Sometimes, insurance providers will deny your TPD claim. It's a common occurrence, especially for claims made without the assistance for specialist lawyers.
Common reasons for TPD claim rejections
Claim made before waiting periods completed
Policy no longer active - this may be the case if you transferred or closed a Super account
Not meeting required definition regarding ability to work again - this can be difficult to prove as insurer may claim you can still work in some limited capacity
Dispute over evidence - Insurers may dispute the claims you have made on your application based on medical or work records. Some insurers may even use surveillance to catch you out and gain evidence to show you are physically able to work.
How to dispute and appeal a rejected TPD Claim
In the event that this happens you can seek a review of the claim. This will involve an appeal of their decision. To get this process started you will need to:
Submit a complaint to your insurance provider. This may require contacting the chief underwriter of your provider to talk about your claim. They will require a full explanation of your matter and you may need further evidence from your medical provider to support a claim to review.
Make a complaint to your insurer’s internal dispute resolution service. You may not be happy with the response you get from the initial complaint. If this is the case, you can contact the complaints and dispute management department of your insurance provider.
Complain to the Financial Ombudsman Service (FOS). If after going through the first two steps you are not satisfied, contact the FOS for a review.
A legal service provider can offer support and guidance throughout this process, and if you are seeking compensation for TPD it is important to know your rights and responsibilities.
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Last update on:
September 10, 2020
Disclaimer: This information is designed for general information in relation to Queensland compensation law. It does not constitute legal advice. We strongly recommend you seek legal advice in regards to your specific situation. For expert advice call 1800 266 801 or chat via live chat to arrange free initial advice with our Principal lawyer, Greg Smith.
Next steps — get advice now
It’s important to get advice for your specific situation. Check if you can make a risk-free compensation claim and get free initial advice from our Principal lawyer, Greg Smith.