TPD claims are complex financial products and there is a lot of confusion about how they work, what you have to prove to make a successful claim, as well as the bases on which an insurer can deny a claim.

It is generally well understood that a TPD policy covers you if you are unable to work due to injury or illness. One frustrating area is the insurance company’s definition of “any occupation” as opposed to “your occupation”. The policy might provide cover if you are unable to work in your occupation. If that’s what your policy says, your chances of making a successful claim are better. However, if the policy refers to “any occupation” then the insurer may be able to deny the claim if you can work in a position for which you are qualified for by your education or training/experience.

Another difficult area is the concept of “pre-existing conditions”. It is not uncommon for insurers to deny a claim for a condition which exists now and which relates to a condition which existed before the policy was purchased.  The link between the two conditions may not need to be particularly strong.

There are also strict time limits which apply to challenge an insurer’s decision about your claim. The applicable time limit depends on whether you challenge the claim in Court, or in the Superannuation Complaints Tribunal or through the FOS.

To learn more, contact us, or read more here.