Published 11 Sep 2018
Mr P of Nelson Bay is our client for a TPD case. He was injured at work in 2012 in his lower back/lumbar spine. He had at that time hired another law firm to assist him. That firm ran both his Workers Compensation case and TPD claim. The TPD was not approved. The Workers Compensation claim was ultimately resolved but for far less than promised, and he was also disillusioned by the significant fees of that other firm.
Mr P did not want his initial team to continue and hence contacted Gerard Malouf and Partners for legal assistance. We reviewed our client’s TPD file and it became immediately clear the previous solicitors merely sent all the Workers Compensation material with the mandatory “forms” to the insurer. They had not made any arguments as to why, and more specifically when, our client satisfied the TPD contract. This is a complicated issue as our client had made attempts to return to work and it was unclear when he became completely unable to work.
GMP immediately prepared the appropriate arguments and acquired the evidence to support it, including acquiring expert doctors’ reports to address the questions specific to satisfying TPD which was not answered in any of the previous material. These took around 3 months to put together. GMP directed this detailed position to the insurer and demanded payment. The insurer accepted the claim after 2 months, paying to our client just under $500,000.00.
Our client is greatly relieved by this outcome and the funds arising alleviates many of the financial pressures resulting from his injuries. He is very satisfied that GMP can assist him and to achieve payment so quickly, and thankfully with no need for court proceedings.
TPD insurance is presented as very simple, requiring only a few forms. The insurer sells it that way, many people believe it, and even lawyers focus too heavily on the formal elements of making a claim. Many people equate serious illnesses with successful TPD, and simply send volumes of material as the claim – and getting the claim declined.
On the contrary, TPD claims often become very complicated arguments about “Working Dates”, “Dates of Disability”, and alternate definitions. These are all part of the complicated TPD contracts – designed to be unclear by the insurer.
Gerard Malouf & Partners have experience in insurance contracts and have assisted 100s of clients in successful TPD claims. Should you have a TPD or Income Protection claim and need assistance, please don’t hesitate to contact us for a free consultation.