TPD Insurance Claim Admitted One Month After Being Submitted by Lawyer

Published 24 Nov 2016

Mr L is a resident of Revesby who worked as a truck driver until 2011, when he suffered a severe episode of epilepsy.  After which he did not return to work due to risks of further episodes.

Mr L’s claim had several significant issues.  Firstly, his condition had afflicted him for many years prior to the commencement of the policy and secondly his work history was very sporadic.  The policy had specific clauses in relation to pre-existing conditions and requirement that Mr L be able to undertake full time work at the time of his condition in order to be eligible to claim on the policy.  The insurer required very specific medical records and employment records to demonstrate to their satisfaction that Mr L was both working sufficient hours and that the condition had deteriorated to the extent that it could be considered a new condition.

Mr L being unable to untangle what the insurer had requested retained the assistance of Gerard Malouf & Partner.  Our solicitors advised that Mr L had to show conclusively the significant change of his medical condition at 2011 and his ability to carry out work prior to the episode.  To that end, our firm gathered evidence and prepared the submission to persuade the insurer that our client satisfied the terms of the contract.  After one month of the claim as submitted by Gerard Malouf & Partners was submitted, the insurer admitted the full amount of the policy to Mr L.  Mr L is greatly relieved that his case no longer needs to be pressed and is very satisfied that Gerard Malouf & Partners was able to achieve for him a successful outcome which would assist him in his circumstances.

TPD insurance policies as held in superannuation funds are often set up without your knowledge and, unless you opt out, in order to ensure that they do not have to pay people who are already ill, put stringent pre-existing conditions and eligibility clauses, sometimes referred to as “at work” and “active employment” clauses into the policy.  It has the effect of preventing anyone with a pre-existing condition, and therefore unable to work, to claim on the policy for those conditions.  However, it is the case that many insurers are found to be unreasonable by the Court.

At Gerard Malouf & Partners, our solicitors are ready to assist you with their expertise and experience should your claim be denied by the insurer where they have inexplicably suggested that you were not “at work” or engaged in “active employment”.  Please do not hesitate to contact our firm on (02) 9630 4122 that we may further assist you in your insurance claim.


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