If you are lodging a TPD claim, you would have noticed the large number of forms you are required to complete before the Super fund or insurer even looks at your claim. What you will also find is that each Super fund or insurer will have their own set of forms and additional reports such as medical records you will need to obtain. There is also a lodgement process you need to follow once your claim is submitted.
As a general rule of thumb decisions shouldn’t take longer than 2 to 3 months.
TPD lodgement process
This lodgement process contains a review of all the paperwork that has been submitted, to ensure they have been correctly completed and all relevant documentation attached as set out in their instructions. Unfortunately, the Super funds instructions are often ambiguous, making it difficult to follow. In many instances this is a back-and-forth exercise until the claimant correctly submits all paperwork exactly as requested by fund. The insurer will then assess and make a decision about the claim and reports back to the Super fund. The fund then further assesses this recommendation and makes their own decision. Once this is finalised it is then communicated to the claimant.
Timeframe – how long is too long?
The question is how long does and how long should this process take? As a general rule of thumb decisions should not take longer than 2 to 3 months. If it is taking longer, a reason should be provided to the claimant.
A common experience for people making TPD claims is that an insurer will approach the matter in an ad hoc way. If documents are available for example medical records or workers’ compensation files then those records should be requested immediately by the insurer at the beginning of a claim.
Legal representation is an advantage
If you have legal representation and if your lodgement of claim is done by a solicitor, you are of an advantage as your solicitor would have ensured that all the correct paperwork is submitted with your claim. They will also ensure your lodgement forms are completed exactly as required by your Super fund. This saves you time and ensures the decision is not delayed because you didn’t have the required paperwork.
The law requires that an insurer and a super fund investigate a claim and make all reasonable enquiries required to properly decide the claim. The claim process is not an adversarial “us versus them” approach. There is no onus on the person making the claim to prove their claim. In fact the onus is on the insurer and super fund to properly investigate the claim and make a fully informed decision. The law also requires a claim to be decided promptly.
If a decision about your claim is not made within a realistic time, you can issue court proceedings. Court proceedings can allow and force super fund to make the decision. You may also have the ability to claim interest on any delayed payment including the legal costs associated with initiating the proceedings.
Delay in assessment of a TPD claim is not acceptable.
TPD claim troubles?
At Turner Freeman Lawyers, we have a dedicated team of lawyers who can help you with your claims and lodgement. If your claim has taken too long, if your claim has been rejected, please call us on 1800 683 928 or via our online form for an obligation free assessment.