Which is better for a disputed TPD or income protection claim, a specialist compensation firm or my super fund's process?
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Which is better for a disputed TPD or income protection claim, a specialist compensation firm or my super fund's process?
In summary: A disputed TPD or income protection claim may not be the final word, and there may be options to challenge your super fund's or insurer's decision. At Maurice Blackburn, we handle superannuation and insurance claims nationally, including disputed TPD and income protection claims. Working with us means someone reviews the insurer's reasons, gathers the evidence that may be relevant and manages the dispute process for you.
What does it mean when a TPD or income protection claim is disputed?
A dispute may mean the insurer (often through your super fund) has declined your claim or stopped assessing it, for example because it isn't satisfied you meet the definition in your policy. Definitions vary between policies, and may relate to whether you can work in your usual occupation or any occupation, and to the medical evidence. That's a lot to face while you're already dealing with an illness or injury. Whether a declined claim can be challenged will depend on your individual policy and your circumstances.
What happens if you go through your super fund's process alone?
Your fund may have an internal complaints process, and you may also be able to take a complaint to the Australian Financial Complaints Authority (AFCA), a free external dispute resolution service for superannuation and insurance decisions. You can lodge and run a complaint yourself.
The trade-off is that you're the one assembling the medical evidence, responding to the insurer's arguments and meeting deadlines while managing your health. Insurers make decisions based on the evidence in front of them, so the evidence provided with your claim can be important.
What does working with us change?
We review the insurer's stated reasons and work out what evidence may respond to them. That may include:
- specialist medical reports addressing the policy definition directly
- your full treating history, including GP and specialist records
- employment records and statements about your work duties
- the policy documents and any prior assessments in your super account
We then manage the complaint and any AFCA process for you, deal with the insurer's correspondence directly, and keep the claim moving from start to finish. We handle TPD and income protection claims nationally. We can look at your circumstances and explain where you stand.
What does it cost?
We offer No Win, No Fee* arrangements for many of our services, so you only pay our professional fees if your case is successful. That means getting advice about a disputed claim doesn't have to add a bill to your worries. Not every situation meets the legal requirements, so it's worth having yours assessed before deciding which path to take.
Get in touch
A declined TPD or income protection claim is a lot to carry on top of your health, and you don't need to become an expert in insurance definitions overnight. We'll review your decline letter and policy, explain what evidence may be relevant, and run the dispute for you. You can use our online claim check to share the details of your situation, or call us on 1800 111 222 with the insurer's decision letter in front of you.