When should TPD claims be assessed?
The definition of TPD in most insurance policies state that you need to have been out of work for 3-6 months before you can lodge a claim. The insurer will then make an assessment on how likely you are to return to work given your education, experience and training.
This decision will be made based on the evidence available after the waiting period, in many instances not taking into consideration any other evidence that have been generated after this period.
Assessing any likely permanent effects of an injury or illness 3 – 6 months after ceasing work is too soon as doctors in many instances say that the injury needs at least 12 months to stabilised before a decision can be made. In some injury cases, for example head injury, this period can be over 2 years.
If the injury requires rehabilitation and ongoing treatment, this time period of 3 – 6 months is also too early to predict any permanent effects.
If an insurer has these types of policies, the courts understand that the decision can, and should be deferred until the injury is stable. The courts also acknowledge that further evidence can and should be obtained after this 3 – 6 months waiting period.
If an insurer has made a decision ignoring such evidence then you can dispute their decision. You can also dispute the decision if the insurer did not take into consideration any such evidence gathered after the waiting period.
If your decision is rejected, you should always obtain written reasons for the rejection and seek legal advice about your options as in many instances this decision can be disputed.
Turner Freeman Lawyers – TPD claims specialists
Should you have any queries whatsoever or wish to discuss your TPD claim, please do not hesitate to contact Turner Freeman’s Superannuation, TPD and Insurance team on 13 43 63.