD claims. If you find yourself in a dispute with your insurer, it’s essential to understand your rights and options for resolving the issue.
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The Role of the AFCA
The Australian Financial Complaints Authority (AFCA) is an independent external dispute resolution scheme that can help resolve disputes between consumers and financial services providers, including insurers.
If you have made a claim for income protection or TPD benefits and the insurer has denied your claim or you are dissatisfied with their decision, you can lodge a complaint with the AFCA. The AFCA will investigate your complaint and try to resolve the dispute through negotiation or conciliation.
If the dispute cannot be resolved through these methods, the AFCA can make a binding decision, which the insurer must comply with if you accept it. The AFCA can consider complaints about a range of issues, including:
- Denial of claims due to non-disclosure, exclusions, or insufficient evidence
- Delays in processing claims or making decisions
- Incorrect calculation of benefits
- Failure to follow proper claims handling procedures
It’s important to note that the AFCA can only consider complaints after you have first tried to resolve the issue directly with the insurer through their internal dispute resolution process.
The Role of a Compensation Claim Lawyer
While the AFCA can be a valuable resource in resolving disputes with insurers, it’s often helpful to have an experienced compensation claim lawyer on your side. A lawyer can:
- Help you understand your policy and your rights;
- Gather evidence to support your claim, including medical reports and witness statements;
- Negotiate with the insurer on your behalf; and
- Represent you in any legal proceedings, such as court hearings or arbitration.
A lawyer can also help you explore other options for compensation, such as:
- Workers’ compensation claims if your injury or illness is work-related;
- Personal injury claims if your condition was caused by someone else’s negligence; and
- Disability Support Pension (DSP) applications if you are unable to work and meet the eligibility criteria.
Choosing the right lawyer is crucial. Look for a lawyer who specialises in compensation claims and has experience dealing with income protection and TPD disputes. Many lawyers offer a free initial consultation, so take advantage of this to discuss your case and get a feel for whether the lawyer is a good fit for you.
Dealing with an injury or illness that prevents you from working can be a stressful and overwhelming experience. If you have income protection or TPD insurance, you may be entitled to benefits that can help ease the financial burden. However, disputes with insurers are common, and it’s essential to know your rights and options for resolving them.
The AFCA can be a valuable resource in resolving disputes, but it’s often helpful to have an experienced compensation claim lawyer on your side.
Book a consultation
Getting the income protection you deserve and dealing with TDP disputes can be challenging. Don’t hesitate to contact our expert compensation lawyers at ROC Legal today who can help you navigate through the complexities and get the entitlements you are owed.
Call us: 1300 196 219
Check if you’re eligible for a Compensation Claim
Find out if your injury or illness is eligible to make a compensation claim. Your online check only takes 3 minutes.