Published 07 Oct 2014
At first glance, lodging a TPD claim may look like a simple process. You advise your fund of your intention to make a claim and they send you out the paperwork required. This usually consists of a Claim Form for you to complete, a Medical Statement for your treating doctor to complete and an Employer Form for your previous employer to complete.
Once there documents are completed and returned, you may think that the decision will be made fairly quickly but on most occasions, this is simply not the case. The documents are passed onto the Insurer to assess and there are actually copious amounts of further documents, reports and information they request before making a decision regarding your entitlement to the benefit amount.
Often, the documents, reports and information they request is not warranted or needed to assess your claim and will be requested on a ‘piecemeal’ basis, meaning that they request information in intervals and thus drag out the assessment process in an untimely manner.
Further, because you do not have someone managing the case from your perspective, you will not be privy to the information they have requested or be provided with this information prior to the decision being made.
The end result is usually a denial of your claim or a decision simply not being made in a timely manner. There are no clear guidelines that govern how long the Insurer and Trustee have to make a decision. There is some indication from Supreme Court judgments, however there are hardly adhered to, especially if the fund member is handling their own application.
At Gerard Malouf & Partners our team of specialised Superannuation Lawyers have extensive knowledge in the insurance process. When your claim is lodged by us on your behalf, we make sure that we have provided everything the Insurer and Trustee may request at later stages in the first instance. Further, we give the Insurer and Trustee clear timeframes of when a decision is expected to be made and are prepared to commence court proceedings to enforce your rights if a decision is not forthcoming in a timely manner or if we believe the decision is incorrect.
We do not allow the insurance company to be idle when investigating your case and know exactly what information should or should not be used in the decision making process, thus not allowing them to make any unnecessary requests.
If you are unable to work due to having suffered an injury or illness, please do not hesitate to immediately contact the Superannuation Lawyers at Gerard Malouf & Partners for friendly, expert, legal advice.