Insurance companies and their high rejection rates of TPD claims
Tuesday, 8 November 2016
CS – Chris Smith /KB –Kerry Byrnes /C1,2,3, etc – Callers
CS 20 minutes to 2 – 20 minutes to 1 in Queensland – time for Legal Matters – we are going to hear about the compensation claims you can make with superannuation. Maybe you didn’t know about this – often, when you are at Turner Freeman Lawyers – they find out that the client’s haven’t and they turn up and say – “are you for real?”. It’s true and maybe it’s something you need to know a little bit more about, which is why we give you free legal advice on Tuesdays on subjects like these. Thanks to Turner Freeman Lawyers and the Legal Matters Segment, I’ve also got a $100 Westfield Voucher to give away to a caller today.
Turner Freeman Lawyers provide a range of specialised legal services including compensation and negligence law, asbestos litigation, superannuation and disability claims, family and employment law Wills and estate and property law. Offices in Sydney, Parramatta, Campbelltown, Penrith, Newcastle and the Gong (Wollongong) – also in Queensland, South Australia and WA – if you’ve got a legal question on claiming with super and TPD, give us a call on 131 873. Kerry Byrnes is an associate based at Turner Freeman’s Sydney office and
KB Thank you for having me again Chris.
CS Yeah good to have you here. Kerry is quite happy to take your call. Maybe it’s a predicament you’d like some help with. Call in. 131 873 – but don’t leave it too long because Kerry won’t be here forever. Westpac subsidiary – BT Super for Life has sent all of its total and permanent disability insurance claims it previously refused for legal review. Why has this happened?
KB Well, I can’t say for sure because I don’t work for BT – I have a couple of claims for clients against BT but my understanding is that…….
CS They’ve been too tough?
KB Potentially yeah – they’ve been found to have the highest rate of rejections of these kinds of claim in an assessment that was done recently by the regulator and so probably to combat the suggestion that their rate of rejection is too high, they’ve decided to have all of these things reviewed by a law firm.
CS So they haven’t been pushed into this at all?
KB I suspect they are probably trying to avoid the situation that CommInsure have found themselves in recently. There’s been a lot of media – negative perception in the media about CommInsure and I suspect that Westpac and BT are probably trying to avoid that by taking these sorts of steps.
CS So for those who have had their claims refused, they should just hold on one second, should they?
KB Yeah I think that’s probably a good idea. I mean certainly with anyone who has made their own TPD claim and had it rejected, I would say they should be getting some legal advice in any event, but potentially this review could be a good thing for those people who have had their claims rejected.
CS Okay – one of those individuals could be this fellow from Casula. Mohammad – go right ahead.
Caller 1 – Mohammad
Mohammad Hi. How are you going?
CS Very well. Kerry is listening. Might be able to be of assistance to you. Go right ahead.
Mohammad Three years ago I had a motorbike accident and what happened is the police put a negligent driving fine on there which I took to Court and fought because he had no jurisdiction to put on me and I had – and I was told that I wasn’t able to claim because of that fine. Now that fine is gone, was I able to claim on my BT Financial Super?
KB It’s a bit strange that they would say that you can’t claim as a result of that fine that the Police tried to put on there. It’s certainly worthwhile to have another go at it and if there were something we could do to assist, I would be more than happy to talk to you about that off air Mohammad, but certainly yeah – I think it is a good idea for you to look into making a claim again in relation to that. Have you not been able to work as a result of it at all or ?
Mohammad Well for nine months – well actually 6 months – I’d [done] 3 months surgery then I was on 3 months on strong rehab and then for the next 9 months after that I was trying to find a job and no-one wants to put me back in because they considered me to be a liability due to my accident.
KB I mean, have you been able to return to work in a similar industry now?
Mohammad Well no – I used to be an accountant – now I’m a courier.
KB Okay. And can you not work as an accountant anymore as a result of your injury or illness?
Mohammad Well that’s the thing because now when I do apply they go because of your duration you have not worked, we are afraid of what you have forgotten what you have done – even though I have been doing it for like 8 years.
KB .Okay, I think it’s probably a good idea to get some advice about that. It really comes down with these sort of TPD claims to a question of capacity. Do you have the capacity to work as an accountant again or don’t you. So yeah it might be that getting some advice about that is a good idea.
CS So Mohammad you were in with BT Super were you?
CS You were with BT Super were you?
Mohammad Yeah, yeah. I’ve been with BT Super for a good 5 years now I’d say so.
CS Okay. Alright – you might have some joy. I’ll put you on hold and we’ll get the team to take your details and I think Kerry will be in touch. Good on you Mohammad. Thanks very much for that. But they’re the kind of scenarios if he was with BT Super – he needs to maybe give some separate advice through someone like yourself but also watch very carefully what happens with this legal review.
KB Yeah – it might be that – I don’t have any details on specifically what the law firm has been instructed to do. Interestingly they haven’t said which law firm it is, but certainly there’s a possibility that they might be contacted by BT to say “we have reviewed your case and either we’ve stood by our decision or we’ve reviewed it and decided to accept your claim”.
CS Let’s hope it’s not a marketing ploy and it’s really a proper review.
KB Let’s hope.
CS And there’s some justice seen here. Peter. Go ahead – Kerry is listening.
Caller 2 – Peter
Peter Yes – hello.
KB Hi Peter.
Peter Hi. How are you?
KB . Good thanks – how are you?
Peter Very well thank you . I’m ringing up because I was with a company called TAL.
Peter I injured myself at work and I had – I believe I had ……….
CS Well hang on – just hang in on this – I want to get in on the joke here. What was the….. why did you laugh when he said what company he was with?
KB Oh – TAL’s a very well known insurer in the TPD/Income Protection industry.
CS Ok. Alright – keep going Peter.
Peter I had income protection. Now one of the – I injured myself at work which has – it’s been over a year now – I haven’t been able to return to any sort of work and when I put the claim with TAL – they said there was a question there – was there any other thing that prevents you from not working apart from your injuries and I said due to my injuries, I’ve injured my back which I need surgery on as well. Then they sent me a letter – they said look unfortunately because you have been to the???? previously for your back – you’re not covered – even that wasn’t my claim at the time and so they cancelled my policy and they sent back to me all the money – all the premiums that I paid over the year.
KB Yeah that sounds like a bit of a tricky one Peter. What was the injury that made you stop working?
Peter My knee and my hand.
Peter I injured them at work and because of the way I was walking, I injured my back.
KB So even though – you might have had a couple of back problems previously but it wasn’t preventing you from working before?
Peter That’s correct – yeah – and I never ever had back problems prior to that.
KB Okay and I think that that might be one that we could give you some independent advice in relation to – sometimes it might be – sorry one question I was going to ask you, the policy you had – the insurance policy – was that one that you took out yourself or was that through your superannuation?
Peter No, I took out myself.
KB You took it out yourself. And so there would have been a questionnaire that you had to fill in about any previous injuries or illnesses that you had presumably?
Peter And I’ve filled out everything… we had done blood tests, they got papers from my doctors – everything – So I didn’t hold back [nothing].
KB And so they are now saying that…. are they now saying there were things that you didn’t disclose at the time….. or?
Peter Yeah – well see because I have the claim I put my knee and my hand and then the question that said “is there anything else that prevents you from working?” – and then I said yes, I’ve injured my back at the time that I was off work and they used that against me saying – well sorry because you didn’t disclose your previous back injury, which I never ever had…..
KB Yeah I think that is probably something that you need to come and get some advice about Peter. There interest that the insurers have is obviously they don’t want to pay out any claims if they don’t have to and with these sorts of matters it is really a case of trying to figure out what injuries became relevant at what point in time. So if your back injury – if you never had a back injury before the knee and the hand injury or if you did but it never prevented you from working, it might be that you can potentially challenge that decision.
CS And surely a medic at the time could determine whether that was an injury caused by the accident as opposed to an injury that was pre-existing.
KB Yeah, I mean obviously – it happens pretty frequently that if you have got a knee injury it will affect the whole way up the rest of your system as well. So yeah, I think it will be a really good idea to get some advice about that one.
CS Okay Peter – stay right there – we’ll put your contact details in that list and we’ll make sure that Kerry gets in contact with you. Back with Kerry Byrnes from Turner Freeman and our Legal Matters Segment right after the break.
CS Those Rural Fire Service are fighting a bushfire at the moment on the M1 – north of Sydney at Freeman’s Waterhole, southbound lanes are currently closed – southbound lanes are currently closed – William go right ahead – Kerry Byrnes from Turner Freeman is ready to take your call.
Caller 3 – William
William Yes – look I’ve got lung disease and eventually I am going to have to – I won’t be able to perform my duties in my position that I am employed in and I just want to know – can I – do I qualify for a permanent disability superannuation payout and I’m with BT Superannuation.
KB Hi William – it’s possible that you may do – in order to be successful with these kinds of TPD claims you usually need to be able to show two things – first of all that you have had the minimum period time off work and with TPD claims it’s usually somewhere between 3 and 6 months depending on your particular policy and then the second thing that you need to be able to show which is a little bit more difficult is that you can convince the insurer that it’s unlikely because of your injury or illness that you will be able to ever return to the job for which you have the education, training and experience. So what sort of field are you in?
William I work in like a tank farm……
KB Okay. So in order to be eligible for it, you would need to show that you can’t work as in the tank farm industry or in your particular role in that industry and it is unlikely you could do anything else that you had the education, training and experience to do. So it’s certainly worth – once you get to the point where you’re not able to work or it’s getting pretty close, it would certainly be a good idea to get some information about – first of all to check that you definitely do have a TPD cover and then to sort of see what the steps are in order to make the claim – usually there’s a couple of doctors which would need to fill in reports for you – there would be a document that you would need to fill in – there might be a document for your most recent employer to fill in as well. But also with your case it would be a really good idea I think to have a look at whether there might be some sort of income protection as well, sometimes that’s available through people’s super funds or if they’ve taken out a policy themselves.
CS Yes you might explore that sooner rather than later – I want to give you that $100 Westfield Voucher William – is that okay?
William Yes – that would be fine thank you.
CS Okay a $100 Westfield Voucher coming to you – stay on the line though because not only do we have to get that voucher out to you but it might be worth William catching up with you afterwards as well given all of that….
CS Thank you very much for your time today – can’t get to any more calls but we have had a fair few and still had some questions to ask off you – maybe next time – Thank you Kerry.
KB My pleasure – thank you so much.
CS Happy birthday too by the way.
KB Hehe thank you very much.
CS Kerry Byrnes – an Associate based at Turner Freeman Sydney office and our Turner Freeman Legal Matters Segment and you can return and ask a question next Tuesday as we have Legal Matters on air once again.