Super funds and their insurers have different requirements for a claim to be made for TPD benefits. Commonly they will require the completion of a number of forms by the member, their employer and medical practitioners.
What is the lodgement process ?
Once a claim is lodged the super fund will firstly review the claim to ensure that all of their forms have been provided and any other claim requirements fulfilled. Once that preliminary review is undertaken the super fund will forward the claim documents to the insurer to assess the claim. The insurer will assess the claim and may request further information or further documents. Once the assessment is completed the insurer will make a decision and report back to the super fund. The super fund will then have their trustees review the insurer’s decision and make their own decision regarding the claim which will then be communicated to the member.
How long does it take?
So how long should this process take? In most cases the time from lodgement of the claim to a decision being made should take no more than 2 to 3 months. If the assessment process is taking longer than that then questions should be asked as to why there has been such delay.
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.
Advantages of employing a lawyer
Commonly people with legal representation will have already provided those documents to the insurer because their lawyers will have investigated the matter and obtained as many records as possible to submit with the claim documents. However where a person is unrepresented they need to ensure that the insurer and the super fund meet their obligations.
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.
What if the decision making is taking too long
If an insurer and/or a super fund do not make a decision within a reasonable period of time then a member can issue court proceedings to enforce their entitlement to TPD benefits. Court proceedings are a mechanism which can be used to force an insurer and the super fund to make a decision or properly respond to the claim. Once court proceedings are issued it is possible to also claim interest on the delayed payment as well as some of your legal costs incurred in pursuing the proceedings.
Extensive delay in assessment of a TPD claim is not acceptable.
How can Super Claims Australia help with your TPD claims?
At Super Claims Australia we have dedicated solicitors who can help you assess your claim to make sure all the right paperwork and records are submitted as expected by the insurer and that your matter is not delayed. If your claim has been rejected, you may also be able to challenge or dispute this decision. Give us a call on 13 43 63 for an obligation free assessment of your situation.