Why is my insurer or fund refusing to pay my TPD claim?

Published 27 Jun 2017

Becoming disabled, whether it’s due to an accident or illness, is a life-changing event that can leave individuals and their loved ones unsure about the future.

Not only do disabilities have a significant impact on your day-to-day activities, they are likely to cause problems for you in the workplace. In some cases, you may never be able to return to your previous job or any other form of employment due to the severity of your condition.

Fortunately, many people have total and permanent disability (TPD) cover included as part of their superannuation contributions or as a separate insurance policy to provide financial support when such incidents occur.

Not all funds or insurers pay out on claims, however, so let’s take a look at some of the common reasons you may get rejected.

1. Your claim was too late

Many TPD policies have a deadline within which you must file a claim, so you are likely to have your payout turned down if you fall outside of this time limit. However, you may be able to argue that extraordinary circumstances prevented you from submitting the claim on time, so contact a superannuation disputes lawyer to see whether you still have a case.

2. You do not classify as totally and permanently disabled

Every policy has its own classification of what constitutes a TPD, and the insurer or fund may decide that your disability doesn’t meet its criteria. TPD claims can be expensive for organisations to approve, so they will be keen to find ways of avoiding a payout. Again, check with a qualified lawyer to see whether the insurer or fund’s decision is questionable.

3. You are too old

Many TPD policies stipulate that claimants must be aged below 65 years of age on the date that they withdraw from the workplace due to a TPD. So even if you have an insurance policy in place on the day you cease active employment, you may be rejected if you are older than the maximum age allowed.

4. The insurer has gathered evidence against you

Insurers commonly carry out surveillance on individuals to gather evidence reject claims. This can be a stressful experience for claimants, particularly those with mental health disabilities that may be intermittent and not always obvious to outside observers.

Has your TPD claim been rejected for one of these or any other reason? Please contact Gerard Malouf & Partners Superannuation Lawyers.

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