Greg (not his real name) had not worked since August 2005. A history of PTSD, depression, anxiety and polysubstance abuse had made ongoing employment impossible, and by the time he came to Berrill & Watson, his circumstances made the claims process particularly challenging.
He had spent much of his life moving between states and had experienced periods of incarceration, which meant his medical records were fragmented and his personal history was difficult to document in a way that would satisfy insurers.
What followed was a complex investigation that ultimately uncovered evidence of identity theft and ended with two accepted TPD claims totalling $122,000.
Background to Greg's TPD claims
Greg held superannuation accounts with two funds, both of which carried TPD insurance cover. Based on the nature and severity of his conditions, we considered him a strong candidate for TPD claims under both policies.
The central challenge was establishing Greg's date last physically worked. Greg had stopped working in approximately August 2005, but with no consistent treating practitioner and medical records scattered across multiple states and facilities, piecing together the evidence to support that date required significant groundwork. We tracked down historical records and contacted providers across jurisdictions to build a clear and well-supported picture of Greg's conditions and his capacity to work from 2005 onwards.
This kind of records investigation is not unusual for clients whose lives have involved transience or periods of incarceration. It takes time, but it is essential to getting the claim right.
Uncovering tax file number fraud in Greg's ATO records
While preparing Greg's claims, we obtained his ATO tax records as part of our standard process. What we found was unexpected and potentially claim-ending: the records showed Greg had been employed at an aviation company between 2016 and 2018, earning approximately $74,000 per year.
Greg had no knowledge of this employment. It did not appear anywhere in the employment, training and education history he had provided to us, and it was entirely inconsistent with his circumstances during that period.
We contacted the aviation company directly to verify the information. They confirmed that Greg had no employment history with them whatsoever.
The conclusion was clear: Greg's tax file number had been stolen and used fraudulently. The fraudulent employment had been recorded in ATO systems and, had we not identified and investigated the discrepancy, it could have been used by the insurers to suggest that Greg had in fact been working and to decline his claims on that basis.
We documented the issue thoroughly and provided both insurers with a full explanation of what the ATO records showed and why they could not be relied upon to reflect Greg's actual employment history.
The outcome: $122,000 in accepted TPD claims
Both claims were accepted.
- Super fund 1 — TPD claim: $80,000
- Super fund 2 — TPD claim: $42,000
- Total: $122,000
What this TPD claim case illustrates
- A complex personal history is not a barrier to a successful TPD claim. Clients with fragmented records, periods of incarceration, or interstate moves often assume their circumstances make a claim too difficult to pursue. In our experience, it means more preparation, not an insurmountable obstacle.
- ATO records are not always accurate. Tax file number fraud is not common, but it does happen. Where ATO data appears inconsistent with a client's known history, it is important to investigate rather than accept the records at face value. In Greg's case, that investigation was the difference between a successful claim and a wrongful denial.
- The date last physically worked matters, and it needs to be properly established. Eligibility for a TPD claim turns on the insurance cover in place when the client stopped working, and on demonstrating that they have been unable to work since that time. Building that evidence base carefully is central to a well-prepared claim.
Could you be entitled to a TPD claim?
If you stopped working due to a physical or mental health condition and hold superannuation, you may be entitled to a TPD benefit even if your circumstances are complicated or years have passed since you last worked. Berrill & Watson offers free initial advice Australia-wide and acts on a no-win, no-fee basis.
Contacting Berrill & Watson
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