When claiming for TPD through superannuation, it is not the claimant’s responsibility alone to prove the claim. It is the responsibility of the superannuation trustee to ensure they are assisting the claimant with their TPD claim. It is also the responsibility of the trustee to assist the claimant to challenge an insurer’s decision if the correct decision was not made by the insurer.
Dealing in good faith
For many years all parties in an insurance policy need to act in what is called ‘good faith’. Since 28 June 2013 this now includes third parties who benefit from an insurance policy like superannuation fund members. This means all parties to a TPD claim and insurance policy must act fairly and reasonably in line with commercial and community standards of courtesy.
To formulate a decision in the TPD claim, the trustee and/or insurer may ask the claimant to attend an independent examination or medical appointment. However these requests must be reasonable and relevant to the claim. If there is no relevancy and/or the request is not reasonable then the claimant can refuse to attend or take part in these appointments.
Example of what is an unreasonable request
For example, if you have provided your employment history in the form of a resume or other document as evidence when you have lodged your claim, if you are then requested to show tax returns or other financial document to prove your employment history, then this request may be unreasonable and you may refuse.
Another element of acting in good faith is ensuring the insurer is making a decision of a claim in a timely manner and not dragging things out unnecessarily by asking for information bit by bit, instead of at the same time where possible.
You should also not be requested to spend significant money or resources to provide things like medical reports if it is requested by the insurer. If it is relevant to your claim, these should be paid for by the insurer with the help of a trustee.
Finally, if the insurer or trustee is refusing to make a decision because of lack of evidence or documents provided by the claimant, you can still insist on them making a decision on your claim. Not providing some information to the insurer or fund should not be an excuse to not make a decision on the claim.
Still no decision on the claim?
If you find that the decision of your TPD claim is taking too long, call 13 43 63 to speak with our specialist superannuation and TPD lawyers in Queensland as there are many ways we can help you get the insurers to speed up their decision making on your claim. Alternatively, if the decision has been made but you are unhappy with it, we can help you challenge the decision. Get in touch with us online or visit us at any of our Queensland in Brisbane, Logan, North Lakes, Ipswich, Toowoomba, Gold Coast, Sunshine Coast and Cairns.
