When assessing a clients eligibility to claim on their Total & Permanent Disability (TPD) Insurance and subsequently preparing lodgement of that claim, it’s important to do so in a methodical and comprehensive manner.
A successful claim application without the need to issue proceedings is always preferable and this article from Nawaar Hassan, and experienced Barrister with particular expertise in insurance and superannuation matters, helps by providing understanding of the process and some tips around submitting strong claims from the outset.
A couple of key takeouts:
- As far as possible, medical evidence should be directed to the definition, not the severity of the claimants injury or illness
- Evidence should be gathered early so that a strong claim can be submitted from the beginning. “A slow drip‐feed of evidence with multiple requests for reconsideration is counterproductive as it is likely to draw out the process, frustrate the client and cause the insurer to become further entrenched in its opinion”
- The claimant is unlikely to succeed simply by establishing on the balance of probabilities that they meet the definition of their policy. The claimant’s right to the benefit usually rests not on an objective assessment of the evidence, but on the insurer having formed the OPINION that the claimant is so entitled.