No one expects to become totally and permanently disabled (TPD) during the course of their work life. Most people live under the assumption that they will remain healthy and employable until they decide to retire. As a result of this assumption, they often do not elect TPD insurance, over and above what might be offered via their superannuation (super) through their employer. This can be a very risky decision.
What is Total and Permanent Disability?
The definition of TPD is the inability to work in your own chosen occupation or the inability to work in another occupational capacity in accordance with your experience and education.
Hence, the definition does not require that you simply cannot do the type of work you are accustomed to doing. Instead, it does require that you be permanently and totally disabled from work that it is possible for you to do, based upon your work history and education.
If you can no longer perform your chosen profession, or one that fits your skills and experience and education, then you may be eligible for a lump sum monetary award for your status as being totally and permanently disable.
How to File a Claim
- The first step in filing a claim is to review your super policy. If you have more than one super policy, it is important to review all of them to determine which ones are still viable to file a claim against.
- The second step is to review the policy requirements for a finding of total permanent disability. These requirements often include the following;
- Completion of the insurers form requesting review of your circumstances
- Medical evidence of your disability and your restrictions
- Your ability, or lack thereof, to return to work in your usual capacity or some other qualifying capacity
Why Would a Claim Be Denied?
A claim might be denied for a variety of reasons. If your claim is denied, the insurance company will most likely explain to you the reasons why your claim has been rejected. Some of those reasons might include;
- A lack of sufficient medical proof that qualifies you as totally and permanently disabled
- Mistakes on your claim form
- The insurer may have evidence that you are not totally and permanently disabled
- The insurer may have evidence that there is a form of employment that you could perform despite your current injury or illness
What Should I do If My Claim is Denied?
First, look over all of the reasons your claim has been denied. If you can provide the insurer with the information they are requesting, you should do so. However, at this point it is wise to enlist the assistance of a solicitor who is familiar with handling such claims and have it reviewed by them. A professional in this area of law can provide you with the following assistance and guidance;
- Review the policy details and fine print to determine what else the insurer might be looking for to find in your favor
- Contact the insurance adjuster to gather more information regarding the nature of the denial
- Assist you in gathering additional evidence that the insurer might not have requested, and you might not have considered providing to the insurer
- Represent you in the appeals process
- It is important to understand the process the insurer provides for appealing a denial of a total and permanent disability claim
- A Solicitor will be an asset to you in navigating this process, preparing the necessary appeal documents and representing you at a hearing, should attendance at a hearing be necessary.
While most people do not plan on ever being found totally and permanently disabled, it is a good idea to know what policy you currently have in place via your superannuation. In addition, you should consider if you need to buy additional insurance to protect you and your family should you be unable to work in your chosen profession, or any other work you might be qualified to perform.
In the event that you find yourself in need of assistance, please contact the law offices of Owen Hodge Lawyers. At Owen Hodge, we are always happy to assist clients in understanding the full ramifications of any and all of your legal needs. Please feel free to call us at your earliest convenience to schedule a consultation at 1800 770 780.