5 steps to a successful TPD claim

If you become ill or injured and are unable to work as a result, benefits from TPD insurance can be an important way of ensuring you can still put food on the table and take care of yourself and your family. Many of us already have a lot of different kinds of insurance – be it health insurance, home and contents insurance, income protection insurance – and we’re comfortable making insurance claims without any assistance, dealing directly with the insurer. However, TPD claims are more complex. As a consequence, we’ve seen TPD claims rejected by insurers, even where it is an eligible claim that should have been approved. Given the high stakes that are often involved, including the future financial wellbeing of your family, people often decide to enlist the help of expert TPD lawyers to manage their claim. 

Whether you choose to use a lawyer or not, if you’re thinking about making a TPD claim, you should put yourself in the strongest position possible. Littles is here to help! Our expert TPD team has developed this 5 step guide to making a successful TPD claim.

#1 Check your super

The first step is to locate all of your super accounts, and associated TPD policies. Chances are, if you have had a job, you’ve got a super account – with TPD insurance. Many people have multiple super funds from having had multiple jobs over the years, although there are initiatives to prevent this from happening moving forward. If you do have multiple super funds, then you might have a number of TPD policies you can claim against. Your member statements will indicate what insurance cover is included with each fund, so start by gathering your super statements. Depending on your circumstances, this can involve a lot of digging. Not everyone has their statements to hand, or knows where to easily find them!

Let Littles help! We can do a FREE super claims check so that you know exactly what your entitlements are.

#2 Check which policies were in place when you became ill or injured

Having all the information about your policies to hand is important, because to make a claim against a policy, it will need to have been valid at the time you became injured or ill. You’ll need look at which of your TPD policies were in place at that time.

Let Littles help! We know that not all illnesses and injuries have a clear-cut ‘start date’, and can develop over time. Littles can help you work through your policies and medical history, and communicate with your insurer on your behalf. 

#3 Check and understand your insurance policy criteria

TPD insurance policies differ from super fund to super fund. This means that the success of your claim may depend on the key terms and definitions in your particular TPD policy or policies. To be entitled to TPD benefits, you will generally have to 

• cease work due to illness or injury, and 

• be permanently unable to work in any occupation which you are suited to by education, training or experience 

Some policies provide that you need to show that you are unlikely to work again even if you are retrained; while others place no obligation for re-training. This is an example of some of the important differences between policies which could greatly impact on the success of your claim or not. 

Read more here: Calling all tradies and construction workers! Do you have TPD insurance with CBUS – Littles

Let Littles help! We can carefully assess the fine print in your TPD policy or policies, and provide you high quality expert advice. 

#4 Put your best foot forward and prepare a thorough application, including all records needed to substantiate your claim.

Once you’ve completed steps 1-3, the hard work really begins. Not only do you have to complete the insurer’s application form, but you must ensure that it is accompanied by sufficient evidence to support your claim. These may include medical, employment and taxation records. If you do not substantiate your claim in this way, it’s likely your insurer will seize on this as an opportunity to ‘drip feed’ requests for information, refusing to process your application until the appropriate documents have been provided and dragging out your claim. Many people just don’t necessarily know where to find, or how to obtain this information. As a result, people become deeply upset and frustrated, unsure of what they need to do to satisfy the insurer, and sadly give up on their claim.

Let Littles help! We can request and compile all of the necessary evidence on your behalf, and deal with the insurer’s requests – so that you can concentrate on your wellbeing.

#5 Follow the dispute process if your claim is denied.

Has your TPD claim been rejected? Don’t despair! We understand that having your TPD claim denied can give rise to a range of emotions, including anger, frustration and worry over your family’s financial future. While we understand that you may want to write an angry letter of complaint, there are a number of important things to consider before you take your next step.

First and foremost, you need to closely look at your insurer’s reasons for refusing your claim. Have they misinterpreted your TPD policy? Have they made a mistake or mischaracterised your illness or disability? Is the insurer relying on a technicality to deny the claim?

If this is the case, seeking review of the insurer’s decision may often be a more effective approach in terms of helping you get access to much needed funds to help pay the bills and put food on the table. There’s nothing to stop you from making a complaint at a later date.

Seeking a review can be a complex process that often involves complex legal considerations.

Let Littles help! While it is best to seek legal advice as early as possible in your TPD claims process, Littles has helped many clients successfully seek a review of an insurer’s decisions to refuse their application.

Don’t delay – seek advice now

Do you have an injury or illness that prevents you from working, or just want to know more about what insurance you have under your super? 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.

Free advice and no upfront fees

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. 

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