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Fund tries not to award TPD payout

Case Overview

In 2010, our client was subjected to physical, verbal and emotional abuse at the hands of her former partner.

She sustained severe physical and psychological injuries and as a result has continued to suffer from insomnia, nightmares, weight loss, hypervigilance, anxiety, irritability, shortness of breath and social isolation. She was eventually diagnosed with severe anxiety, depression and PTSD.

Our client maintained regular attendance with her GP, psychologist, psychiatrist and the outpatient PTSD clinic at her local district hospital. In order to reduce the time she spent at home, she sought employment as an administrative assistant. 

She achieved minimal benefits from her treatment and the trauma continued to impact her ability to work and cope with her daily activities. She attempted to reduce her working hours, but her inability to cope with her employment duties together with regular complaints from other staff members led her to cease work for an indefinite period in the future.

Our Approach

Our client approached Gerard Malouf & Partners and engaged the services of our experienced Superannuation Solicitors to investigate her TPD insurance claim. Our Solicitors recognised how sensitive our client’s case was due to the circumstances surrounding the nature of her injuries and quickly identified that great care and extensive evidence was required to prepare the TPD claim for submission on the Superfund.

Despite our Solicitors providing a compelling case to the Superfund, during the assessment process, the Superfund gathered unfavourable medical and employment evidence in support of their preliminary assessment to decline the claim. 

The Superfund asserted that the evidence they obtained identified that under the relevant policy our client was not “Disabled”, because at the time of the disabling event she was not “At Work” and in receipt of supplementary Government benefits. This assertion was a turning point in the way this claim would be assessed because if the date of disability was to shift to an earlier date (date of the assault), our client was not insured for TPD.

 

The Result

Our experienced Solicitors worked timelessly and gathered the necessary evidence to get our client’s claim to resolution for a TPD insured benefit amount of $92,200.

Aadil Ahmed Lawyer Photo

Aadil Ahmed

Senior Associate
Every step towards the goal of justice requires sacrifice, suffering and struggle; the tireless exertions and passionate concern of dedicated individuals” – Martin Luther King
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.

TPD claims, which are payouts from a type of disability insurance purchased either privately or through your super, have the lowest rejection rate of insurance cover and an approval rate of more than 80%.
 

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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 — Personal Injury Compensation Lawyers

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