Your TPD only Lawyers

CLAIM

Jed contacted WKB Lawyers to assist with his TPD claim, as the process he felt was a bit overwhelming.

We contacted all his treating Doctors and obtained all relevant information to run his claim for him. We completed all relevant forms and he signed them. We lodged the claim with the fund, but the claims assessor wanted to arrange an IME because of irrelevant comments made in a Workcover claim. We argued that this was unnecessary and that all relevant information and evidence has been supplied.

Jed’s claim was approved three weeks after submitting a complaint response to the fund’s IME request.

TPD Benefit amount: $76,800

First name of the client: Jed

Injury/illness: Psychological Injury

CLAIM

Mohammad contacted WKB Lawyers to run his TPD claim as he had a retail policy as well as a default cover policy.

We arranged all relevant evidence to be collected and submitted the claim promptly. The fund attempted to claim that our client had a non-disclosed pre-existing condition of mental health. We were able to successfully argue that there was no such pre-existing condition and that the incident they were referring to was completely situational and resolved very quickly.

Mohammad’s claim was then promptly approved a few short weeks later.

TPD Benefit amount: $500,000.00

First name of client: Mohammad

Injury/illness: Micro-sleeping & Sleep Apnoea

CLAIM

In 2014, Nick had his first back fusion, a further fusion in 2018 in Hong Kong. Unfortunately, the fusion was not successful, Nick and his wife flew back to Australia for further surgery.
The TPD claim was submitted with the IPI claim in late 2019. In April 2020 a further two surgeries were performed.In June 2020, the insurer issued a procedural fairness. The client continued with insurer, stating that he was unable to complete his duties under his ‘own occupation,’

In October 2020, further surgery preformed due to failure of previous surgery, the claim was further declined.

WKB Lawyers came on board, and while a further 3 months passed with writing submissions and providing evidence. It took, writing an executive complaint to point out the facts of the case and the reasons why the client is unable to continue under his own occupation policy.

The claim was overturned and paid and now we have an interest claim has been lodged with AFCA, as the claim should have been paid in October 2020.

TPD Benefit amount: $1,791,784.05

First name of client: Nicholas

Injury/illness: 5 back fusions

CLAIM

Fiona submitted her claim with SunSuper. When her claim was declined due to not meeting the ANY occupation definition, she requested WKB Lawyers to review the decision.

On receipt of reviewing the procedural fairness it was determined that and independent medical review by a physiatrist was required. We summarise the claim for the psychiatrist and provide all the medical reports and request the doctor to answer very specific questions which takes into account the definition, the facts of the matter.

A re submission to the insurer was provided with the material evidence. The claim decision was overturned within 6 weeks.

TPD Benefit amount: $154,000

First name of client: Fiona

Injury/illness: Mental Health, depression, anxiety.

CLAIM

In 2018, Ian ceased work due to his Mental health.

The TPD claim was submitted by Ian in June 2019, accompanied by treating doctor reports from his specialist.

In September 2020, the insurer issued a procedural fairness. This letter stated that our client had a high likely hood of returning to work within his education, training and experience.

WKB Lawyers were instructed to review the claim to see if our client has prospects of having his TPD claim overturned. After reviewing all the evidence, it was found that there were some evidentiary gaps in the medical evidence. Therefore, WKB Lawyers were instructed to take over the claim with a nice, fixed fee cost agreement.

WKB lawyers then proceeded with technical submissions including the use of some decided case law in support that our client was TPD.

We were very proud to contact the client and let him know that his TPD claim was overturned and paid in January 2021.

TPD Benefit amount: $2,500,000.00

First name of client: Ian

Injury/illness: Mental Health

CLAIM

In 2020, Des ceased work due to his Mental health, Knee and Shoulder issues.

Our client decided to have a Lawyer lodge the claim on his behalf to take the stress away and to make sure his claim was guided to a successful conclusion. The client contacted several firms and after a meeting with Warren, decided to go with WKB Lawyers because of their experience and well fixed fee.

After gathering the medical evidence necessary, The TPD claim was submitted by WKB Lawyers on 4 September 2020, accompanied by treating doctor reports from his specialist, medical evidence from CSC and the claim forms along with the support of some strong submissions.

Unfortunately, the Insurer had made some errors in the initial assessment by requesting irrelevant reports and after 5 months, WKB Lawyers made a complaint that the claims assessor did not have the skills necessary to assess the claim. Our client’s claim was then past onto another “more senior” case assessor. The claim was then assessed as to whether our client provided full and frank disclosure. Overall, the Insurer took a very tough and tortured approach to our client’s TPD claim.

After complaints to the executive team and more technical submissions including the use of some decided case law in support that our client was TPD.

We were very proud to contact the client and let him know that his TPD claim was approved for the full amount and paid in September 2021.

TPD Benefit amount: $2,216,000.00

First name of the client: Des

Injury/illness: Mental Health, Knee and Shoulder

CLAIM

Trevor had been working in the construction industry where his duties entailed lifting heavy bags of render, heavy physical labour and operating a hoist. Unfortunately, due to a workplace injury moving 14 bags of render 3 times, our client noticed immediate lower back pain that developed which radiated through his neck and left arm.

In mid-2021, Trevor reached out to WKB Lawyers to run both his TPD claims with CBUS and BUSSQ. We quickly collected all of Trevor’s existing reports from his Workcover claim and requested Medical Attendant Statements from two of Trevor’s primary treating Doctors.

We were able to lodge the claims quickly with both funds. Our client was also in financial hardship so WKB acted quickly, and also lodged a Permanent incapacity claim with the trustee for CBUS, which took less than a week to be approved. Shortly after, both TPD claims were approved.

TPD Benefit amount: $105,118.24,

First name of the client: Trevor

Injury/illness: Cervical Spine injury, Lumbar spine

CLAIM

Chris had initially injured himself 1996, when he was working to lift engines from cars and found that after 3 months, our clients back was starting to hurt and cause issues, after 6 months he started seeing his doctor as it was impacting his capacity to work. Unfortunately, our client was diagnosed with spondylolisthesis. Chris attempted to use consistent pain relief and exercises to try and extend his work life.

In 2008, Chris had a spinal fusion which did give some relief for a few years, however, the surgery noted severe degenerative lumbar disc disease. In 2017, his injuries escalated, and he was offered light duties but was unable to use his left arm and consistent chronic back pain.

Chris was referred to WKB Lawyers in April 2021, and we quickly worked with Chris to obtain all relevant medical evidence. WKB Lawyers then promptly submitted the claim in mid-July. Within in a month, we had obtained a successful outcome, by taking the time collect and corroborate all evidence for the fund prior to submission.

TPD Benefit amount: $130,742.89

First name of client: Christopher

Injury/illness: Back injury – Lumbar, Shoulder injury – Left Shoulder, Mental Health

CLAIM

In 2019 Susan ceased working due to a decline in her mental health following workplace incident, she unfortunately could not return to the work she was educated, trained, or had experience in. WKB invested the time to ensure that we were able to obtain all the required evidence to lodge a successful claim. We drafted a detailed submission and after a short 8 weeks the claim was formally approved.

TPD Benefit amount: $348,000.00

First name of client: Susan

Injury/illness: Major depressive disorder, adjustment disorder and respiratory reaction from inhalation of chemical.

CLAIM

In 2017 David was diagnosed with Parkinson’s Disease. He continued to work up until July 2021. David contacted WKB to assist with his TPD Claim, while we were waiting for the Waiting Period to lapse, we were obtaining the required medical evidence. We were able to lodge his claim with all the relevant medical evidence in September 2021 and a decision was made within 7 weeks.

TPD Benefit amount: $617,985.00

First name of client: David

Injury/illness: Parkinson’s Disease

CLAIM

Caleb had three TPD claims. He lodged all three claims himself. Two claims were successful, however Caleb was issued Procedural Fairness for the third claim.

Caleb contacted WKB Lawyers to assist with providing a response. After reviewing the Caleb’s file, it was noted that due to the complications with his employment, it would be very difficult to provide the required information for the fund to make a favourable outcome.

WKB Lawyers were able to determine Caleb met the conditions of a different TPD definition. We then obtained specific further medical reports in line with the alternative definition and submitted a detailed response to procedural fairness.

Caleb’s claim was approved four weeks after submitting Procedural Fairness response.

TPD Benefit amount: $300,000

First name of client: Caleb

Injury/illness: Myotonic Dystrophy

CLAIM

Delon approached WKB Lawyers regarding the prospect of a TPD claim.

Delon had also returned home overseas to assist with his recovery but made the prospect of lodging a claim himself more complicated.

Due to Delon’s ongoing medical conditions he didn’t feel he could handle the claim himself.

WKB Lawyers was able to work through these hurdles along with the support of his treating doctors and Delon’s claim was approved in six months.

TPD Benefit amount: $1,000,000.00

First name of client: Delon

Injury/illness: Mental Health<

CLAIM

Karl was diagnosed with Parkinson’s Disease shortly before ceasing work. He moved interstate and lost the ability to have his treating Specialist complete the required reports for his TPD claim.

Karl came to WKB Lawyers to handle the claim as he needed to focus on looking after his medical condition.

WKB Lawyers quickly tracked down each of his past Specialists Doctors, as well as his prior employer to gather the required information for Karl’s claim.

Despite a complex medical diagnosis and treating doctors located within multiple states, WKB Lawyers had Karl’s claim approved within 3 months.

TPD Benefit amount: $104,000

First name of client: Karl

Injury/illness: Parkinson’s Disease

CLAIM

Kate was seeking a firm that could take on her TPD claim and get her an outcome quickly and easily.

WKB Lawyers submitted Kate’s claim in April and by early July had received confirmation that the claim was approved.

All medical reports, employment information and claim documents were managed entirely by WKB Lawyers so that Kate could spend her energy focusing on the important things in her life.

TPD Benefit amount: $64,500

First name of client: Kate

Injury/illness: Breast Cancer, Fibromyalgia, Depression & Anxiety

CLAIM

A brief scenario: Luke came to WKB Lawyers after he got sick of the fund constantly asking for more and more information from him. The Fund were of the opinion that his claimed condition was considered pre-existing, due to a clinical note showing he had a similar condition as a child. Prior to the Fund being able to issue procedural fairness or a decision, our office was able to obtain the necessary medical evidence to show that the condition was in fact different to the condition he had as a child and were able to get the claim approved.

TPD Benefit amount: $100,000.00

First name of client: Luke

Injury/illness: Bowel resection and deteriorated mental health

CLAIM

A brief scenario: Mohamad was a Machine Operator who unfortunately had to cease working in March 2021 due to the ongoing symptoms of MS. Mohamad only had one treating doctor, so we were able to assist him with obtaining the required 2nd Medical Attendants Statement. Once the medical evidence was received in April 2022 we were able to lodge Mohamad’s and his claim was approved by June 2022.

TPD Benefit amount: $110,655.00

First name of client: Mohamad

Injury/illness: MS

CLAIM

A brief scenario: Garry came to WKB Lawyers after the Fund issued procedural fairness. The Fund were of the opinion that our client had not undertaken sufficient treatment and hadn’t reached maximum medical improvement. We were able to obtain additional medical evidence to show the clients extensive treatment history and doctors support that he had exhausted all treatment options. The Fund were able to then approve the claim.

TPD Benefit amount: $1.28 million

First name of client: Garry

Injury/illness: Major Depression

CLAIM

WKB Lawyers assisted Afton with her claim from start to finish. She was assessed under a TPD tailored cover policy. Despite the supportive medical reports submitted by WKB Lawyers for assessment by the fund, the claims assessor still requested a further medical report from Afton’s treating GP. WKB lawyers ensured that the further report requested was fair and in accordance with the TPD definition.

After receiving pushback from the insurer, a further obstacle encountered was the insurer’s request for our client’s Medicare/PBS records and Centrelink file due to a significant backlog. We advocated around this to avoid any further delays to the assessment of the claim.

Further, after applying pressure on the insurer to make a decision, Afton’s claim was approved. We then assisted Afton with finding out the tax implications on the withdrawal of her TPD benefit by putting her in touch with a specialised financial planner. Before finalising her matter, we assisted Afton with making a lump sum withdrawal of her benefit sum.

NAME: Vishani Khoosal

TPD Benefit amount: $351,422.00

First name of client: Afton

Injury/illness:

1. Whiplash injury
2. Cervicogenic headaches
3. Chronic bilateral shoulder subacromial bursitis and laberal tear of the right shoulder
4. Bilateral occipital neuralgia
5. Anxiety depressive disorder
6. Post traumatic stress disorder

CLAIM

WKB Lawyers assisted Rosemary with her TPD claim which was approved in under a week from the time of lodgement.

Rosemary’s claim was advocated under a TPD definition involving a second limb for retraining. We advocated that Rosemary met the TPD definition including that she could not be reasonably expected to acquire work in the future within a suitable rehabilitation/retraining program.

We ensured all relevant medical evidence from Rosemary’s treating GP and treating specialist had been completed before lodging her claim. This avoided any potential delays and led to a prompt assessment and approval.

Throughout the process, we were regularly in touch with Rosemary to answer her queries, address her concerns and confirm her instructions.

Rosemary was very happy with the timely outcome of her TPD claim and the payout on her eligible superannuation policy.

NAME: Vishani Khoosal

TPD Benefit amount: $20,000

First name of client: Rosemary

Injury/illness: Left Frozen Shoulder related to her left upper limb injury and left wrist fracture