Have your TPD Claims Been Rejected or Declined?

Why were my TPD claims rejected?

It can be very disheartening and frustrating when your TPD claim is rejected, particularly when you are relying on it for critical financial support. While you may be able to have the decision reversed,  understanding the reason your claim was declined is crucial.

In case of a rejected claim, you may reassess your claim based on the following:

• Was your TPD insurance policy valid and active at the time you became disabled?

• Have you met your policy’s definition of disability (you may refer to your policy’s Product Disclosure Statement)?

• Did you submit enough medical evidence and documents that can support your disability?

• Is there any relevant information or pre-existing medical conditions that you have forgotten to disclose in your application?

• Have you met your policy’s waiting/qualifying period?

Thinking outside the box can often allow you to tackle these requirements in a more effective manner. With our years of experience in handling complex TPD claims, we can help you collate and prepare the evidence the insurer requires, advocating for you throughout the process. 

What to do after your claims are denied?

Do not be discouraged when your TPD claim is denied—in most cases, it is not always final. Your insurer may simply need more details to verify your eligibility. Below are the steps you can explore to get a better outcome:

• Internal dispute resolution – Most insurers have a formal dispute resolution process, giving you the chance to request a review of your claim/s. The common process is as follows:

  • Read the rejection letter from your insurer carefully

  • Clarify the reason for the decline

  • Check if there are errors or missing information in the submitted documents

  • Provide the corrected or missing documents in support of your claim

• Seek help from a TPD claims adviser – Engaging with an adviser to process your TPD claim decreases your level of stress and can help improve your chances for a better outcome. At Curo Financial Services, we assist our clients in:

  • Handling the paperwork and guiding you throughout the process

  • Communicate and negotiate with medical providers and insurers on your behalf

  • Receiving customised and expert advice based on your claim situation

• Submit a complaint through the Australian Financial Complaint Authority (AFCA) – If eligible, you may lodge a complaint through AFCA. It is an independent organisation that helps individuals and small business owners resolve disputes with accredited financial firms. You may head over to AFCA’s website to learn about their process.

• Work with a legal professional – If an internal resolution or AFCA complaint does not work, you can take your dispute to legal court. However, this option can be very costly, time-consuming, and stressful. You may need to attend court proceedings and meet frequently with your legal counsel while on treatment.

Challenges for TPD Claims for Mental Health Conditions

It can be more challenging to process a TPD claim due to a mental health condition than a physical condition. Typically, your insurer may require intensive documentation to prove your disability. These are the common challenges you might encounter:

• Mental health conditions can be subjective and difficult to prove.

• Typically, insurers would require intensive medical evidence to support your claim.

• Your symptoms may vary over time, making it harder to declare as permanent.

• Your insurer will conduct a thorough assessment of your inability to work.

• In some cases, insurers may view medical health conditions as treatable with medication over time.

• It can be difficult to lodge a complex TPD claim when dealing with a mental health condition.

Working with a TPD claims adviser helps you build a strong claim case to increase your chances of approval.

Get expert advice about your rejected TPD claim

Do not let a rejected TPD claim get in the way of having financial support. Your TPD insurance policy is supposed to provide a financial safety net during challenging times—let us help you get that.

At Curo Financial Services, our decades of experience working with hundreds of clients have given us the expertise to deal with complex claims. Our services include:

• Customised and expert TPD claim advice

• Guidance and support throughout the process

• Communication and negotiation with your insurer on your behalf

• Helping you maximise your TPD payout

Get in touch with us. Our team will be happy to assist you.

Frequently Asked Questions 

What percentage of TPD claims are successful?

About 86% of TPD claims in Australia are successful, according to the 2019 report of the Australian Securities & Investment Commission (ASIC).

Is it difficult to get a TPD payout?

The complexity of processing a TPD claim will depend on your situation. If you can provide the necessary and required documents and medical evidence, and meet the eligibility criteria, you may access your TPD payout within weeks. However, if your medical condition is complicated, the process can take months to a year.

What happens when claims are rejected?

When your TPD claim is rejected, here are the options you can explore to appeal your insurer’s decision:

• Process an internal dispute resolution with your insurer

• Seek help from AFCA

• Get expert help from a TPD insurance claims adviser

• Engage with a legal professional

What is a typical reason for a denied claim?

The typical reasons for getting TPD claims rejected are:

• Being unable to meet the policy definition of total and permanent disability, and

• Not being able to provide enough medical evidence.

What is the average TPD amount? 

There are a few factors that determine the amount of your TPD payout.

• The predetermined amount of insurance coverage is when you purchase or obtain your policy.

• Policy terms and definitions can impact your payout.

• The severity of your disability can affect your TPD payout with some insurers.

It is also important to consider the impact of taxes on your payout.