What Insurers May do to Deny or Delay TPD Claims?

When filing a TPD (Total and Permanent Disablement) insurance claim, people often worry about their eligibility and the loopholes that insurers use to deny or delay claims. It’s understandable to be concerned.

Insurance companies can further complicate the TPD claim process. Here are a few ways they may delay or reject your claim:

Misleading Advice – “Complete” or “Permanent” disability

Many people will consult their insurer or super fund to check their eligibility for a TPD claim. However, many times insurers provide poor advice which leads them to believe they aren’t “disabled enough” to be eligible.

Many insurers will imply that you need to be “permanently” or “completely” disabled after a horrific event, to be eligible for a TPD claim. However, that is untrue. Generally, for the claim, you need to prove your inability to work your current job due to your injury, despite being qualified by experience, or education, etc.

Confusing Dates

For most TPD claims, the work-based TPD definition implies that you were working at the time you were injured that left you unable to continue your job. If you were not working at the time of the injury, the insurer may not assess your claim under a different TPD definition

However, sometimes insurers may imply that you were not working at the time of your injury – you ceased work for an unrelated injury. Hence, they conclude that your claim doesn’t fall under a work-based TPD definition. This could mean that insurers can reject your claim.

Here’s why some insurers may do this

Instead of resigning, you accepted a redundancy
Your medical condition is not diagnosed yet
You didn’t consult a medical professional when you ceased work
Other reasons

Usually, you can challenge the insurer’s decision about the severity and time of your injury.

Difference of Medical Opinion Between Doctors

Sometimes, the doctors might argue about your ability to resume your job. Your treating doctor could be saying that your disability has prevented you from the job forever – supporting your claim. However, doctors working with insurance, might feel differently and imply a possibility of you working again – rejecting your claim.

The insurer will usually choose the doctors working with insurance, over the treating doctors. This can be troublesome when

Your consultation with the insurer’s doctor was brief and inadequate.
The insurer’s doctor is unaware of the current circumstances and has mixed up the details on their final report
Both!

Medical evidence is crucial to argue with the insurer’s doctor’s opinions. Your treating doctors can usually help provide that evidence.

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Never-ending and Unreasonable Requests

You complete the claim forms with all relevant details and submit them to the insurance company. Usually, they request some documents – tax records, medical reports, and so on.

Insurers may request information or documents, one by one, to delay your TPD claim. However, providing as many relevant documents as possible, even when not requested, will stop insurers from causing any delay. Our TPD lawyers are experienced and know exactly what they will request.

However, you can also choose to refuse any unreasonable requests. But, you must understand which requests are reasonable and which aren’t. If you deny a reasonable request, it could delay your claim even more.

Contact Us

These are just a few of the things that insurers do to reject or delay your TPD claims. Hence, many people opt for a TPD lawyer to help them get through the tedious process quickly. The value and experience of a TPD lawyer are crucial because we know how the system works – which documents are necessary, what requests they may make, what requests are reasonable, and more.

If you are unable to continue your employment due to an injury, consider a TPD claim. We understand how important it is for you to have someone stand up for you when dealing with a well-resourced insurer.

Let us help you navigate through the complicated claim process, and understand the fine print in insurance policies. We are dedicated to your rights and will ensure you get the benefits you deserve.