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GMP Solicitors secure a result for a client after an unreasonable superfund delay

Case Overview

Our client was working as a Community Support Worker when she developed a multilevel degenerative disc disease in her lower thoracic spine. The associated paraesthesia of the left leg, burning sensation to her right foot, pain in the lower back, bilateral shoulder pain, left neck pain together with pain in her left foot and ankle resulted in her having to cease work.

Our client engaged in multiple spinal surgeries, pain relief medication, physiotherapy, hydrotherapy and exercise physiology, which did not improve her symptomology.

She was rendered unable to sit, drive, stand or walk for extended periods of time and doctors supported that she would not be able to work in any role she was educated, trained or experienced to do.

Our Approach

Gerard Malouf and Partners prepared a compellable case, gathering all the available medical, employment and other evidence to support our client’s case. Despite this, our client’s claim was subjected to unnecessary delay tactics from the Insurer that pushed the assessment period past what we viewed as reasonable.

Courts have provided a guideline for how reasonably long a TPD claim can be assessed. They dictate as a guideline that 6 months is generally enough to make all the necessary enquiries to conclude their investigations. However, even if a TPD claim appears to be straightforward, many can take longer to determine.

In the event that an Insurer is taking an unreasonably long time to make a decision, requesting documents that have already been supplied or requiring documents that are irrelevant, our Solicitors are willing to take action to take back control of the assessment.

In this circumstance, we had provided detailed submissions, extensive medical evidence and put forward the necessary documents to have the claim assessed. Despite this, our client had been waiting a year. We wrote to the Insurer and advised we would be filing proceedings in Court should a determination not be forthcoming.

The Result

Fortunately for our client, our efforts agitated the Insurer into making a decision and the claim was successfully approved for a TPD benefit amount of $180,000.00.

Angelica Adhar Lawyer

Angelica Adhar

Law Clerk
There is no greater joy, nor greater reward than to make a fundamental difference in someone’s life. – Mary Rose McGeady
Frequently Asked Questions

More Information

In general, a TPD insurance claim takes around six months for the insurance company to assess. However, it can take longer if there is a dispute, or it can be wrapped up in a shorter time frame if your claim is extremely clear and you have the right superannuation disability attorneys on your side.

Be aware that once the insurance company has made its decision in regard to your TPD claim, the trustee of the superannuation fund will need to follow up with their own separate assessment of the claim. This can add an extra month or two to the process.

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.

In Australia, there are protections in place for people who suffer injuries or illnesses that render them permanently unable to work in their previous career. This is called total and permanent disability insurance (or TPD insurance) and it will provide a lump-sum payment that will help you maintain your finances to a certain extent, even as you can no longer earn an income in the traditional way.

It is important to note that you do not have to have suffered this injury or illness as a result of your job to make a TPD claim.
 

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%.
 

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Gerard Malouf & Partners
 — Personal Injury Compensation Lawyers

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