Before an insurer makes a decision on a TPD claim, they are required to provide claimants with procedural fairness so that the claimant can respond to any unfavourable evidence presented by the insurer during assessment. The claimant can also correct any errors in the documents during this time.
What is procedural fairness in TPD claims?
Generally, procedural fairness enables the insurer to do the following 2 things. It allows them to provide you a copy of the documents they obtained during the assessment of your claim. These documents can include things that may have a negative effect on your claim. They may also not be using all the documentation you provided that you want the insurer to rely upon.
Procedural fairness also gives the insurer the opportunity to point out in the documents what caused them to take an adverse view about your case.
In situations where an insurer is seeking comment from a doctor or an expert on a document, you should ask to see the document prior to it being sent to the expert. This will allow you to correct any information or facts in the document that may not be correct or accurate.
Your insurer must cooperate with you and help you with getting a positive outcome on your claim, however they rarely do. By knowing your rights and options it can help you achieve a positive outcome on your claim.
An example is if you attend a medical examination requested by your insurer. You should request that the results and report be provided to you within a set period of time as part of your conditions of attending this medical appointment. As this report contains private information about you, you have rights to access it under the Privacy Act 1988.
If you receive a letter from your insurer which says that they are providing you with procedural fairness, it generally means that your claim will be rejected. If your claim is rejected, you should always request the reasons for rejecting your claim and the information and documents they relied on to make this decision. If they refuse or are unable to tell you or you disagree with their decision, you should seek independent legal advice about your options.
Our author, Adam Tayler regularly features on the Chris Smith Afternoon Show on 2GB discussing matters that relate to superannuation, TPD and insurance.
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If your TPD claim has been rejected, or you have been waiting too long for the insurer to make a decision on your claim, call us on 13 43 63 and speak to our expert superannuation lawyers. Our Queensland offices are in Brisbane, North Lakes, Logan, Ipswich, Toowoomba, Gold Coast, Sunshine Coast and Cairns.
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Adam also has extensive experience in employment law including industrial relations and workers compensation matters having acted exclusively in that area for over 10 years.