At Berrill & Watson, we have helped thousands of people to successfully claim TPD and other insurance benefits (like income protection, trauma insurance and death benefits). We are often so busy helping our clients with their insurance claims that we don’t get time to reflect on the life-changing impact of those outcomes for our clients.
The following are just a couple of stories which show the work that we do helping people, how we do it and how a successful TPD claim impacts the lives of our clients. The names of the clients in each of the scenarios have been changed to protect their privacy, but the stories are 100% true.
We secured $245,000 for Dean after his initial TPD claim was rejected
Dean ceased work due to chronic back pain in 2016. He lodged a TPD claim prior to engaging us, and the claim was rejected because the insurer decided that the work he did before he stopped working was work in a “special risk” occupation. Under his policy (which is a well-known and common group insurance policy), people that work in special risk occupations do not get work-based TPD cover, but are only paid a TPD benefit if they satisfy an activities of daily living TPD definition.
Dean knew his rejected TPD claim decision was wrong
When the claim was rejected, Dean knew the insurer’s decision must be wrong but did not know how to go about challenging the decision. So, he came to us for some free advice. We agreed that the decision was wrong and to act for him on a no ‘win no fee basis’. We lodged multiple complaints with the insurance company disputing the rejection of the claim, and focused on proving that the occupation which Dean was doing before he ceased work was not a special risk occupation.
Wrong job recorded by the insurer - Dean’s actual job was not high risk
By way of background, the insurer thought that Dean was working as a handyman before he ceased work and decided that this was a special risk occupation under the relevant policy. However, the truth was that he was working in a retail setting at a well-known hardware store prior to ceasing work. Handyman work was something he did as his “side hustle” for extra cash. We were successful in convincing the super fund/insurer that their decision that Dean was working in a special risk occupation was wrong.
Remarkably, if we were not able to prove that Dean’s work was in retail rather than as a handyman, the insurer would likely have stuck to its position that the work was special risk (yes, handyman work is special risk…) and would have maintained their decision to reject the claim. At that point, we would have litigated.
Successful TPD claim sees Dean receive $245,000
At the end of the day, we were able to use old payslips and other employment documentation to prove that Dean’s employment was not special risk, and he was paid a $245,000 TPD benefit! Since ceasing work in 2016, Dean had lived on Newstart/Jobseeker and Disability Support Pension payments and had been under constant financial pressure. The $245,000 payment relieved much of this pressure.
Also, because of the unreasonable delays in the assessment of Dean’s claim, we were able to successfully claim interest for the delay in making the payment to him.
As an aside, policies which change the TPD definition which applies to people depending on their occupation, are not uncommon. Even very innocuous occupations can be considered special risk (like handyman, deli assistant, factory worker) and result in rejected TPD claims. However, there are things that can be done to challenge the reasonableness of these policies. If you find yourself in this situation, you should get in touch for some free advice, just like Dean did.
Jimmy successfully claimed a TPD benefit and then accessed early withdrawal of super funds due to mental illness
Jimmy ceased work due to mental health issues in February 2019. At the time that we met with him in May 2020, he was in prison. We act for a number of people who are in prison and successfully claim TPD benefits. The benefits which we help these people receive make a huge difference to their ability to reintegrate into society after they are released from prison.
Jimmy had suffered from mental health issues most of his life. These conditions were first diagnosed at the age of 18, but his ability to receive adequate treatment had varied over the years, particularly when he was in prison.
Also, getting medical reports to support a TPD claim was very difficult for Jimmy whilst he was incarcerated. Nonetheless, we worked hard with Jimmy and his friends and family to get the medical reports which were needed to support his claim, and the claim was approved.
This meant that when Jimmy was released, we were able to help him withdraw some of the money from his super account, and that money helped him to secure immediate accommodation upon his release.
Diana wins $45,000 TPD claim years after her initial injury
Diana came to us for assistance with a TPD claim. Diana was referred by a financial counsellor who thought that Diana may be able to claim a TPD benefit. When we first spoke to Diana, she had no idea what TPD was or where her super was held. She last worked in 2007, and at the time that we first spoke with her (years later), she did not have any active superannuation accounts.
Investigation finds old super funds in Diana’s name
We helped Diana contact the ATO and old employers and find out where her super accounts were in 2007 before the accounts were closed. After we found out where Diana’s superannuation was in 2007, we were able to contact each of the super funds and confirm if there was any insurance coverage for TPD in 2007 when she last worked. As is often the case, two of Diana’s superannuation accounts in 2007 did have cover, and we were able to help her to lodge multiple TPD claims.
However, because it had been so long since Dianna last worked and because she had not regularly engaged with her doctors since ceasing work in 2007, we had a lot of trouble getting medical evidence to support the claim. Not to worry, we were able to get copies of Diana’s old medical records and submit them to the insurers and put pressure on them to accept the claim, and one of them did.
Successful TPD claim payout for Diana
Diana was paid $45,000 which allowed her to buy a new car and visit her family interstate for the first time in a long time. Diana’s second claim is ongoing, and we hope it can be approved soon.
TPD claims years after the injury or illness that caused you to stop work are difficult but not impossible.
It’s important to note that a TPD claim is payable on any insurance you had at the time you stopped work, not at the time you lodged your claim. So, for example, if you stop work due to injury or illness in 2018 but do not lodge a TPD claim until 2022, if your claim is successful, you will be paid the benefit that applied in 2018. This is important because as you age, your payable insurance benefit ordinarily decreases.
Get help from a TPD lawyer
Some people think that submitting a TPD claim is as simple as filling out a form and getting their payment. As you can see from these stories, there can be a lot of complexity with TPD claims.
It’s important to remember that the insurer’s interests are not always the same as yours. Some people don’t realise there are options for claims years later, multiple claims (under certain circumstances), interest on delayed claims etc.
Engaging a lawyer highly experienced with TPD claims and who understands the nuances of how insurance companies work, increases the chances of a successful claim. It also removes the stress and frustration associated with the claim’s process which is particularly important for people dealing with injury or illness.
Contacting Berrill & Watson
📞 Melbourne: 03 9448 8048
📞 Brisbane: 07 3013 4300
📞 Anywhere else in Australia: 03 9448 8048
How we charge
We are Australia's best-value superannuation/insurance law firm. Other law firms charge nearly double (& sometimes more than double) what we charge. So, if you get a quote from them, or have a cost agreement, ask us what we will charge you.