$141, 000 TPD Insurance Claim Admitted Two Weeks After Being Submitted by GMP

Published 20 Jun 2018

Author: Jesicca Yousif

Our client, Mr F of Bringelly was formerly employed as a Truck Driver.

In July 2016, Mr F was involved in a motor vehicle accident where he sustained serious, life threatening, physical and psychological injuries.

Our firm was initially approached in relation to a Motor Vehicle Accident claim.

Given the severities of Mr F’s injuries, he was unlikely to return to work indicating a potential claim for a Total and Permanent Disablement (TPD).

The expert solicitors at Gerard Malouf and Partners identified that Mr. F had TPD insurance in the sum of $141,000.00 held in a superfund. Following consultation, our solicitors commenced the process to investigate and lodge a claim for TPD on behalf of Mr F.

Investigations were undertaken to identify:

  1. Whether valid cover was held
  2. If our client was eligible to claim
  3. Whether the evidence supported that our client satisfied the definition of ‘Total and Permanent Disablement’ as set out in the relevant insurance policy

We gathered extensive evidence including medical documentation to strengthen the claim and demonstrate that Mr F had not worked since the date of the injury and that his disablements would render him unable to return to work.

The claim was submitted to the superfund effectively demonstrating that our client satisfied the definition of ‘TPD’ within policy. The claim was approved in less than 2 weeks of being lodged.

Each Superfund defines ‘TPD’ differently. While lodging a TPD claim may appear to be a straight forward process, it is often more technical then revealed at first glance. Various considerations including date of injury, date ceased worked, hours worked prior to ceasing work may be taken into account by the insurer in deciding whether (1) someone is eligible to claim and then (2) are they TPD?.

Only upon satisfying this first test of eligibility, is the insurer then required to assess whether or not someone is TPD. Failure to satisfy this test of eligibility can ultimately result in an inability to lodge a TPD claim irrespective of whether or not you are TPD.

At Gerard Malouf & Partners our lawyers are experienced in handling insurance claims for TPD and income protection. If you intend to make a claim or believe you have a claim, please do not hesitate to contact our lawyers on 1800 004 878 for a free consultation.

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