Q & A on 2GB discussing Disability Insurance Claims 02/07/14

Tuesday, 2 July 2014

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AM – Andrew Moore/AT – Adam Tayler/C1,2,3,4 – Callers

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AM     Alright 24 minutes to 2, I’ll get back to your calls shortly, in fact if you’d like to talk about superannuation laws which we are going to discuss this afternoon, 131873 the open line number, Adam Tayler from Turner Freeman Lawyers joins me on the line, g’day Adam how you going

AT      G’day Andrew I’m well thanks and yourself

AM     Mate not bad at all, superannuation law I don’t know how much that we understand about it, but we talk about things like disability claims for example through superannuation law and the length of time it takes through your super fund, what should we be looking at

AT      Andrew my experience in these matters is that if a claim is taking any longer than between sort of 2 to 3 months its taking too long. Unfortunately I’ve seen many experiences from client’s coming to us for assistance where it’s taken much longer than that and they have just not been able deal with the insurer themselves.

AM     There are some that take up to a year or more aren’t there

AT      I’ve certainly had an example of a case recently where a client came to me after 18 months, so he had lodged his claim online thinking that would be a quicker and easier way to do it and 18 months later he still didn’t have a decision

AM     Adam how do people know if they are eligible

AT      Generally there is two ways to do it, one is on your statement that you receive from your super fund there should be some details of the insurance that is available to you on your account, if there is nothing there or you’re not sure about it than you can speak to the super fund direct and they should be able to tell you about that. People are generally eligible if they are unable to work because of an injury or illness and that’s permanent injury or illness

AM     Well if listeners have any questions about this now is the time to ring and get some advice on 131873 because I would assume when you are going through something like this and you hear from the insurer, look we are assessing the claim, you just sort of accept it, it might be frustrating but you just accept it or things are being reviewed, how long should we put up with hearing that sort of thing

AT      I think sometimes we are a bit too willing to accept those sorts of excuses

AM     Probably because we don’t know any better I guess

AT      I think that’s right and you know we expect that a super fund and an insurer will deal with a claim promptly and reasonably and they are required to do that, but quite often we hear these excuses happening and as I say if claims are taking more than sort of 2 to 3 months then it’s too long

AM     Yeah ok, because I think we’re in an area here where a lot of people are really, I don’t know whether clueless is the right way, but we probably don’t have enough confidence to know exactly what our rights are and how long everything should be taking

AT      I think that is right Andrew and the difficulty that people have is there are not used to dealing with insurers and their particular ways in which they handle claims and every insurer is different particularly in the superannuation field there is a number of different insurers out there that deal with this sort of work and they all have their own processes and procedures as to how they follow on, sometimes it’s a little bit hard to understand

AM     So what’s the first tip you’d give someone who finds themselves in a position where they need this

AT      Look I think seek some advice about it, I mean there are certainly firms like ours that and others out there and there are other non profit organisations as well that assist people with these sorts of claims. You need to get some advice at the beginning. You can get yourself into a bit of trouble if you do it yourself

AM     Alright, well calls are starting to come through now on 131873 and we will start with you Brian, g’day

C1       Hi Andrew, I love your work mate especially with the continuance call team

AM     Thanks Brian I appreciate it, Adam is here for you mate

C1       I’ve just got a question, I’ve put a claim in for total and permanent disability from a football injury I had years ago, it got to the stage where I had two surgeries, one which was in 2012 the last one, still sort of recovering from that and I made a claim through my superannuation fund for the TPD and we put that in last October my wife and I and we’re still waiting. The last correspondence we received was a letter from them that stated that they are finished their assessment or something and they attached all the forms that I and my doctor and specialist had filled out and that was about 6 weeks ago and I just heard you say if in 2 or 3 months you haven’t heard from them that’s a bit long, it’s been like 8 months now

AM     Yeah Brian I certainly think that that’s taking way too long. What they appear to have done recently in giving you copies of those documents is what we call a, a step call procedural fairness. They are required to give you copies of any documents that might be adverse to your claim and give you a chance to comment on those. It’s taken way too long Brian

C1       So what do you have any advice if I call them is there any way I can force their hand or I really just have to wait to they are ready to give their

AM     That’s the key ultimately to know it’s taking too long and know that they are delaying it as long as possible what does Brian say to them to force this issue along

AT      My suggestion Andrew would be that Brian put a demand on them to make a decision by a certain date. If the decision is not made he can then deem the claim to be declined and he can take action either through the Courts or other tribunals about that so he can start forcing the issue

C1       Ok, thank you

AM     Ok Brian, alright good onya mate. 131873 the open line number we are with Adam Tayler from Turner Freeman Lawyers. Dale is next, hello Dale

C2       Yeah g’day boys how are you

AM     Good Dale

C2       My question relates to my mother. She has got terminal cancer now and she actually worked right up until about a month ago. The doctors are suggesting she has probably only got a couple of months left and yeah we have had a real pain with her super to try to get the disability support. She is talking now about taking it out. What does she need to have, to be able to access that

AT      Generally Dale you need the certificate of 2 medical practitioners which will certify that she is unable to work permanently because of the cancer. The other thing to think about and this depends on her particular fund, but if there is a terminal illness coverage she may be able to get an advance payment of her life insurance effectively on that so she can use those funds now for medical treatment and the like

C2       Yeah that would be great. I know it’s just a real pain she was setting up her death nomination form and they rejected it three times for simply writing over the line and stuff like that, it is real frustrating dealing with these people

AT      That sounds a bit technical and a bit silly to me, but they really should, it’s not hard to a binding nomination

C2       I guess my worry is how long all these claims take. You know if she puts in a claim now with the documentation, she may be gone by the time it happens

AT      Certainly the claim should be made sooner rather than later. My experience with terminal claims is they do actual deal those a little bit quicker, but it still takes some time, but they should certainly try and push that through. Now the expectation is that they would do that

C2       Ok thanks for your time today guys

AM     Good on you Dale, hope that helps mate, 131873 the number to ring. If you do have a question particularly pertaining to superannuation, Adam Tayler from Turner Freeman Lawyers and of course compensation can’t change the past put it will make a difference to your future, so if you’re suffering because of someone else’s negligence, turn to Turner Freeman Lawyers, yes Turner Freeman Lawyers, they’re heavy hitters the type of law firm you need on your side to way and they have been winning claims for a very long time. When a Turner Freeman Lawyer acts for you they draw on over 500 years of combined experience, the financial and legal resources of a national firm and a reputation as tough, uncompromising litigators who don’t rest until you get the compensation that you richly deserve. So give Turner Freeman Lawyers a call, they have offices throughout New South Wales. You can visit TurnerFreeman.com.au to find the details of your nearest office. TurnerFreeman.com.au. Turner Freeman Lawyers when you need to win your case, they have a no win, no fee policy and you can call them today for a no obligation assessment of your claim. 1800 800 088, 1800 800 088 or TurnerFreeman.com.au. Adam Tayler with us, we’ll come back and take more of your calls for Adam on 131873, it’s a quarter to two

AM     It’s eleven minutes to two, Andrew Moore for Chris Smith and I am joined by Adam Tayler from Turner Freeman Lawyers taking your calls on 131873. And Adam we’ve got Amelia on the line for you. G’day Amelia how you going

C3       Hi Adam

AT      Hi Amelia

C3       Andrew, sorry about my voice

AM     Oh your croaky Amelia, that’s alright darling

C3       Yes, I just had a triple by-pass, the medication does this to me

AM     Are you Ok

C3       Oh not really but I’m getting there, I had a triple by-pass on the 3^rd of December, I ceased work on the 20^th with chest pains, 20/11 and I ceased work, the next day I woke up got myself off to hospital because the pains were still there. Anyway on the 3/12 I had a triple by-pass, they have done that. Apparently it’s all healing bar my voice. Everyone can’t explain why I keep losing my voice, but the thing is you know total permanent disability, I’m insured in America in the super industry for a year. But they are still continuing on their search of my records and they are going back like 10 years. Can’t they pay me or, the lower part of my heart is damaged muscle, through the by-pass and through the heart attack. I can’t really, I’m not eligible to do any work without exertion and shortness of breath as you can understand right now

AT      Amelia obviously it’s a very serious condition and that would be a condition that should qualify for TPD. Provided you had coverage at the time you ceased work there should be no issue. I don’t understand why they would need to go back 10 years to work that out. It should be a straight forward thing for them to tell you that you did have coverage at the time you ceased work or you didn’t.

C3       My cardiologist and all the other doctors have confirmed it but I rang them in Melbourne. They are stationed in Melbourne from the US. They said it is on doctor so and so’s desk right now, we will wait until the 17^th of July to get an answer from him and I said can’t this be decided, I can hardly make a phone call to my daughter let alone to important people such as yourself

AT      That sounds like a crazy excuse to me Amelia, I think they are just delaying it, if they have got the evidence there from your cardiologist they should be able to make a decision based on that. All that the law requires is that there be two certificates from medical practitioners. Now if you’ve got something else there from your GP, that sufficient. If it’s clear that you are totally disabled they should be accepting the claim

AM     So what can Amelia do Adam

AT      Probably similar to what I suggested to Brian before, I think we need to put it back onto the insurer to make a decision by a certain date

C3       Absolutely, thank you. I have had my family doctor since I was 16 in 1971 when my first child was delivered and she still with me and said, Amelia don’t even do anything bar walking and your breathing exercises I’ve told you to do

AM     So you have covered everything you need to cover Amelia

C3       Yes

AM     Now we need an answer so, hold on there and make sure we pass on exactly the advice from Adam to you

C3       Thank you Andrew

AM     Don’t go anywhere Amelia you hold on

C3       Thanks guys

AM     And we’ll make sure we talk to Adam off air to find exactly the course of action you need to take. We will keep going though we’ve only got a couple of minutes left. G’day Ian, how are you going

C4       Yeah good mate, yourself

AM     Good mate, Adam is here for you

C4       Yeah mate, if you’ve got have an operation are you allowed to access your super fund? I don’t have TPI insurance or anything like that because the fund knocked me back, because of my BMI because I’m an interstate truck driver. Are you actually allowed to access your actual super fund itself if you’ve got have an operation in hospital and you can’t work?

AT      Ian you should be able to access for that reason, there is a couple of exceptions to getting early access to your super, one is an exception called compassionate grounds and that includes accessing money to get medical treatment so that is something that you should be able to access your super for

C4       Ok, so I just have to get a certificate or something off the doctor and do it that way and ring the super up, yes

AT      You will need to get proof from the doctor as to what the treatment is that you require, you do also need to obtain a certificate from the Department of Human Services which is the department that runs Centerlink to confirm that you are eligible, you then take those to your super fund and they should release the money to you

C4       Alright thanks for your help

AM     Good on you Ian and one more Valerie, hello Valerie

C5       How are you?

AM     Well thanks

C5       Thanks good. I’ve been on compo since 2008. The company sacked me in 2010 and I’m still on compo and I applied two years ago for my total and permanent disability. Does it make a difference that they have put down on my certificate that I can work 20 hours a week? I retire in December, I’m 65

AT      It could adversely affect the claim Valerie if you do have a capacity to work then that can defeat a claim, but we’ve got to look at what the reality is of you actually being able to work 20 hours a week and hold down a job, that’s going to depend obviously on the condition that’s got you off work, I mean these things can’t just be a theoretical yeah you might be able to work 20 hours, we’ve got to look at that in real terms and in the real world can you actually hold down a job

C5       A job, I can’t get jobs anywhere. The doctor sent a letter into the compo and the solicitor has been pushing it and I got a letter from them saying they had moved it over to a trace thing.

AT      Yeah look 2 years is again way too long Valerie for a decision to be made on these sorts of things. Your age obviously would impact on your ability to gain other work as well all of those factors need to be taken into account I think a decision should have been made a long time ago

AM     Alright thank you Valerie, good luck with it. So Adam in keeping with what we said at the start, because it’s a complicated law really to the lay person, they don’t know who exactly how pressure insurers into getting this done, getting it finalised

AT      Sometimes unfortunately Andrew, it takes a solicitor’s letter or lawyers getting involved to push these funds to actually do something

AM     Alright Adam I appreciate your time today, well done, thank you

AT      Thanks Andrew

AM     Alright if you just hold on we will put you back to Bridget and so we can give especially Amelia that direct advice as to how to fix her situation up as well. Adam Tayler from our sponsors Turner Freeman Lawyers and you can have a look at their site online, TurnerFreeman.com.au or give them a call 1800 800 088 for a no obligation assessment of your claim, 1800 800 088.