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Successful TPD and IP claim due to chronic fatigue delivers $1.5m in benefits


Successful TPD and IP claim due to chronic fatigue delivers $1.5m in benefits

If you become sick or you’re injured and that illness or injury causes you to stop work, you will likely have disability insurance, like TPD or income protection (often inside your super) that provides a lump sum benefit or monthly payments. We’ve run and won many TPD and income protection claims with significantly complex and tricky hurdles to overcome. In this blog, we review just one of those success stories which delivered our client $1.5 million dollars in TPD and income protection benefits that may ordinarily have been lost to them.

You can read more detail about TPD and income protection and securing a successful claim in our earlier blogs:

Case review - TPD and income protection claims due to chronic fatigue


We acted for a client with chronic fatigue syndrome who had lodged two Total and Permanent Disablement (TPD) claims and one Income Protection (IP) claim.

In respect of all three claims, the applicable insurance policy required our client to work at least an average amount of hours per week in the period before they ceased work, to be entitled to be paid any TPD or IP benefits.

If we were unable to demonstrate that our client had worked at least an average amount of hours per week, then our client’s claims would be assessed against a much harder “Activities of Daily Living” definition and the claims would have likely been declined.

Claims denied despite doctors’ support

Although all our client’s treating doctors supported that our client satisfied the TPD and IP definitions, the claims were substantially delayed for over a year. The insurer made multiple requests for information to support that our client had worked the necessary average amount of hours per week before they ceased work.

Providing financial records proved difficult

Our client was self-employed, and there were significant challenges in obtaining financial records, which demonstrated the number of hours they had worked before ceasing work due to their medical condition. If you’re self-employed and considering a TPD claim, you may find our earlier article useful: “TPD and other disability insurance claims when you’re self-employed”.

We were unable to provide financial documents to the insurer as our client had been too unwell to prepare them.

Instead of providing financial documents, however, we were ultimately able to submit a summary of the hours our client worked which was calculated on the basis of their appointment diaries and approximations of the hours required to prepare for, travel to and attend those appointments.

We made legal submissions targeted at each of the policies’ requirements for our client to work a certain amount of hours before ceasing work. We submitted that the summaries provided were sufficient to satisfy the insurer’s requirements and asked that the claims be finalised in reliance on the summaries.

Complaint lodged against the insurer

One of the insurers did not accept the summaries and required us to further provide a statutory declaration completed by our client. We submitted a complaint in respect of the insurer’s handling of our client’s claim and were ultimately successful. The insurer approved the claim in reliance on the summaries we had previously provided.

A well-deserved win delivers $1.5 in benefits

Our client’s two TPD claims and income protection claim were all subsequently approved, and our client received approximately $1,500,000 in total insurance benefits.

We are now assisting our client with an ongoing claim on the basis that their claim could have been approved much earlier in the claims process.

The insurer’s delays and repeated requests for financial information were understandably distressing to our client, and they required significant support from us during the assessment of the claim. As a result of all three of their claims being approved, our client is now financially secure, able to afford medical treatment and plan for their future.

Get help from a TPD lawyer

Although TPD and income protection claims can sometimes appear to be quite a straightforward process, as you can see from this case, they can become technically complicated very quickly. This will often lead to claimants simply not proceeding with the process.

It’s important that if you receive an adverse decision (rejected claim) in the first instance from an insurer, you should not simply accept that initial decision. Get in touch with our TPD and income protection team for free advice. It costs you nothing to find out where you stand.

Contacting Berrill & Watson

📞 Melbourne: 03 9448 8048

📞 Brisbane: 07 3013 4300

📞 Anywhere else in Australia:  03 9448 8048

📧 [email protected]

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