Life insurance

The “At Work” definition and why this is important when Superannuation Funds change Insurers for TPD claims

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Rest announced they will replace AIA for TAL commencing 1 December 2019. In my opinion, I am happy to see this after working extensively against both insurers for over 7.5 years.

However, when a new insurer takes over, a few potential issues could arise for their members TPD lawyers and Financial Advisors when submitting a TPD claim. The biggest potential issue being the “at work” definition.

 

At Work Definition

If a member ceases work due to injury or illness and they cannot perform the full inherent requirements of their role, as of the takeover date, they may be subjected to an “at work” definition.

In a nutshell:

you must be actively performing or capable of performing all of your normal duties, without limitation or restriction due to Injury or Illness, and where working is working normal hours on the day cover is to commence;

 not restricted by Illness or Injury from being capable of actively performing their full and normal duties on a full-time basis (for at least 30 hours per week) even though actual employment may be on a full-time, part-time, casual or contract basis.

And some super fund definitions exclude members who are on any type of compensation or Centrelink payments as at takeover date.

 

Date Last Worked

Date last worked issues can arise and unfortunately I have seen this many times(claims submitted prematurely), but a diligent lawyer and financial advisors should have solid documentary evidence of the date last worked before they submit a TPD claim, so they know from the outset which Insurer forms to obtain. Having the evidence of your client’s date last worked will prevent significant delays on the claim.

 

Superannuation funds will always change their Insurers, and it’s very important for TPD lawyers and Financial Advisors to make sure our client’s get the right advice from the beginning so no delays are caused on our end.

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