Case Overview
- Self-employed floor layer challenged by an insurer on his retail TPD policy of $2.3 million.
- The insurer further attempted to deny the claim on the basis that our client attained transferrable skills in the use of his own business that could be applied in alternative job roles.
- Our staff was able to have the matter determined without litigation and with no compromise to the full TPD entitlement of $2.3 million.
Our client, a 43-year-old self-employed floor layer ran a successful flooring business for 15 years. He sustained significant injuries to his back, right thigh, right hip, right arm, right elbow and right shoulder when he fell down a flight of stairs during a site inspection.
As a result of his physical injuries, he went into severe depression. The combination of these injuries prevented him from returning to any form of employment. He filed for total and permanent disablement with his superannuation insurer.
Initially, the insurer attempted to reduce our client’s benefit from $2.3 million to $1 million, claiming he misrepresented his employment duties when applying for cover. In particular, they relied on his disclosure that he spent 10% of his time only performing manual labour work.
On receipt of the claim lodged, the insurer requested an occupational questionnaire in which our client disclosed that 80% of tasks performed in the business by him were manual in nature.
“Initially, the insurer attempted to reduce our client's benefit from $2.3 million to $1 million, claiming he misrepresented his employment duties when applying for cover.“
Angelica Adhar
Our Approach
The insured benefit amount was disputed, so the evidence was reviewed by a team of Gerard Malouf & Partners professionals. Further submissions were provided to the insurer which was later accepted and the higher insured benefit was applied.
The abundance of medical evidence was suggestive of the fact that our client could never return to work as a floor layer. The insurer challenged this incapacity and claimed that while they accepted that he could never perform future work as a floor layer, our client acquired transferrable skills that could be utilised in alternative job roles.
As a result of ongoing pain and disability, our client developed psychological sequelae and was referred to a psychologist for treatment. On this point, our team argued that the insurer did not appropriately consider the extent of both his physical and psychological injuries which in totality prevented his return to work in any capacity. The insurer proceeded to gather evidence to support its position.
At this point, however, our client was suffering financially. Our team then forwarded to the insurer a letter of demand reminding them of their obligation and duty of good faith and fair dealing towards our client. The claim was resolved shortly after the insurer received this correspondence.
Our professional team worked tirelessly to ensure that our client received his maximum benefit without compromise. Engaging professional services can increase the likelihood of your matter being resolved in the first instance without having to go to Court.
To discuss any potential entitlements you may have, please contact our firm for a free consultation on 1800 959 280 or by filling out an enquiry form online.
The Result
With the help of GMP lawyers, our client was able to have the matter determined without litigation and with no compromise to the full TPD entitlement of $2.3 million.
Angelica Adhar
Senior Superannuation Case Manager
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.
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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