Total and Permanent Disability (TPD)
Why are so many TPD claims rejected?
Category: Claims
TPD claims face higher rejection rates than many other insurance types due to several factors. The strictness of the 'total and permanent' criteria creates a high threshold - you must prove your disability is permanent (will never improve) and total (prevents all work), which requires compelling medical evidence. Insufficient medical evidence is the number one rejection reason - reports that don't clearly establish permanent work incapacity, lack of specialist involvement, or gaps in treatment history all lead to denials. The 'Any Occupation' definition used in super policies is extremely difficult to satisfy - you must prove you can't do any job suited to your education and experience, not just your previous role. Non-disclosure of pre-existing conditions, whether intentional or accidental, leads to policy voidance and claim rejection. Policy exclusions catch many claimants unaware - mental health exclusions in older policies, self-inflicted injury clauses, or substance-abuse related disabilities. Insurers sometimes engage in questionable practices including conducting surveillance to find evidence contradicting your claim, deliberately delaying assessments hoping you'll give up, or using independent medical examiners who tend to find against claimants. Procedural failures like missing waiting periods, not seeking appropriate treatment, or not submitting claims within required timeframes also result in rejections. Understanding these pitfalls and engaging specialist TPD lawyers significantly improves success rates.
Related Topics:
tpdclaimpolicyinsurerexclusionwaiting perioddisabilityoccupationpre-existing conditionany occupation
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