For many injured Australians, a TPD claim can provide considerable support. Unfortunately, not all claims are approved. We understand how disappointing having a rejected TPD claim can be after you’ve already been through physical, emotional, and financial challenges. But you are not alone. According to a 2023 report from the Australian Prudential Regulation Authority (APRA), up to 23% of individual non-advised TPD claims are initially rejected. However, it’s important to remember that it’s not the end of the road. Remedies are available that can help you get the compensation you deserve. In this guide, we’ll explain why TPD claims are rejected and how to challenge a rejection.
Ready to challenge your rejected TPD claim? Talk to one of our expert Super and TPD Claims Lawyers now.
What is TPD Insurance and Why Is It Important?
Total and Permanent Disability (TPD) insurance is a crucial financial support for Australians who cannot return to work after a serious illness or injury. However, some are unaware they have TPD coverage, as it’s often integrated into their superannuation fund. When a claim is successful, TPD insurance provides a lump sum payment to help cover medical expenses, living costs, and ongoing care needs.
Given the significant role TPD insurance plays in supporting individuals during difficult times, it’s no surprise that claim rejections can be frustrating. However, it’s worth noting that many of these rejections are overturned through appeals and legal action when necessary.
Why Do TPD Claims Get Rejected?
Understanding the common reasons behind TPD claim rejections can help you prepare for the next steps. While each case is unique, there are several key reasons why insurers reject claims:
Policy Status Issues
One of the most common reasons for TPD claim rejection is a policy that has become inactive. This often happens if your superannuation account has been closed, or if no contributions have been made for an extended period. This is particularly relevant if you’ve switched jobs or had breaks in employment. If your TPD policy has lapsed, insurers may reject the claim on these grounds.
Misalignment with the Policy Definition
TPD policies contain specific definitions for what constitutes a “total and permanent disability.” Sometimes, the condition causing your inability to work doesn’t meet these precise criteria, even though it severely impacts your life. For example, mental health conditions often face a higher bar for proving permanent disability, as insurers may argue the condition is not sufficiently severe or ongoing.
Insufficient or Incomplete Evidence
A significant number of TPD claims are rejected due to insufficient or incomplete evidence. Insurers require comprehensive documentation to support the claim, including medical records, specialist reports, and evidence of how your disability prevents you from working. If your documentation is incomplete or inconsistent, your claim may be rejected.
Failure to Meet Employment History Requirements
Another common reason for rejection is failure to meet the policy’s employment history requirements. Some TPD policies require you to have a certain level of employment or work history to qualify for benefits. If you fail to meet these criteria or your employment status isn’t clearly documented, your claim could be rejected.
Rejected TPD Claims: What to Do
If you’ve received a rejection for your TPD claim, don’t be discouraged. Several options are available to challenge the decision, and many rejected claims are successfully overturned. Here’s a clear, step-by-step approach to help you move forward:
Review the Rejection Letter
Read the rejection letter thoroughly. The letter will outline the reasons for the rejection, which will help you determine the best course of action. Request a copy of your full claim file from the insurer so you have all the relevant documents at your disposal.
Gather Additional Evidence
If your claim was rejected due to insufficient evidence, it’s time to strengthen your case. Here’s what you can do to improve your evidence:
- Medical Reports: Obtain updated and detailed reports from your treating doctors and specialists.
- Treatment History: Provide a complete history of your medical treatments and ongoing care needs.
- Employer Statements: Get statements from your employer or former employers to demonstrate the impact of your condition on your ability to work.
- Rehabilitation Attempts: If applicable, gather evidence of rehabilitation efforts or attempts to return to work.
Appeal the Decision
You have several pathways to challenge a rejected TPD claim. What you choose depends on the specifics of your case.
Internal Review
Your insurer will typically have an internal review process. You can request this review, which involves submitting additional evidence and information that directly addresses the insurer’s concerns. Many claims are successfully overturned during this review stage, especially if the insurer thinks there was an error in the initial decision or if it lacked sufficient evidence.
AFCA Complaint
If an internal review doesn’t lead to a satisfactory result, you can lodge a complaint with the Australian Financial Complaints Authority (AFCA). This is a free, independent service that resolves disputes between consumers and financial service providers, including insurers. You have up to two years from the date of rejection to file a complaint with AFCA.
Legal Action
If all else fails, legal action is always an option. You have six years from the date of the rejection to initiate court proceedings. While this course is more complex and can be time-consuming, it is often the most effective route for complex cases where the insurer is being particularly resistant.
Time Limits and Why They Matter
It’s essential to act quickly after your TPD claim is rejected. Remember these strict time limits for filing appeals and complaints:
- 2 years to lodge a complaint with AFCA.
- 6 years to initiate court proceedings.
Taking prompt action helps ensure your evidence is still fresh, and it also avoids unnecessary delays in your case. Delaying the process could weaken your position, so the sooner you take steps to challenge the rejection, the better.
How We Can Help
Challenging a rejected TPD claim can feel like an additional burden, especially when you’re already dealing with the physical and emotional toll of your condition. This is where our experienced TPD & Super Claims Lawyers can make a significant difference. Here’s how we can help:
Comprehensive Claim Review
We will carefully review your rejected TPD claim to identify the reasons for rejection., and pinpoint weaknesses in the interpretation of evidence or policy. Our expertise in TPD insurance claims allows us to evaluate your case from all angles.
Expert Evidence Collection
This part is crucial. To ensure maximum claim support, we work with medical professionals and employment experts.
Strategic Appeal Advice
Whether you’re pursuing an internal review, filing an AFCA complaint, or considering court action, we’ll help you determine the most appropriate strategy for your situation. We’ll guide you every step of the way to make the process as smooth and efficient as possible.
No Win, No Fee Arrangement
We understand the financial stress of dealing with a rejected TPD claim. That is why we have a no-win, no-fee guarantee to help you pursue your claim without worrying about upfront costs.
Moving Forward
Dealing with a rejected TPD claim is tough, especially when you’re at your most vulnerable. But with expert advice, you can turn the situation around. We’re here to give you expert advice and support throughout the process to help you succeed. Take note, however, that strict time limits apply. The sooner you act, the better.
If your TPD claim has been rejected, don’t give up. Reach out now to our experienced Super and TPD Claims in Brisbane, Gold Coast, Bundaberg, Hervey Bay, or Rockhampton for a FREE claim check, no strings attached! 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.