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TPD Claims: Seven Steps to a Successful Claim.

To make a successful TPD claim, you need to qualify under the criteria set out in your TPD policy. But just because you qualify for a TPD claim doesn’t mean your claim will be a simple process. What many people fail to understand is that you also need to complete a thorough application that clearly shows why you qualify. As a result, a lot of valid TPD claim get rejected by insurers or are abandoned because the process becomes too difficult. 

In this guide we take you through the seven steps to successful TPD claims, including tips from specialist TPD lawyers on how to win a TPD claim and receive a lump sum TPD payout for your injury or illness.   

TPD Claims: Seven Steps to a Successful Claim.

How do you qualify for a TPD claim? 

If you’ve been off work for three or more months due to injury or illness, with no prospect of returning to work, then it’s possible that you’re eligible to make a TPD claim. But different policies have different provisions and definitions, so you’ll need to check your policy to confirm that you qualify to make a TPD claim. 

For example, your TPD policy might cover you for:

What happens when you claim TPD? 

To get your TPD claim approved, it’s important to fully understand the TPD claim process, and avoid the pitfalls that result in TPD claims being denied.   

A successful TPD claim starts with getting in touch with your superannuation fund. They’ll ask you to complete some forms and they’ll carry out an initial assessment. At this point, you’ll usually be asked for any evidence of your injuries or illness. You’ll also need to make a written submission to the superannuation fund explaining why your claim should be approved.  

Following this, your claim will be passed onto the insurer who will carry out their own assessment and decide whether to approve or deny your TPD claim. The insurer could also ask for more evidence in support of your TPD claim.   

Although time frames can vary, this process typically takes up to six months to complete.   

How to make a successful TPD claim – the seven steps.

Step 1: Identify your superannuation / TPD policies.

The first step is to identify all your TPD policies. Many people have multiple super funds from having had multiple jobs over the years. If you have multiple super funds, then you might have multiple TPD policies you can make TPD claims against. Your member statements will indicate what insurance cover is included with each fund, so start by gathering the statements and make a list of which of your super funds have TPD policies.

If you’ve lost the statements or you’re not sure what insurance is included, you can contact us, and we’ll help you identify what you’re entitled to.

Step 2: Check which policies were valid when you were injured or became ill.

To make a TPD claim against a policy it will need to have been valid at the time you became injured or ill. This can be a grey area, as some illnesses and injuries develop over time, so if you’re unsure, think about the date you first became aware of your injury or illness. Then look at which of your TPD polices were valid at that time.  

Step 3: Take time to understand the approval criteria.

Read through the terms of your TPD policy (or policies) to understand what qualifies for a lump sum payout. For example, your TPD policy might cover you for:

So, with some TPD policies in Australia, you don’t necessarily have to be unfit for all work to make a successful TPD claim.

Step 4: Submit a thorough application, including all documents and medical records to substantiate your claim.

This is the key step in successful TPD claims. Many people simply complete the application forms and assume their claims will be approved. But if you do that and fail to supply all the evidence needed to support your TPD claim, it’s likely the insurer will simply keep asking you for more information and the process can really drag on. This is why many people who handle their own TPD claims end up failing to get the TPD payout they’re entitled to – they simply give up out of frustration.  

A TPD claim specialist can compile all the evidence and submit your claim on your behalf so that the insurer has all the information they need and you’re more likely to get your TPD claim approved.

Step 5: Include a thorough written submission explaining why your TPD claim should be approved.

This is also an essential part of a successful TPD claim, but something that is often overlooked by people who have their TPD claims rejected. A well-written submission will clearly state how your situation satisfies the criteria in your TPD policy.  Our TPD specialists write literally hundreds of these submissions every year. When insurers see well-written applications, they know they’re dealing with claims that have been professionally prepared and are highly likely to be valid claims. A poorly prepared submission or application, on the other hand, may be seen by the insurer as an indicator that the claim may not be valid.  

Step 6: Follow up with the insurer to make sure they have everything they need.

Being proactive will help avoid unnecessary delays and frustration in the TPD claim process. Don’t assume that the insurer will tell you immediately if anything is missing or not filled out correctly – follow up with the claim assessor to check on the status of your claim, and make sure they have everything they need from you.  

Step 7: Follow the dispute process if your claim is denied.

If your TPD claim is denied, don’t assume that’s the end of the matter – there are options available to dispute insurers’ decisions. Our TPD specialists have made successful TPD claims on behalf of many clients who originally submitted their own claims and had them denied.

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What percentage of TPD claims are successful? 

According to a 2019 ASIC report*, the percentage of TPD claims approved varies from 71% to 91% across Australian insurers. So with some major Australian insurers, as many as 3 in 10 claims may be declined.   

But while this may seem daunting, you shouldn’t let this put you off making a claim. The stronger your case the more chance you stand of having your TPD claim approved, and there are plenty of things you can do to strengthen your position.

First of all, it’s always a good idea to check your policy terms to make sure you fully understand your entitlements, eligibility criteria, the amount you’re insured for, and any deadlines or time limits. To make a claim for TPD, you must as a minimum:

There’s more to it than that, though. You need to submit a thorough application that ticks all the right boxes. Remember that it’s in the best interests of insurers to not pay out, so it’s likely they’ll reject any claims that aren’t watertight.

A strong application provides full and clear evidence of injuries that includes evidence like medical reports and X-rays, workers compensation files, as well as evidence that you can no longer work.

*ASIC Report REP 633: Holes in the safety net: A review of TPD insurance claims (page 14)

What could get a TPD claim rejected?

There are many reasons why you could end up having your TPD claim rejected by an insurer. Some of the more common reasons include:

If you’ve had a TPD claim rejected, you might still be able to reverse the insurer’s decision and have your TPD claim approved.

For example, if you’ve submitted a claim with weak evidence, it might be possible to track down and submit stronger evidence. Or if you’ve submitted your claim too late, there may be legitimate reasons for the delay which can be overlooked.

The biggest mistakes we see when TPD claims get denied are a lack of evidence, missing details, or a failure to provide all the right information. This sends the claim back and forth with the insurer and can cause the process to drag on before ultimately leading to a rejection.

It’s important to remember that because most people have never submitted a TPD claim before, they’re in a weaker position. And although they may be entitled to a TPD payout, missing critical information and evidence can frustrate the process or lead to a TPD claim rejection.

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Was your TPD claim rejected?

If you’ve had your TPD claim rejected, our TPD specialists might be able to help. The TPD claims process can be quite complicated, so it helps to have a trained and experienced professional who knows how to win a TPD claim on your side.

Remember, just because you’ve been declined doesn’t mean you don’t have a claim. It could be because you haven’t submitted strong enough evidence or that you’ve missed something during the claims process.

If you’ve had a TPD claim rejected, our TPD specialists can:

Speak to a TPD specialist at Law Partners today if you’d like advice on your TPD claim, or to find out more about how to get your TPD claim approved.

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