Have you received a procedural fairness letter in your Total and Permanent Disablement (TPD) claim?

The term ‘procedural fairness’ might indicate that an insurer is taking steps to ensure your best interests are being considered prior to making a determination about your claim. This is not necessarily the case.

It is standard practice for insurers to issue procedural fairness letters to applicants when they are considering denying a claim.

Procedural fairness letters are letters that are provided to an applicant which provides all material that an insurer is relying on when making a determination about an applicant’s claim. Sometimes the insurer will make written submissions about their position on the application and set out the reasons why they say the claim should not be accepted.

The process of receiving a letter such as this is to afford the applicant an opportunity to respond meaningfully to the material.

Procedural fairness letters are very important and need to be responded to meaningfully. Failing to respond to a procedural fairness letter may lead to a denial of a claim.

These letters usually have a set timeframe in which to respond. The period in which to respond is usually reasonably short, often around 21 days. The exact period in which to respond will vary depending on the insurer. You may be able to secure an extension of time to respond, but this is not always the case. Seeking urgent legal advice at the time of receipt of this letter is important.

Often the period of time allowed is insufficient to traverse the material that is provided by the insurer, make submissions in support of your application and seek further supporting medical material, if necessary.

Given the limited period of time in which most of these procedural fairness responses need to be submitted it is imperative that you act on these letters without delay.

What to do if you receive a procedural fairness letter?

Just because an insurer is proposing to reject your TPD claim, does not mean that you do not have a valid claim with prospects of success.

If you have received a procedural fairness letter from an insurer it is an indication that your claim is likely to be rejected. We would strongly encourage you to seek legal advice about your claim as soon as possible.

We have extensive experience in managing TPD claims which have been subject to procedural fairness and have achieved successful outcomes in many of these matters.

Should you require assistance we would recommend that you contact us for advice.