$200,000 TPD payout for psychological condition

Our client was referred to us by another lawyer who did not specialise in insurance claims. 


Our client’s TPD claim

Before our client came to us, she had been on Centrelink benefits for close to 10 years. Her last paid employment had ceased approximately 10 years earlier.


Almost by accident, our client discovered that 10 years ago (i.e. in her last job) the employer opened for her a superannuation account. That is where the employer’s superannuation contributions were paid. More importantly, like many other super accounts, this one also came with a total and permanent disability insurance policy. This policy was organised by the superannuation fund, without our client ever even thinking about it. 


Prior to coming to us, when our client discovered that a TPD policy had been arranged for her, she made a claim for a TPD payout. 


The insurance company requested our client to provide proof that 10 years ago, she ceased employment due to a medical condition and that that medical condition now prevents her from returning to work. 


As you can imagine, this would be an extremely difficult thing to prove given that all relevant events occurred some 10 years ago.  Who has records going that far back?


After our client engaged us, we conducted investigations into her medical background. We obtained her Medicare claims history going back over 10 years, and we also identified all previous medical treatment providers. We contacted all practices and doctors and requested their records going back more than 10 years. 


Eventually, we received a large number of medical documents which we then reviewed. 


Based on our review of the medical documents, we concluded that there was ample evidence that our client was diagnosed with a relevant medical condition 10 years earlier and that medical condition prevented her from continuing to work. 


However, to be absolutely sure, we also contacted our client’s employer from 10 years ago, and actually met in person with her then supervisor. She remembered our client and she provided us with a detailed statement setting out why our client’s employment ceased (i.e. because she was medically unfit to continue to work there). 


We presented all this evidence and written submissions to the insurance company. We argued that the evidence was overwhelming and that if the insurance company still refused to pay our client’s claim, then we would be commencing legal proceedings in court. 


The insurance company elected to internally review its previous decision, and it agreed to pay out our client.