Unfortunately, TPD claims can be rejected or declined, and in this article, we discuss what appeal rights you may have in the event that this occurs.

What sort of reasons can my claim be declined?

Firstly, TPD claims are rejected or declined due to the following reasons:

  • Did not meet the TPD definition;
  • Medical evidence does not support the TPD definition;
  • A different clause in the policy; and
  • Pre-existing condition/s.

The above is not exclusive, but these reasons ar very common when your TPD claim has been rejected or declined.

What can you do?

 There are a few ways that you can appeal the decision.

First step, is to lodge a review with the Internal Disputes Resolution Department (“IDR”). Generally, the IDR team can take around 42 days to respond to your complaint.  If your TPD claim is rejected or declined, then you may lodge an appeal with Australian Financial Complaints Authority (“AFCA”). Generally, AFCA will go through a process including a informal mediation to see if the parties can come to some sort of a resolution. If not, AFCA will make a binding determination.

However, before doing the above, we suggest that you give WKB Lawyers a call for a free review of your TPD claim. Not only are we experts in TPD claims, but this is all we do, meaning that we have been through every possible decline and can give you advise on how to proceed quickly.

For a free review of your case, please contact WKB Lawyers at 1800 862 225 or visit our website.