If you have suffered a life-altering injury you may have recently tried to access your Total and Permanent Disability (TPD) insurance. In some cases, these claims are rejected by the insurer and if this is the position you have found yourself in, you may be feeling lost and confused about your options going forward.
As you would already know, the process of making a TPD insurance claim and accessing your benefits can be long and involved and usually means incurring added costs due to visits to the doctor, so it is understandable that in addition to living with a life-altering injury you may also be feeling overwhelmed at the thought of not having an income or your medical expenses paid for. It is important to remember that you are not alone and you may have options.
Read on to learn more about why your TPD claim might have been rejected and what steps you can take next.
Why was my TPD insurance claim rejected?
Every insurance and superannuation policy is different and each claim for TPD benefits to be accessed is reviewed individually, but some of the most common reasons for why a TPD claim might be rejected include:
- your policy’s minimum waiting periods have not been satisfied;
- your policy’s required level of disability has not been met;
- your work history requirements have not been fulfilled (for example, you may not have been able to prove a loss of income);
- another claim, such as workers compensation or a claim relating to a motor vehicle accident, already covered your injuries;
- your policy no longer covers you because you have either closed your account or the account has remained inactive for a long period of time (for example, you may not have made contributions to your superannuation fund for an extended period of time); or
- you simply did not provide the correct or adequate evidence to support your claim.
What can I do if my TPD claim has been rejected?
It may not be the end of the road if your TPD claim has been rejected and you have the right to have your claim reassessed.
The first step to take is to find out why your claim was rejected. This enquiry may provide you with a quick answer, for example, you may find that your account was closed or your cover had lapsed which may mean you were ineligible for cover.
If the reason for your TPD claim being rejected has to do with incorrect or inadequate evidence then you should seek the assistance of a personal injury lawyer who can help you to pursue a reassessment of the claim. These types of claims typically require the support of extensive documentation from medical professionals, including their expert opinion on your ability to work in the future.
If you believe that the rejection of your claim was not made in good faith, you may also be able to take one of the following options:
- lodge a complaint with your insurer’s dispute resolution service;
- lodge a complaint with your insurer more broadly; or
- lodge a written complaint about the insurer with the Financial Services Ombudsman.
Insurers can be difficult to deal with and having a claim reassessed can be time-consuming and complex, particularly if you have already gone through the process of submitting your initial claim. If your TPD insurance claim has been rejected and you need professional advice on what your options are, our personal injury lawyers can assist.