Are you suffering from an injury, or were you diagnosed with a severe health condition that has made it unlikely you will return to work?
Then, you might want to consider lodging a total and permanent disability (TPD) insurance claim.
TPD insurance typically provides a lump sum if you become permanently unable to work due to injury or illness. This can provide you with financial assistance for your medical needs and financial support for your family.
Overview of the TPD Claims Process
While our process is simple, making a TPD claim can be a complex and lengthy process that requires a lot of paperwork, evidence, and patience, especially for someone who is not experienced with life insurance products.
On top of these often daunting tasks, you may have to deal with uncooperative insurers in proving your disability.
That is why we have created the 7-step guide to help you understand each stage of the TPD claims process and get the compensation you deserve. In this article, you will learn:
- How to obtain the claim forms and list of requirements?
- What to check for TPD claim eligibility?
- What are the common TPD claim requirements?
- How to write a TPD claim supporting letter?
- What to consider when submitting a TPD claim application?
- When and how to follow up with your TPD claim application?
- What to do when your claim is denied?
By following these steps, you will have a better chance of making a successful TPD claim and securing your financial future. Ready to get started? Let us dive in!
The 7-step TPD Claim Process
Based on recent data, the industry average for successful TPD claims in Australia is around 83.5%. This includes both professionally guided and individually processed claims.
This means there is still a high chance of getting rejected for TPD claims. The reasons for this could vary from incomplete medical evidence supporting the claim, inconsistency with the follow-ups, or misinterpretation of the TPD insurance definition, which can be incredibly complex.
It is for these reasons that our team created a free 7-step guide for anyone to use to help them increase their chances of getting approved for a TPD claim.
If you think our process is still a burden for you to get done, please reach out to us.
Our TPD claims advisers will handle every step for you so you can focus on your treatment and recovery.
Step #1: Obtain TPD claim forms and a list of requirements
Contacting your superannuation fund or insurance provider (if the TPD policy is held under your name) to inform them about your intent to lodge a claim is your first step.
Your insurer might ask for some basic information, such as your name, policy number, date of injury or illness, and the reason for your claim as initial screening before sending you the TPD claim pack and the list of documents you need to submit.
A clear understanding of the requirements and documents will help you to provide accurate and comprehensive information and documents.
Step #2: Check your eligibility for a TPD claim
Before proceeding to the next step, it is important to check that you are eligible for a claim. There are two main factors that you need to consider:
Make sure that your TPD insurance policy is valid and active at the time you become disabled.
A common requirement from insurers is that you are paying your premiums. However, some insurers may have complex criteria to declare that your policy is active and valid. In this case, working with a professional TPD claims adviser will be beneficial for you. An adviser can guide you in proving the validity of your policy to your insurer.
Next is to confirm your eligibility’s condition based on the disability definition of your policy and your insurer.
The Product Disclosure Statement (PDS) will help you understand your TPD coverage, whether it is defined as:
Own occupation – unable to work permanently in the same occupation you had when you became disabled.
Any occupation – unable to work permanently in any occupation suitable to your education, training, or experience.
Activities of Daily Living – unable to work again and can no longer perform two or more daily living activities permanently.
You can contact your insurer or your broker to get the PDS.
Step #3: Gather medical evidence and documents
This step requires you to be organized and persistent in following up with your doctors to get a copy of all the relevant medical evidence and documents that will prove your disability.
The documents and evidence may include:
- Medical reports and certificates from your treating doctors
- Statements from your employer, colleagues, or family members
- Proof of income and expenses
- Tax returns and payslips
- Workers’ compensation files or other insurance claims
- Any other relevant information that supports your claim
You should keep copies of everything you send and keep track of the dates and communication with the insurer.
Step #4: Write a TPD claim supporting letter
Writing a compelling TPD claim supporting letter is not mandatory, but it will add an authenticity appeal to the insurers which can result in a favorable response.
While there is no standard template, a supporting letter should include the following:
- Basic personal details and policy information such as policy number and effectivity date
- Description of your injury or illness and how it affects your ability to work
- How it satisfies the eligibility requirement of the policy
- A polite request for a prompt and fair assessment of your claim
Should you choose to work with Curo, we will guide you on how to come up with a compelling letter that will highlight the strong points of your application.
Step #5: Submit your TPD insurance claim
When it is time to submit your TPD insurance claim, remember to:
- Know where to send your claim
- Review and make sure you have all the files ready
- Create a copy of all the documents
- Take note of the date of submission
Step #6: Follow up with your insurer
After you submit your TPD claim, you will need to wait for the insurer to assess it and make a decision. This can take anywhere from 2 to 12 months, depending on the complexity of your case and the responsiveness of the insurer.
During this time, you should stay in touch with the insurer and provide any additional information or documents they may request. You should also monitor the progress of your claim and ask for updates regularly.
If you feel that the insurer is delaying or avoiding your claim, you can escalate the matter to their internal dispute resolution team or lodge a complaint with the Australian Financial Complaints Authority (AFCA).
Step #7: Be persistent even if your claim gets denied
As mentioned at the start of this article, more than 10% of TPD claims in Australia are declined by insurance providers. However, the insurer’s decision is not always final, and every individual has the right to appeal for reconsideration. You can explore these action steps if your claim is rejected.
- Requesting a review of their decision and providing new or additional evidence
- Seeking an independent medical opinion or assessment
- Negotiating with the insurer for a better outcome
- Taking legal action against the insurer in court
It is possible that your insurer might misinterpret your claims as well. Therefore, a polite request to appeal can be helpful.
But if you think you have exhausted all the efforts, you can reach out to Curo and take advantage of our no-win, no-fee basis on your TPD claims.
Step #8: (BONUS) What to do next after getting approved for TPD claim
An approved TPD claim means having access to financial support for your medical needs or to be able to support your family.
However, if misused, TPD payouts will not serve their purpose, and you could still be in financial trouble.
If you work with Curo Financial, you can also take advantage of our financial planning service which can further help you in managing your finances and TPD payout.
We will give you expert advice on how to compute your TPD tax and how to reduce them, create a budget plan that lets you set aside funds for all your expenses, and even maximise your payout for future endeavors.
Factors Affecting A Successful TPD Claim
Aside from not meeting the eligibility requirements or not having enough medical evidence, there are other reasons for the rejection such as:
- The medical condition is deemed to be not permanent and not total: Qualification is likelier with a more severe, permanent disability. Medical evidence from at least two doctors is required.
- You missed the TPD claim window: When filing for a TPD claim, it is best to know if your policy has a window or deadline. While most TPD insurances do not have it, there are insurers that have this under their policies.
- Misinterpretation of Policy Terms and Conditions: Understanding your policy’s definitions, exclusions, and limitations is crucial. Consult your insurer or get legal advice if needed.
- Work History and Income: Eligibility may depend on minimum work history or income. Proof of employment, income, and expenses is necessary.
- Daily Task Performance Ability: Some policies assess your daily functioning. Statements from those who know your functioning level may be needed.
- Ongoing Medical Care Need: Costs of ongoing care like medication or surgery might affect your payout. Receipts and other documents can demonstrate these costs.
How Curo Can Help You With Your TPD Insurance Claims Process
Whether you are just starting on the TPD claim process or have already been rejected by your insurer, Curo Financial can help you.
Our team of TPD claims experts has worked with hundreds of TPD claims with different complexities and sizes of coverage in Australia.
Curo can help you with:
- Checking your eligibility and coverage for a TPD claim
- Identifying all the benefits you may be eligible for
- Determining exactly why you are eligible for a benefit under the terms of the policy and concisely presenting this to the insurer
- Gathering and preparing all the necessary documents and evidence
- Guiding you through all the necessary paperwork
- Compiling your story for the claims assessor so that your circumstances are not misunderstood
- Following up and communicating with the insurer at regular intervals
- Negotiating a fair settlement offer and escalating issues where necessary
- Appealing a denied or disputed claim
- Taking legal action if necessary
Curo Financial works on a no-win, no-fee basis, which means you do not pay anything unless they win your case. We also offer a free initial consultation, where we can assess your situation and advise you on the best course of action.
If you are ready to start your TPD claim or if you have any questions about the process, do not hesitate to reach out to our team. Our goal is for you to access the financial support promise of your TPD insurance.
Frequently Asked Questions
How long does a TPD claim take to process?
The time frame for a TPD claim can vary depending on the complexity of your case and the responsiveness of the insurer. Generally, it can take anywhere from 2 to 12 months for a TPD claim to be processed and paid out.
However, some cases may take longer if there are disputes or delays along the way.
You can read more about how long TPD claims take in our blog post.
What is the average payout for TPD?
The coverage amount for TPD insurance has a wide range. It could go as low as a couple of thousand dollars to over a million dollars.
The amount is based primarily on the amount of coverage, which was set from the time of effectivity. TPD insurance coverage is usually larger when purchased outside of super, as it was designed to target a specific number of financial needs.
How do you successfully claim TPD?
To successfully claim TPD, you need to meet the criteria set out in your policy and provide sufficient evidence to support your claim.
You also need to complete a thorough application that clearly shows why you qualify for a TPD payout.
Our free 7-step guide will help you throughout the TPD claims process.
Why do TPD claims get rejected?
TPD claims can get rejected for various reasons, such as insufficient evidence, conflicting opinions, policy exclusions, pre-existing conditions, etc.
If this happens, do not give up hope. We are experts at turning around complex TPD claims into favorable decisions. Our expertise allows us to understand the intricacies of your TPD policy and see exactly what the insurer is taking issue with.
If we believe it is a misunderstanding on their part, we can reposition our evidence to ensure that the insurer or super fund can see the angle we are coming from.
Due to our standing in the industry, we have numerous senior claims relationships at insurers which often allows us to deal directly with those who have significant technical expertise but also the ability to make a decision.
General Advice Disclaimer
General advice warning: The advice provided is general advice only and in preparing it we did not take into account your investment objectives, financial situation or particular needs. Before making an investment decision on the basis of this advice, you should consider how appropriate the advice is to your particular investment needs, and objectives. You should also consider the relevant Product Disclosure Statement before making any decision relating to a financial product.
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