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GMP settles 2 TPD claims for a client post work injury

Case Overview
  • Mr. K became injured during the course of his employment while he was lifting a 55kg roof bolter into a dolly car without assistance. As a result, he sustained a nerve impingement at the L5/S1, lower back pain, right leg pain and paraesthesia.
  • The team at Gerard Malouf and Partners quickly assessed Mr K’s situation and began preparing Total and Permanent Disablement claims with his various Superfunds.
  • Once Mr. K’s funds were identified, insurance with 2 superfunds were confirmed totaling over $126k.

Mr. K was a 47-year-old man who was last employed as a coal miner, when he became injured during the course of his employment. In mid-2008, he was lifting a roof bolter weighing approximately 55 kilograms into a dolly car without assistance. As a result, he sustained a nerve impingement at the L5/S1 and continued to suffer from lower back pain, right leg pain and paraesthesia. Mr. K underwent multiple surgeries, physiotherapy, analgesia and trialed steroid injections but continued to suffer from pain when trying to walk, bend, lift or stay in one position for an extended period of time. He also suffered from secondary depression, anxiety and hypotension.

By the time our client contacted Gerard Malouf and Partners, there was little to no prospects of any meaningful recovery or improvement that would have enabled him to return to any form of work for which he was reasonably suited by education, training or experience.

Our Approach

The team at Gerard Malouf and Partners quickly assessed Mr. K’s situation and began preparing Total and Permanent Disablement claims with his various Superfunds

When lodging a claim for total and permanent disablement, it is important to identify all the Superfunds you belong to or have previously belonged to. If you are unsure, engaging experienced solicitors can help ensure all avenues are explored and exhausted. 

Once Mr. K’s funds were identified, insurance with 2 superfunds was confirmed totaling over $126k. GMP proceeded to obtain various medical, employment and other documents to review, assess and submit in support of Mr K’s claim. Once lodged, GMP actively liaised with the Superfund and Insurer to ensure the swift progression of each claim, and to facilitate the assessment of the claim within a reasonable timeframe. When the Superfund and Insurer asked for further information, the reasonableness of each request was considered and either complied with or addressed with the fund/insurer.

At Gerard Malouf & Partners, we have a proven track record of getting positive outcomes for our clients’ TPD claims. We have hundreds of TPD matters either ready to be lodged or awaiting a decision in court. Call us now for a free consultation at 1800 004 878

The Result

Gerard Malouf and Partners quickly assessed Mr K’s situation and began preparing TPD claims with his various Superfunds totaling over $126k.

Jesicca Yousif Photo

Jesicca Yousif

Associate
“Start by doing what’s necessary; then do what’s possible; and suddenly you are doing the impossible.” – St. Francis of Assisi
Frequently Asked Questions

More Information

You can purchase TPD insurance as a standalone product from insurers, although there’s a chance you may already be receiving total or partial coverage under other policies.

There are various ways that you may be entitled to disability benefits, including through:

  • A superannuation policy;
  • Life insurance;
  • Income protection cover;
  • Mortgage protection or loan protection insurance;
  • Employment disability and/or trauma cover; and
  • Sickness or accident policies.

However, you may not know how much you are eligible to receive and what criteria you must meet. Check the wording of your policies closely and contact a personal disability claims lawyer for information if you want further clarification.

Many people have access to TPD cover through their superannuation policy, although others may choose a standalone product from an insurer if they have tailored needs. Payouts are used to cover past and future income losses, medical bills, care and rehabilitation needs, out-of-pocket expenses and other costs.

However, policyholders must meet certain criteria to receive payments, which means there is always a chance the insurer or super fund refuses to approve the claim. But how often does this happen in Australia?

TPD claims rejected more than any other life insurance

In 2016, a comprehensive ASIC report into the life insurance industry examined the decline rates of four types of cover:

  • Life (cover for death).
  • TPD.
  • Trauma.
  • Income Protection.

Overall, nine out of 10 life insurance claims are paid in the first instance, but the figures for TPD cover were less encouraging.

In fact, disability insurance was the least likely of the four products to result in compensation, with 16 per cent of claims rejected. Some insurers had particularly high decline rates; ASIC found three companies turned down 37, 25 and 24 per cent of claims, respectively.

Fewer than half of funds make full or partial payments on between 71 and 90 per cent of claims, according to SuperRatings. The research, published in the Australian Financial Review, also showed nearly one in ten successful policyholders receives less than 60 per cent of the amount claimed.

Fortunately, compensation is typically available for TPD sufferers through their superannuation fund or separate insurance policies. But what if you have TPD protection under more than one type of policy? Can you make multiple claims?

You’ll be happy to learn the answer is often ‘yes’. However, there are some factors to consider before pursuing claims.

TPD stands for Total and Permanent Disability, and is usually attached to life insurance provided by your superannuation fund. It delivers a lump-sum payout if you have a medical diagnosis indicating that your life has been irrevocably changed and you will most likely never be able to work again.
 

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Gerard Malouf & Partners
 — Personal Injury Compensation Lawyers

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