Answers

Questions? We have answers.

How long will my claim take?

Based on our experience, most TPD claims are approved in less than 3 months from the date of lodgement. This is faster than the industry average which tends to be around 6 to 12 months.

Ask us how we can expedite your claim today.

What is your record for the fastest time a claim has been approved?

Our Principal, Atticus Maddox, recently had a TPD claim approved in 7 business days from the date of lodgement. The client was a construction worker who found it increasingly difficult to maintain regular employment after sustaining a closed head injury 3 years earlier.

Can I claim multiple benefits?

It is possible to claim multiple benefits, provided you held cover at the 'event date' and meet the eligibility criteria for each policy.

Does my claim need to be work-related?

No. TPD benefits are usually paid out as a lump sum after we satisfy the other side that you are unable to perform your usual occupation or any occupation (depending on the applicable policy definition) as a reliable employee. It is not necessary to establish a connection between the cause of the disabling symptoms and previous employment. Likewise, it is not necessary to prove negligence to succeed in a TPD claim.

Where does the insurance come from?

TPD insurance can be procured through a financial advisor (Retail), directly from an insurer (Direct) or by an employer or the trustee of a superannuation fund (Group). Most adults in Australia with a working history have at least one group life insurance policy. We investigate your insurance cover free of charge as part of our service.

What happens if my claim is rejected?

The assessment of a life or disability insurance claim involves 2 stages. The claim is first allocated to a claims assessor on the insurer side. The insurer makes an interim decision, which is then submitted to the trustee for independent review. If the insurer has identified significant barriers to a claim being approved, they will issue a procedural fairness letter. You will be given an opportunity to respond to the perceived barriers before the insurer finalises their position. Likewise, the trustees may issue a letter of declinature upon review of the evidence. At this point, it may still be possible to seek a reconsideration.

Regardless of any adverse determination made by an insurer and/or trustee, if we consider your claim to have reasonable prospects of success, we will advise you of alternative dispute resolution and other avenues to progress your matter forward

What is the 'standard' TPD definition?

A 'standard' TPD definition contains 3 key elements:

  1. You ceased work due to injury and/or illness before age 65;

  2. You have been unable to return to work for a minimum period of time (usually 3 or 6 months) due to symptoms associated with your medical condition(s); and

  3. It is unlikely that you will engage in or work for reward in any occupation that falls within the scope of your education, training or experience.

A variation of the 'standard' TPD definition involves an assessment as to whether you are likely to engage in or work for reward within your 'own occupation'.

What is the Activities of Daily Living Test?

Depending on the terms and conditions of your policy, you may not be eligible to be assessed using a 'standard' TPD definition. This may occur, for example, if you fall within the following categories:

  1. You were employed as a casual;

  2. You worked part-time and less than 15 hours per week;

  3. You were a fixed-term employee;

  4. You worked in a 'high risk' occupation; or

  5. You were unemployed at the date of disablement.

If you fall into one of the above categories, you may be assessed under an ADL definition instead.

ADL definitions typically contain the following elements:

  1. List of defined activities of daily living, e.g. bathing, eating and dressing.

  2. Level of impairment required to satisfy the threshold, e.g. an inability to independently perform certain tasks without the assistance of another adult; and

  3. Minimum number of activities required to satisfy the definition.

The ADL test is heavily biased toward physical disabilities that are catastrophic in nature.

 

Talk to us about whether or how you can avoid being assessed under an ADL definition.

Do I need a lawyer to pursue a TPD claim?

We are probably the only TPD lawyers in Australia who will tell you that you do not always need to engage a lawyer. However, you must be prepared to conduct the mandatory investigations, review the eligibility criteria in your insurance policy, set up the evidence and argue your claim with reference to medical evidence and the law. People come to us after they have exhausted their own efforts or are making limited headway with their existing legal representatives.

What is income protection (IP) cover and can I claim it concurrently with TPD?

Income protection insurance pays a monthly benefit for a defined period if you are totally or partially disabled from work. We frequently run IP and TPD claims together.

The value of your IP cover will depend on whether you hold an 'indemnity value' or 'agreed value' insurance policy. Under an indemnity value policy, you will usually be paid the lesser of 75% of your pre-disability income or the monthly sum insured value of your benefit. Agreed value policies pay an agreed monthly benefit, determined at the policy application and inception date.

The benefit period refers to the duration in which monthly benefits may be paid. Most IP claims pay compensation for 2 or 5 years, or to age 65.

The waiting period refers to the length of time you must wait before IP payments can commence. Most waiting periods in group life insurance policies include a provision for 30, 60 or 90 days. On the other hand, retail policies may contain waiting periods ranging from 14 days to 2 years.

We will advise you if you are eligible for TPD as well as IP benefits.