People making a TPD or income protection claim are often accused of nondisclosure, especially when they have previously sought help for significant life events. In this success story, we explain how insurers cherry-pick medical evidence to assess disclosure obligations. Our legal strategy relied a lot on clarifying the medical evidence, which helped our client overturn a denied TPD and income protection claim.
When Jennifer (not her real name) first came to us, she was facing an overwhelming situation. Her group superannuation income protection and TPD cover, worth approximately $1.4 million in total, had been avoided (legal term for retrospective cancellation) by the insurer on the basis of alleged fraudulent non‑disclosure.
To make matters worse, another law firm and a barrister had already told her that her case had no reasonable prospects of success.
TPD claims and disclosure
The insurer claimed that Jennifer had failed to disclose a mental health condition. This allegation was used to deny her access to the disability insurance benefits she desperately needed.
But the reality was very different. We submitted that our client had sought help for difficult “life events”, not because she had a diagnosable mental health condition. Like many people, she had experienced challenges such as relationship breakdowns and stressful personal circumstances, and she had reached out for support.
Seeking psychological help in these situations is not uncommon, nor should it be stigmatised.
You can learn more about your disclosure obligations in our earlier blog, “Duty of disclosure in injury and illness insurance policies”.
Life event vs mental health diagnosis
It is important to recognise that many people go through significant life events, such as the breakdown of a relationship, the death of a partner, or other personal crises. This can lead them to seek psychological support; for example, through their GP, psychologist, psychiatrist or a counsellor.
Case law makes clear that there is a difference between experiencing conditions like situational depression or stress (due a specific event), and having a diagnosed mental health condition that must be disclosed to an insurer.
Insurers often blur this distinction, alleging non‑disclosure of a mental illness when in fact the person has not been diagnosed with a condition that would trigger disclosure obligations. This is why it is critical not to accept an insurer’s allegation at face value.
If your TPD or income protection claim has been denied, you don’t have to accept this as the final decision. Seek legal advice to protect your entitlements.
Our strategy to have the TPD and income protection claims accepted
We knew the key to successful claims was to clarify the medical evidence. Unfortunately, some medical notes contained comments that were either inaccurate or misleading, and the insurer relied on these to justify its position.
We spoke directly with Jennifer’s psychiatrist, who was able to explain the context of her treatment and correct the inaccuracies in the medical notes. This step was crucial. Without clarification, the insurer’s interpretation of the notes would have stood unchallenged.
Armed with this evidence, we issued proceedings in the Supreme Court of Victoria. By presenting a clear and accurate picture of our client’s circumstances, we were able to challenge the insurer’s position head‑on.
Further reading:
The importance of your doctors for a successful TPD claim
TPD and income protection win
At mediation, we successfully negotiated a life‑changing settlement. Jennifer finally received some financial security after years of uncertainty and stress.
This result was not only significant for our client but also highlights a broader issue. Insurers sometimes rely on technical arguments and selective interpretations of medical records to avoid paying claims. With persistence and the right legal strategy, these arguments can be challenged.
Benefits of experienced disability insurance legal advice
One of the most important lessons from this case is the need for specialist legal advice from a lawyer experienced in both TPD and income protection claims. The wording of the questions an insurer asks at the time a policy is entered into is critical. Policies often require disclosure of treatment or advice for diagnosed conditions, not every instance of stress or counselling.
Without legal advice, many people accept an insurer’s rejection as final. But as this case shows, allegations of non‑disclosure can be challenged successfully.
Further reading:
Three options to appeal a rejected insurance claim
Key points to remember when claiming TPD or IP
- Don’t accept “no prospects” at face value. Even if another law firm tells you your case cannot succeed, it’s worth seeking a second opinion (and we’ll provide that advice to you for free).
- Life events are common. Seeking psychological support after events like relationship breakdown or bereavement does not necessarily mean you have a diagnosable mental health condition.
- Case law matters. Courts have recognised the difference between situational conditions (like depression following a life event) and diagnosed mental health conditions.
- Medical evidence matters. Clarifying and correcting medical notes can make all the difference in disputing an allegation of non-disclosure.
- Legal advice is essential. The wording of insurer questions and the timing of the policy are key to determining whether a claim can be challenged.
- Persistence pays off. Challenging an insurer in court can be daunting, but with the right support, it can lead to a successful outcome.
Get help from a disability insurance lawyer
Insurers’ allegations of non‑disclosure should never be accepted without scrutiny. With the right advice and determination, even the most daunting claims can succeed.
If you’ve been told your TPD or income protection claim has no prospects, remember: getting a second opinion costs nothing, and it could change your life. We provide free initial advice, no upfront fees and run cases on a “no win, no fee basis”, so it costs you nothing to find out where you stand.
Contacting Berrill & Watson
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📞 Brisbane: 07 3013 4300
📞 Anywhere else in Australia: 03 9448 8048
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