My Insurer is Delaying My TPD Claim: What Are My Rights?

If your insurer is delaying your TPD claim, there are several things you can do immediately.

Under the Life Insurance Code of Practice, your insurer must make a decision on a lump sum TPD claim within six months of receiving it, and update you at least every 20 business days until it does.

If they fail to do so, you can lodge a complaint immediately. There’s no waiting period or deadline for this.

Your rights when a TPD claim is delayed

TPD claims move slowly by design. This is because the insurer has to be satisfied you will not be able to return to work rather than that you are simply unwell.

That does not make an open-ended wait acceptable. There are published timeframes which apply, and they are the same all over Australia.

The timeframes your insurer has to meet

The Life Insurance Code of Practice sets these timeframes out. The version in force took effect on 1 March 2025, and it is owned by the Council of Australian Life Insurers and enforced by the Life Code Compliance Committee. It binds subscribing insurers, so check to see if your insurer is subscribed.

For a lump sum benefit, which is what a TPD payment is, clause 5.49 of the Code of Practice requires the insurer to make a decision within six months of the Claim Received Date, or the end of any waiting period your policy specifies, if that is later.

The Code defines the Claim Received Date as the date the insurer records receiving the first piece of information allowing it to start assessing the claim. Two things then follow:

• It starts at the first document, not the last, so the insurer does not get a fresh six months each time it requests something else.
• It is the insurer's date, not the day you lodged. A claim made through super generally goes to your fund first, and the time it is there lies outside the six months, which means your claim may be younger on the Code's count than it feels.

Read our article on what insurers weigh up when assessing your claim

As well as the six month deadline, the Code requires insurers to:

• Update you on your claim's progress at least every 20 business days while they decide, or issue a Show Cause or Procedural Fairness letter (cl 5.6).
• Respond within 10 business days whenever you inquire about your claim (cl 5.7).
• Inform you of their decision in writing within 15 business days of gathering all the information it reasonably needs (cl 5.50). That sits inside the six months rather than being added to it.
• Give written reasons if they decline, with a summary of the information relied on and copies of those documents sent out within 10 business days of you asking (cl 5.58).

The six months can be exceeded, but not without good reason.

Clause 5.47 renders the timeframes subject to “Circumstances Beyond Our Control,” a closed list of eight situations set out by the Code. Where the insurer relies on it, clause 5.59 requires them to inform you in writing of what those circumstances are before the six months is up, keep updating you every 20 business days and tell you about its complaints process.

If the delay is going to run past 12 months, clause 5.60 means your claim is sent to a senior team member or review committee.

Delay on your side is also on that list of eight situations, so be sure to answer all requests promptly and in writing. Keep a dated record of every request, response and instances where you don’t receive a reply; ask for your claim file; and read your own insurance guide so you’re sure of the waiting period and definition that apply to you.

The Code can be found on the Council of Australian Life Insurers website.

Who your claim is actually with; the insurer or your super fund

It’s usually both, and the distinction will be key in the decision about who you chase.

Most Australians hold TPD cover inside their superannuation under a group policy, which your fund's trustee owns and you are covered by.

You are the life-insured, not the policy owner.

The Code binds life insurers, not super funds. Clause 1.10(a) excludes superannuation fund trustees unless a fund adopts them, which makes the timeframes above the insurer's, even though your fund is generally who you deal with.

Your fund is held to legislation instead.

Under s 52(7)(d) of the Superannuation Industry (Supervision) Act 1993 (Cth), they are required "to do everything that is reasonable to pursue an insurance claim for the benefit of a beneficiary, if the claim has a reasonable prospect of success."

They must also act in beneficiaries' best financial interests (s 52(2)(c)), and belong to the AFCA scheme with a compliant complaints process (s 101(1)). Your insurer separately owes you a duty of utmost good faith under s 13 of the Insurance Contracts Act 1984 (Cth), extended to you as a third party beneficiary by s 13(3).

Your fund is not simply a bystander waiting on the insurer's letter, and reminding a fund that has gone quiet of that often works better than just making another call.

Your right to complain at any time

There is no waiting period and no deadline that applies to you.

ASIC's Regulatory Guide 271 sets out the definition of a complaint clearly as “an expression of dissatisfaction about an organisation's products, services, staff or complaint handling, where a response is expected or legally required” (RG 271.27).

Being left in the dark qualifies, and you don’t need to receive a decision or denial to make a complaint.

• Lodge with either organisation. RG 271.79 states that a complaint about insurance in superannuation can be made to the insurer or the trustee, and the clock starts running from when it first reaches either.
• You must be acknowledged within 24 hours, or one business day.
• A superannuation trustee must give you a written response within 45 calendar days. Where an insurer handles a complaint outside super, the maximum is 30 calendar days (RG 271.56). Those are calendar days, and the day your complaint arrives is not counted.
• Someone other than your claims assessor handles the complaint (cl 7.5). You can also report a Code breach to the Life Code Compliance Committee under clause 8.14, which can sanction an insurer but will not resolve your claim.

There is no 28-day rule when it comes to TPD claims.

The only 28-day period in this area belongs to superannuation death benefit distributions, where a beneficiary objects to a proposed decision within 28 days under s 1056(2)(a) of the Corporations Act 2001 (Cth) (RG 271.80).

This has nothing to do with TPD claims, and if you have read otherwise, that is likely where the figure came from.

Red flags and warning signs

Slow progress is not the same as unreasonable, and TPD assessments depend on medical reports from people who don’t always answer quickly.

None of the following factors prove anything improper has happened, but each one is a point where a published standard is not being met, which gives you something specific to raise.

• No progress update for more than 20 business days, which is the Code's own interval and does not depend on your claim having reached any particular age.
• Six months from the Claim Received Date has passed with no decision and no letter. Both things are due before the six month expires.
• You are told the hold-up is the insurer waiting on its reinsurer. The Code's closed list of “Circumstances Beyond Our Control” covers information required from you, your fund, a service provider, your doctor or a government agency, and explicitly excludes reinsurers.
• A second independent medical examination by the same type of medical specialist is requested inside six months, with no reason given. Clause 5.22 requires the insurer to avoid this wherever possible, and to explain why it’s requested if it does go ahead.
• You are told the six months restarts because a new document was requested. This is not the case. Under clause 5.57, the clock only restarts when a closed or declined claim is reopened or reassessed at your request, which creates a new Claim Received Date.

Common scenarios and questions

These are common situations which arise when a claim has gone quiet.

Every timeframe below comes from the Code, ASIC's guidance or the AFCA Rules, not from any insurer's own practice.

I cannot pay the bills while I wait, can the insurer help?

The short answer is that they must consider any request for urgent access, but if your cover is inside super, the realistic outcome is getting a faster assessment rather than receiving money early.

Clause 6.25 requires the insurer to assess a request for urgent access in the event you urgently need the benefit because of a condition your policy covers. It will likely request evidence of that need.

Clause 6.26 requires the insurer to inform you of what help it can offer within five business days of receiving that evidence, along with your right to request a review and its complaints process.

The help most likely to be available is prioritising your assessment and decision to try and get a decision faster.

The insurer will tell you who you need to contact, and the law limits access to superannuation benefits. Meeting the policy definition is separate from whether your fund releases money early.

There is no repayable interim advance or loan against a group super TPD benefit, so treat any suggestion of one with caution.

How long do I have to take a TPD decision to AFCA?

The short answer is either four years or six years from the decision, depending on why you stopped working. The AFCA will not extend either time limit.

Under AFCA Rule B.4.1.1:

• If you are permanently unable to work because of the condition you are claiming for, you must have claimed within two years of permanently stopping work, and you must make a complaint to the AFCA within four years of the decision.
• If you did not permanently stop working because of that condition, you must file your complaint with the AFCA within six years of the decision.

There is no law which sets a deadline for lodging a TPD claim with your fund.

The two years above is a condition of the AFCA being able to help you later, not a limitation period on the claim. Rule B.4.4.1 states that "AFCA will not extend any of the time limits set out in rules B.4.1.1 to B.4.1.4." These AFCA limits are separate from the 45-day internal complaint timeframe, so make sure you keep the two apart.

There is a trap in Rule B.4.1.2. Where an internal review confirms, varies or substitutes the original decision, that later decision is treated as the original decision and as having been made when the original was made, so a review does not buy you more time.

What can AFCA actually do about a delay, and can I get interest?

The short answer is it can review the conduct as well as the decision. There is no monetary limit on a superannuation complaint, and interest is available in situations where payment was withheld unreasonably.

Under s 1055 of the Corporations Act 2001 (Cth), the AFCA must affirm a decision or conduct if satisfied it was fair and reasonable. In the event it finds either unfair or unreasonable, it may take action, but only to get you as close to a position where that unfairness no longer exists as possible.

Lodging with the AFCA is free once the internal response deadline has passed (which is 45 calendar days for your fund and 30 for an insurer outside super) or you have a response you disagree with.

• There is no cap. AFCA's Rules state that "there is no monetary limit on the amount that may be awarded to the Complainant" for a superannuation complaint. Rule D.4, which sets the caps, applies to complaints other than superannuation ones.
• You cannot get a payment for distress. Rule D.1.4 disapplies the non-financial loss compensation in Rule D.3 to superannuation complaints. The delay and its effect on you are still worth documenting because they go to whether the case was handled reasonably.
• Interest is different. Under Rule D.6.2(a), the AFCA generally calculates interest in line with the Insurance Contracts Act 1984 (Cth). Section 57 runs interest from the day it became unreasonable to withhold payment at a rate that regulation 38 of the Insurance Contracts Regulations 2017 (Cth) ties to the 10-year Australian Government Bond yield. This rate moves, so any fixed percentage you see quoted is likely out of date.

When to get legal advice

Most people can manage the early steps themselves, and this article was written to help you.

Advice is key when the argument stops being about dates and starts being about medical evidence measured against a policy definition.

It’s always worth seeking legal advice when it comes to TPD claims, especially if:

• Six months from the Claim Received Date has passed with no written explanation, or the reason given does not match the Code's list of “Circumstances Beyond Our Control.”
• You are being asked for a third or fourth medical assessment with no straight answer about why.
• Your fund and the insurer are each pointing at the other and neither is moving.
• You receive an internal response you disagree with and are considering going to the AFCA, where the time limit cannot be extended.

Why early advice helps: a delay complaint is won on the paper trail, and that trail is built during the delay rather than after it.

Key takeaways

Remember these essential points:

• You can complain at any time. There is no waiting period and no deadline. The only 28-day rule here applies to death benefit distributions.
• Find out the Claim Received Date before you count anything. The six months runs from when the insurer recorded receiving your claim, not the day you lodged it.
• The 45 days is their clock, not yours. Your super fund has 45 calendar days to respond in writing, and an insurer handling a complaint outside super has 30 days.
• Your super fund has its own duty under s 52(7)(d) of the Superannuation Industry (Supervision) Act 1993 (Cth) to do everything reasonable to pursue your claim, so chase both.
• AFCA can look at delay itself, and there is no monetary limit on a superannuation complaint, although the limits for complaining about a decision cannot be extended.

Get Help Now

If your TPD claim has stalled and you are unsure whether the delay is reasonable or who to chase, early advice will tell you which timeframe applies and what to ask next.

Smith's Lawyers runs superannuation insurance claim (TPD) matters across Australia. Call 1800 960 482 or use the form below, and our team will talk through where your claim is at and what comes next. Fixed-fee arrangements are available in some situations, otherwise our fees reflect the work done and are payable only if your claim succeeds, under our No Win, No Fee, No Catch® promise.