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Making any kind of insurance claim can be stressful – let alone if you can’t work because of an accident or injury. Add to that dealing with insurers who weigh you down with complex, legalistic communications , processes and demands, and an already challenging time can be made significantly worse. At Littles, we’re experts in insurance law, and we know all of the insurer’s tricks and traps. Join us while we bust 5 common ‘myths’ that insurers regularly try out!
…busted! The words “total” and “permanent” disablement often leave people thinking that they need to be catastrophically injured or disabled to claim a TPD benefit. In fact, that is simply not the case. To make a TPD claim, you generally need to show that you’re not able to do the work that you were doing before you stopped work or could do using your transferrable skills. ‘What is a TPD claim’
…busted! Many people speak to their super fund or insurer and, as a result of poor advice, often feel that as a result, they are not entitled to make a claim under their insurance policy. If this happens, hang up the phone on your insurer, and use it to call an expert. At Littles, we’re experts in insurance law, and can read the fine print of your insurance policy with a close understanding of your personal circumstances in mind. Need help? Get in touch for a FREE super claims check today. https://littles.co/contact/
…busted! Insurers expect you to understand the complex legalese in your insurance policy, and will use their own lawyers to help find loopholes to avoid accepting your claim. A common example is in the definition of TPD. Most TPD policies provide that for your TPD claim to be assessed under a ‘work-based’ TPD definition, you must have been working at the time you got sick or injured and became unable to work. If you are not working when you get sick or injured and become unable to work, your claim may end up being assessed under a more difficult TPD definition. Sometimes, to make claims harder, insurers will say that you did not get sick or injured and become unable to work until AFTER you stopped working – that is, that you ceased work for a reason unrelated to injury or illness. Accordingly, they may not allow you to have your claim assessed under a work-based TPD definition. This can result in your claim being rejected.
Confusing, right? We know that in these instances, many people have perfectly reasonable explanations for leaving their jobs, including
· because you accepted a redundancy (rather than resigning due to ill-health).
· because your condition had not yet been diagnosed, or
· because you did not see a doctor when you stopped working.
Usually, there are ways to challenge the decisions that insurers make about why and when you became too sick to work. If you feel like your insurer is tying you up with complex legalese, call Littles a FREE initial consultation. It costs you nothing to find out where you stand (1800 548 853 LITTLES)
…busted! Sometimes the doctors are simply unable to agree about whether you will work again. Usually, what we see is your treating doctors saying you will never return to work and supporting your claim, whilst doctor/s engaged by the insurer says that you will. Your insurer will usually prefer the opinions of their doctors over the opinions of your treating doctors. This can seem unreasonable and frustrating when:
· you have only briefly consulted with the insurer’s doctors
· the insurer’s doctors don’t know your situation or circumstances well, or have got many of your details wrong in their report, or
· all of the above!
At Littles, we’ll fight for you. This means ensuring that the insurer properly considers all of the available medical evidence, including reports from your own doctor or independent medicolegal doctor. If your claim has been rejected due to conflicting medical opinions, Littles can help. Contact us on (1800 548 853 LITTLES) today.
…busted! Our clients come to us telling us that they started their claims in good faith, and were happy to comply with the insurer’s requests for information and documents. They diligently complete the insurer’s claim form, together with the details you thought they would need to assess your claim. Then they request:
· your tax documents
· then your Medicare documents
· then your Centrelink documents
· then a medical report
· then your clinical notes
…and this is often before they tell you that you must their doctor, or undergo a ‘factual interview’!
While being proactive in giving the insurer as many documents as you can may be a good way to stop insurers from delaying your claim, you are entitled to push back and refuse any unreasonable requests. The key to this is knowing which requests are reasonable and which requests are unreasonable. This is one of the many reasons that our clients tell us dealing with insurers added stress to their lives at an already difficult time. If you need assistance dealing with your insurer, let Littles help! (https://littles.co/contact/)
If you have an illness or injury that prevents you from working, you might be worrying about how you are going to pay your bills and put food on the table. You could be entitled to receive a TPD lump sum, as well as other insurance benefits. Get in touch with Littles for a free super claims check. We can help you understand what you’re entitled to. Know where you stand, and get peace of mind.
Not only do we offer a FREE claims check – we handle most insurance claims on a no win, no fee basis.
Our Head of TPD and General Insurance, Rowan McDonald, is an insurance law expert. If you think you might have a claim, get in touch with Rowan and his team for high quality legal advice.