There can be nothing worse than suffering a disability caused by an accident or by an illness. It can change your life and the lives of those you love, and it’s made all the more gut wrenching if you have to manage the fallout of your inability to continue to work full time if at all.
Becoming disabled can leave you and your family unsure about the future. Not only do disabilities have a significant impact on your day-to-day activities, they are likely to cause problems for you in the workplace. In some cases, you may never be able to return to your previous job or any other form of employment due to the severity of your condition.
No matter how or where you were injured, or whether or not it was your fault, you might not realise there are many things you can do with regard to a claim for disability, be that for a pension or a lump sum to give you the best chance of success you should consult an expert lawyer in the field. They will be able to quickly determine if your case is valid and advise you about your Life Insurance policy, Superannuation fund or Disability Support Pension, or other options to help with your claim.
However, not all insurers or Super funds pay out the claims that they receive.
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Reasons for Rejected Claims
1. You Lodged Your Claim Too Late
Some, if not all Total and Permanent Disability (TPD) policies have a time frame in which you must lodge your claim. If you fail to file it on time it is more than likely going to be refused. You might be able to argue that due to unforeseen circumstances you were unable to lodge it on time. The way to handle this is via your lawyer who will be able to discern whether or not you can still make a claim.
2. You Are Not Able to Fit the TPD Classification
Your TPD has to suit the requirements of your particular policy and all insurers and super funds have their own criteria that constitutes what a TPD is. In other words, your TPD has to fit your policy’s classification, if it doesn’t your insurers might decide to reject your claim. Proving such claims can be expensive for your insurers or Super fund so they are not keen on paying out. It’s wise to have a chat with a lawyer qualified in these areas to determine if the insurer or fund’s decision is able to be questioned.
3. Your Age Disqualifies You
The requirements of most TPD policies is that anyone who makes a claim has to be below the age of 65 on the day they stopped work because of a TPD so even if you are insured on the day you ceased employment due to your TPD, if you were over 65 your claim may be rejected.
4. Evidence Has Been Found to Dispute Your Claim
It’s very common for insurers to put a tail on you and for such surveillance to gather evidence so they can dismiss your claim or make it invalid. Claimants can find this a most distressing experience, especially for someone whose claim is for PTSD or other mental disabilities that are almost impossible to detect or to be assessed physically by untrained observers.
The best way to avoid the stress is to get the help you need from an expert lawyer who can support you through the process, arrange medical examinations and reports and give you advice on your claim.
TPD Lawyers
The team of specialty lawyers at PK Simpson are highly trained when it comes to running TPD and Superannuation claims. Your first consultation is free and you’d be taken through the process and we’ll explain our ‘no win, no fee’ basis.
If you have a disability due to an accident or illness and believe you can make a claim, or just want more information, call PK Simpson on 02 9299 1424 for a chat. Or, email enquiries@pksimpson.com.au.
Frequently Asked Questions
Yes, you can. If you’re diagnosed with a serious cancer that has an impact on your ability to work, you may not realise you are entitled to claim insurance benefits through the insurance provided through your superannuation. These benefits may include income protection if your disablement is temporary, and TPD if your condition is long-term and serious. If your condition is terminal, you will be eligible for a terminal illness payment.
Yes, you can. People are now becoming more aware of depression and other mental illnesses, and while there’s a way to go before the stigma is lifted, we’re talking about it more often. Around one in four Australians suffer from a mental illness each year. However, insurers are wary of mental illness disability claims, and it can be quite hard to get cover. But what many people fail to recognise is that the automatic TPD insurance you have through your superannuation fund can pay out much-needed benefits and funds if you cannot work due to depression or any other mental illness.
Mental illness can often be a lingering side effect of a physical injury, even after full physical recovery.
Yes, you can have multiple TPD claims providing your insurance policies or super funds are independent of each other. Bear in mind that, unlike other personal injury claims, when you make a TPD claim, you do not have to prove that the illness or injury was work-related or caused by somebody else.
A successful TPD claim can never be 100 per cent guaranteed, but you are much more likely to win your claim if you contact a TPD specialist lawyer at PK Simpson to discuss your situation. There is a minimum level of evidence required to support your claim, which must be provided to your insurer and your super fund. This includes your claim form, a signed authority, certified ID, and two medical reports from your treating doctors showing that you can never return to work. These will need to be reviewed by a lawyer to ensure all the correct boxes are ticked, and that the evidence strongly supports your claim for TPD.
Often, terms and conditions specific to your policy need to be analysed in order to make sure the fund cannot decline your claim.
Superannuation funds will often require specialist reports. Superfunds do not pay for treatment throughout the claims process. However, PK Simpson pay for all medical reports needed to support your claim.
Most claims are paid out and finalised within three to six months, but it all depends on how complicated the claim is, and how much good evidence you have about your injuries. There is also the matter of whether you fulfil all the criteria set by your insurer. This is why it’s crucial to have a specialist TPD team on your side when you make a claim for TPD for any reason.
As lawyers we will make sure your claim is assessed by the superfund in a timely manner. Delay tactics are deployed by funds to prolong and frustrate TPD claimants who are not legally represented.
If you haven’t been able to work in your usual job for three to six months due to an injury or illness, you are likely to be classed as TPD.
Each superfund has their own TPD definition and this must be satisfied for the TPD claim to be approved. Common factors which are assessed in each claim are the members work history (education, training and experience), suitable jobs, and medical evidence.
Your TPD entitlements are set out in the contract (a.k.a. policy, or product disclosure document) you have with your insurer. Therefore, the definition of TPD will vary between policies and insurers.
If you or anybody you know has ceased work due to illness or injury and they cannot return for at least six months they could be eligible to claim TPD benefits. Call PK Simpson specialist TPD lawyers today on 1300 358 057 or email inquiries@pksimpson.com.au