You have submitted a claim for Total and Permanent Disablement (TPD) benefits and the insurer wants you assessed. The big question is, do I need to attend.
The short answer is, maybe.
Every superannuation fund and underwriter insurer that assesses a claim for TPD benefits has the right to request the applicant attend a medical assessment. It is not unusual for this to occur and the applicant may be asked to attend more than one assessment.
These assessments are referred to as medico-legal assessments or Independent Medical Examinations (IME).
Superannuation funds and insurers are entitled to make reasonable enquiries relating to an applicant’s health and past, current and future work capacity as a part of the consideration of an applicant’s claim.
The doctors the superannuation fund or insurer chooses are usually specialist doctors and their qualifications vary depending on the nature of your illness or injury and the issues in dispute in your case.
Quite often these doctors are occupational physicians, to determine your capacity for employment, but may also be orthopaedic surgeons, psychiatrists or neurologists, the speciality of which will depend on the nature of your injury or illness.
Can I refuse to attend an IME?
Where the superannuation fund or insurer’s request for you to attend an IME is unreasonable you can object to attend. The reasonableness of the request will vary depending on the circumstances of the application and the matter generally.
If objecting to attend an appointment you must usually provide the reasons for the refusal. Sometimes, it may be necessary to put your objection in the form of a complaint and process this through the superannuation fund or insurer’s internal dispute resolution process.
An objection to attend upon an IME assessment is likely to delay any decision in your matter.