My insurer has told me that my disability insurance claim is under investigation. What do I do?

We know that when you make a disability insurance claim like income protection, total and permanent disablement (TPD) or critical illness, money can be tight and you’re eager to start receiving payments as soon as possible.

When assessing an insurance claim, an insurer is entitled to make reasonable enquiries which are necessary for it to make a decision on your claim.

What’s considered reasonable will depend on your particular circumstances,

This process can be stressful when you’ve done the right thing and have paid premiums on time and aren’t sure how to answer these enquiries.

If you’ve made a claim for TPD, income protection, trauma insurance or life insurance, read this article for practical information on what can be considered ‘reasonable enquiries’ by the insurer, and which questions you need to, or should, answer.

What kind of enquiries can my insurer make?

In assessing your claim, an insurer will often make significant requests for information. These may include, among other things:

  • long and complex claims forms (which can be designed to catch you out in the answers you give);
  • a Medical Attendant’s Statement or Attending Doctor’s Report completed by your doctors;
  • a statement completed by your former or current employer;
  • medical records from any and, possibly, every doctor you’ve consulted with;
  • copies of your income tax returns, Notices of Assessment, Pharmaceutical Benefits Scheme or Medicare claims history, or Centrelink file; and/or
  • that you attend a specialist medical examination with a doctor of the insurer’s choice.

Depending on the nature of your claim, they may also ask for additional documentation or information.

Can my insurer request that I attend an interview with an investigator?

Insurers sometimes request that you attend an interview with an investigator they have engaged, even if you have a legitimate claim. These investigations are often completed by former police officers specially trained to do this work.

These interviews are often scheduled before you even understand the particular matters that the insurer is investigating, or that you are being investigated in the first place!

What can I do?

If you are asked to attend an interview with an insurer or their investigator, you should ask for a detailed list of questions before going to the interview.

Under the Life Insurance Code of Practice, you also have certain rights:

  • you are entitled to have a representative or support person (including a lawyer) present with you at the interview;
  • the interview may not run for more than two hours, unless you agree to an extension;
  • you can choose the location of the interview, within reason, and you are not required to allow the interview to be conducted at your home;
  • you are entitled to a copy of the transcript of the interview; and
  • you can choose whether the interview is recorded.

In some cases, you may be able to refuse to attend the interview at all.  

How can Littles help?

If you have been asked to attend an interview with an insurance investigator or any third party during the assessment of your TPD, income protection, trauma or life insurance claim, seek legal advice first!

We know that communicating with insurers and negotiating their complex processes can be stressful and time-consuming. You don’t have to deal with insurers’ enquiries on your own.

Arm yourself with high-quality legal advice now – let Littles help.

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.

We can advise:

  • whether the request that you attend the interview is reasonable;
  • whether you can refuse to attend; and/or
  • what information the insurer must give you before the interview.

We are experts in disability insurance claims and provide a 24-hour claim assessment guarantee. You can have a free, no-obligation chat with us today and know where you stand.

Not only do we offer a free initial no-obligation consultation – we handle insurance claims on a no win, no fee basis

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