Requesting reports from medical specialists
Part of a TPD claim process is for the insurers to request medical reports from doctors or other independent medical specialists. As a claimant, you have the right to access these reports under the Privacy Act.
The type of information that can be requested and the timeframe for this information to be provided is set out in the Australian Privacy Principles. Organisations that hold sensitive information on individuals such as health, are subject to more rigorous obligations.
Australian Privacy Principle 12 states that an organisation that holds personal information about an individual is required to give the individual access to that information upon request. The exceptions, relevant in a TPD process is where giving access would reveal evaluative information generated within the entity in connection with a commercially sensitive decision making process.
Insurers, however use this exception as their reasoning for not providing claimants access to obtained medical reports. The doctor’s report is not covered by this exception. Notes the insurer may have created internally when reviewing the report, however do form part of the exception.
Often insurers will not provide copies of the medical reports until just before a decision is being made about the TPD claim, until provision of procedural fairness. This is not a valid reason for delaying access to medical reports. TPD claimants should be requesting reports from insurers as soon as they are available. Once the medical report is released, it must be reviewed by the claimant so any errors can be requested to be corrected. Otherwise the insurer will rely on the information contained in the report to form their decision on the TPD claim.
Any request for information or reports needs to be made to the claims manager handling your TPD claim. If this is unsuccessful and they refuse to give you access, then it needs to be escalated to the privacy officer of the super fund or insurer who are in possession of the report. If the information or report is still not provided, then you are able to make a complaint to the Office of the Australian Information Commissioner (OAIC) who will investigate the complaint. The OAIC is able to force the insurer to provide access to information and documents. Following this process will give you the most effective and efficient way of accessing the information and reports held by the insurer or super fund to ensure your claim has the best possible chance of success.
If you need assistance with your TPD claim, or if your TPD claim has been rejected and you want to challenge or contest the decision, contact our Superannuation, Insurance and Disability team on 13 43 63. Our Queensland offices are in Brisbane, North Lakes, Logan, Ipswich, Toowoomba, Gold Coast, Sunshine Coast and Cairns.