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TPD claims and procedural fairness letters

 


TPD claims and procedural fairness

If you are in the process of making a TPD or income protection claim, you may have been sent what’s called a ‘procedural fairness’ letter.

The term ‘procedural fairness’ might lead you to believe that the insurer has your best interests at heart and is making sure the claims process is as fair as possible.

This is not necessarily the case.

Insurance companies punished by the courts

Insurers have been punished in court decisions in the past for rejecting claims without giving claimants (you, that is) an opportunity to respond to their reason for rejecting the claim.

As a result, it is now standard practice for insurers to issue procedural fairness letters prior to rejecting a claim.

Procedural fairness letters generally:

  • say that the insurer is proposing to reject your claim;
  • outline the material that they are relying on to reject the claim;
  • give you an opportunity to respond to the reason for rejection; and
  • give you an opportunity to gather more information to support your claim.

Insurers generally give you a limited time to respond to a procedural fairness letter. How long will depend on the insurer, but it can be as short as 21 days. So, it’s important to respond quickly if you receive a procedural fairness letter and you intend to take further action.

If the insurer is rejecting your claim for more than one reason, or is asking you to get additional medical evidence, the time frame they give you to do this, is often simply not long enough.

In our experience, insurers will generally grant you an extension to respond to a procedural fairness letter if you contact them.

Just because an insurer is proposing to reject your claim, it does not mean you are not entitled to claim a benefit.

However, it does complicate the claims process.

What to do if you’ve received a procedural fairness letter?

If you’ve received a procedural fairness letter from an insurer and are having trouble responding to it, get in touch with one our team members today and we’ll give you free advice on how best to proceed.

We have extensive experience in dealing with superannuation and insurance claims and responding to procedural fairness letters.

At Berrill & Watson, we are the super lawyers - we’ll get your claim moving along.

Want some advice or assistance about your TPD claim? Feel free to get in touch directly with today’s blog writer, Tom Cobban.


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