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Why Should a Lawyer Handle Your TPD Claim?

TPD claim - Gold Coast Compensation lawyers

A TPD claim, or a ‘total and permanent disability’ claim, is an insurance benefit you can claim through your superannuation fund in the event of serious illness or injury which leaves you unable to work. Many people may try to make such claims on their own. However, making a TPD claim is a difficult, drawn-out process that can be complex to navigate. This article will explain why you should hire a lawyer to handle your TPD claim rather than attempting to handle it yourself.

Different providers have different definitions of TPD

Each super fund and insurance provider will have their own definition of TPD. They will also have different requirements as to how severe your illness or injury must impact your ability to work and, in some cases, your everyday functions before you can claim it. For example, some funds will require that you are ‘unable’ to work again, and some that you are ‘unlikely’ to work again. These are different words with different meanings in the eyes of the law. Further, in some circumstances, your level of employment (e.g., casual, part-time or full time), duties at work and hours you work per week may mean that some providers will require you to submit evidence that you can no longer perform everyday tasks such as feed yourself, use the bathroom and bathe yourself without assistance in order to make a successful claim.

Such policies are difficult to navigate on your own, particularly if your illness or injury impacts your everyday functioning. A qualified lawyer can help you navigate the specific requirements of your provider’s TPD claim process, and aid you in gathering the evidence necessary to meet these requirements.

Administrative burdens

Claiming TPD can be a very intense experience, with some claim forms being over 20 pages in length. Being injured or seriously ill may make filling out such forms difficult, particularly for those who experience mental illness. A qualified lawyer can help you navigate these administrative burdens and ensure that forms are filled incorrectly.

Even if you are capable of completing the TPD application forms on your own, it is strongly advisable to consult a lawyer first. In some instances, insurers have used the fact that a person was able to process their own claim as evidence that they do not have a total and permanent disability. This is deeply unfair, and if it has happened to you, a lawyer can help you challenge your insurer.

Issues of ‘non-disclosure’ and ‘pre-existing illness’

Insurers and superannuation providers may reject your TPD claim if they believe you did not disclose a previous medical condition when you obtained your policy. This enables them to ‘avoid’ the policy, treating it as if it never existed. Some policies also have clauses that exclude pre-existing illnesses from being covered. This means that if you are claiming TPD for the aggravation of an injury or illness that first occurred before your insurance policy began, you will not be able to claim.

Decisions regarding non-disclosure and pre-existing illnesses are often unfair and decided incorrectly by insurance companies. In making these decisions, insurers often rely on the fact that consumers may not have the understanding of the law to challenge these decisions. Hiring an experienced lawyer to help you through the TPD process ensures that if an unfair decision based on non-disclosure or pre-existing illness is made against you, you put yourself in the best possible position to successfully challenge it.

‘Doctor shopping’ and other medical issues

As part of the claim process, insurers are entitled to have you assessed by a doctor of their choosing. However, claimants are often sent to the wrong doctor or specialist, making their medical advice potentially incorrect or improper. Further, insurers have been accused of ‘doctor shopping’ – that is, attempting to send claimants to multiple doctors or specialists until one provides the information the insurer needs to deny your claim. This is often the case with psychiatrists in the event of mental illness.

Such action goes against the insurer’s duty to act reasonably and in good faith in evaluating your claim. A lawyer can help you understand when to refuse to attend medical organisations organised by the insurance company, and seek redress if they have acted improperly.

If you end up in court

If your insurance provider denies your claim, court intervention may be necessary. At this stage, it is crucial to have an experienced, competent lawyer acting for you.

At Lifestyle Injury Lawyers, we are experienced in TPD claims, including those that end up in the court system. We are committed to providing personalised experiences to our clients and offer a free claims assessment on your first visit. Call us Gold Coast Compensation lawyers today to book a free claims assessment or to find out more about how we can help you lodge a successful claim.