Along with private insurance for illness or injury, many Superannuation funds also have what we call TPD insurance. This allows you to make a claim on that insurance if you become “totally and permanently” incapacitated by injury or illness. In other words, you become unable to work again doing work that you have done in the past due to illness or injury.
Is there a wait period before I can lodge my TPD claim?
Before you can claim a TPD benefit, usually you have to be off work for the wait period. The wait period is usually either three or six months.
Many funds/insurers will tell you that you are not allowed to have the claim forms or lodge the claim until after the wait period expires but sometimes you can successfully ask that the wait period be waived and you can start your claim early.
How long will my TPD claim take?
After you send the claim forms to the fund/insurer, it can take anywhere from 3 to 12 months for a decision to be made on your claim. Of course, there is no definitive answer to the question of how long your claim will take. This depends on a number of factors relating to the assessment of your claim.
Usually what determines whether a claim is assessed and finalised quickly or slowly is how long it takes to gather the relevant information and documentation and how long it takes the insurer and the super fund to assess the claim and make a decision.
After you send the relevant claim forms to the fund/insurer, they will then usually start the claims assessment and request further documents to work out if, in their opinion, you are entitled to the TPD benefit.
What sorts of things will the fund/insurer request when assessing my TPD claim?
It is common that the following requests for more information will be made:
- Requests for Medicare and Pharmaceutical Benefits Scheme (PBS) history;
- Requests for tax and financial documents made to the ATO;
- Requests for Centrelink documents and payment history; and
- Requests for medical records or medical reports.
The above documents are not always requested. However, if they are, then requests can sometimes take time to be gathered from companies, medical providers, superannuation funds, insurance companies and relevant government departments.
Are there ways to speed up the process of providing further information?
As with all things, there are tricks and shortcuts which can be used to get the above documents more quickly. Also, it can sometimes be argued that the documents are not required or we can work out other ways of getting the fund or insurer the information that they want without the delays involved in the above requests.
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For example, if your fund or insurer is requesting your tax documents directly from the ATO, this can take time and it might be quicker to get them from your accountant or you might have copies at home. Also, sometimes funds and insurers use third parties to request medical records or reports and it can be quicker for you or our office to get them directly from your doctor.
Do I really need all the documents they’re asking for to complete my TPD claim?
Sometimes documents are requested which may not be required to assess the claim or the assessment itself takes too long. Sometimes this might seem like a deliberate delay tactic and other times it might just be that the claims manager assessing the claim has changed a few times and the left hand doesn’t know what the right hand has already done.
We can usually speed up the claims process and get around issues or requests which are causing delay by reasoning with the fund or insurer’s claims assessor directly. But other times more drastic action is required.
What can I do if I’m unhappy with the time it is taking for my super fund or insurer to assess my claim?
If you are unhappy with the conduct of your super fund or insurer, you can complain internally via an internal dispute resolution team or externally to the Australian Financial Complaints Authority (AFCA).
We recommend that you seek legal advice before taking this step and you can contact us for free advice at any time if you are unhappy with the way your TPD or other insurance claim is being assessed.
Get help from a TPD lawyer
At Berrill & Watson, superannuation and insurance claims and disputes are in our blood. If you need to get your claim moving, you can speak with today’s blog writer, Tom Cobban.
Or you can contact us directly by phone or email. It costs you nothing to find out what your rights and entitlements are.
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