Declined TPD Claim?
It's Not The End.
71/71 Declined Claims Overturned · Free Assessment
My TPD Claim Was Declined — What Do I Do Next?
If your TPD claim has been declined, don't treat it as final. Read the insurer's decision letter to identify their exact reasons, check your appeal deadline (usually 60–90 days from the decline date), gather any updated medical evidence, and get an independent assessment before deciding your next step. Most declines can be challenged through an internal review, and if that fails, through a free complaint to the Australian Financial Complaints Authority (AFCA).
Read the decline letter carefully
Identify the specific reason(s) the insurer has given. Every appeal starts with knowing exactly what you're addressing.
Check your appeal deadline
Most insurers allow 60–90 days from the decline date to lodge an internal review. Missing it can limit your options.
Get an independent assessment
Before doing anything else, have someone outside the insurer review your decline letter and tell you honestly whether it's worth appealing.
Gather updated evidence
Recent specialist reports, functional capacity evaluations, and employment history often make the difference in a resubmission.
A declined TPD claim is a submission problem. Not an eligibility problem.
Insurance companies decline TPD claims for specific, technical reasons — and in the vast majority of cases those reasons can be addressed. The most common causes are insufficient medical evidence, submissions that do not frame the condition against the specific policy definition, and incomplete employment history. None of these are reasons to stop.
We review the insurer's decision letter, identify exactly why the claim was declined, and build a resubmission or appeal that directly addresses each ground. We have done this 71 times. We have won 71 times.
The free assessment takes less than 15 minutes. It will tell you clearly whether your decline can be challenged and what the path forward looks like.
You may have 60–90 days to appeal from the date of the decline letter.
Most insurers require an internal review request within 60 to 90 days of their decision. Missing this window can significantly limit your options. Contact us as soon as you receive a decline letter.
taken to appeal — overturned
every declined claim we have taken
to successful outcome
That is not a marketing claim. It is our complete record. A declined TPD claim is the starting point, not the final word. The question is whether you have the right people in your corner when you push back.
"We know the clock is ticking. That the client has no income and is still paying premiums. So we future-forecast what is required and ensure the evidence is complete before we resubmit." — Trevor Battersby, Founder
Our 5-Step Appeals Process
Appealing a declined TPD claim requires meticulous attention to detail. Click any step to learn more.
Review Rejection Letter
We thoroughly analyze your declined claim and identify the specific reasons for rejection, examining policy documents, medical records, and the insurer's decision letter to understand exactly why your claim was declined.
Gather Documentation
We collect additional medical evidence, coordinate with your healthcare providers, and ensure all documentation meets insurer requirements. This includes updated medical assessments, specialist reports, and functional capacity evaluations.
Build Your Case
We craft strategic appeals that directly address the insurer's concerns, present evidence in the most compelling manner, and leverage our deep understanding of insurance claim processes to strengthen your position.
Submit Appeal
We prepare and submit a comprehensive internal review to your insurer, ensuring all procedural requirements and deadlines are met. We handle all the paperwork and maintain professional communication throughout.
Negotiate & Resolve
We handle all communications with the insurance company, negotiate settlement terms when appropriate, and pursue all available resolution pathways including AFCA complaints if needed to secure the best possible outcome.
Common Reasons for TPD Claim Denials
Insurance companies decline claims for various reasons. Understanding these can strengthen your appeal.
Insufficient Medical Evidence
Your claim may lack comprehensive medical documentation demonstrating the permanence and severity of your condition.
Policy Definition Not Met
The insurer believes your condition doesn't meet the specific TPD definition outlined in your policy.
Pre-existing Condition Exclusion
The insurer claims your disability stems from a pre-existing condition not covered by your policy.
Incomplete Employment History
Missing or unclear information about your work capacity and how your disability affects your occupation.
Missed Waiting Period
Your claim may have been lodged before completing the required waiting period specified in your policy.
Capacity for Alternative Work
The insurer believes you can perform other types of work despite your disability.
Whichever reason applies to your situation — we have successfully appealed it.
Find Out If Your Decline Can Be Overturned →Common Questions About Appeals
Clear answers to help you understand the appeals process.
How long do I have to appeal a declined TPD claim?
+Most insurance policies require you to lodge an internal review within 60-90 days of receiving the decline decision. It's crucial to act quickly, as missing these deadlines can significantly impact your ability to appeal.
We recommend contacting us as soon as you receive a decline letter so we can ensure all deadlines are met and your appeal is properly prepared.
Should I just go straight to AFCA instead of appealing internally?
+While yes, the Australian Financial Complaints Authority (AFCA) provides free independent dispute resolution for insurance complaints, we start by reviewing your decline letter, identifying exactly why the claim was refused, and building a resubmission that directly addresses each of the insurer's stated reasons. We have taken 71 declined TPD claims to appeal this way — and overturned all 71.
A properly prepared internal review also builds a stronger, clearer record of medical and policy evidence. If your situation does need to progress further down the track, that record works in your favour. The free assessment will tell you exactly where you stand and what we'd recommend for your specific decline — no cost, no obligation.
What new evidence can strengthen my appeal?
+Strong appeals often include updated medical assessments, specialist reports, functional capacity evaluations, and detailed statements about how your disability affects your daily activities and work capacity.
We coordinate with appropriate medical professionals to obtain evidence that directly addresses the reasons for your claim's decline and demonstrates the permanence and severity of your condition.
Do I need a lawyer to appeal a declined TPD claim?
+While not legally required, having expert representation significantly improves your chances of success. Insurance policies and medical evidence can be complex, and insurers have experienced teams handling these matters.
Our experience with TPD appeals means we understand how to navigate the process effectively, gather compelling evidence, and present your case in the strongest possible way.
Why is my TPD claim being declined?
+TPD claims are most commonly declined because of insufficient medical evidence, the insurer deciding the condition doesn't meet the specific TPD definition in the policy, a pre-existing condition exclusion, incomplete employment history, a missed waiting period, or the insurer's view that you retain capacity for alternative work.
In our experience, a decline is a submission problem far more often than an eligibility problem — most of these reasons can be directly addressed in a resubmission or appeal.
What if my TPD claim is denied?
+If your TPD claim is denied, you generally have three pathways: request an internal review directly with the insurer (usually within 60–90 days of the decline), lodge a free complaint with the Australian Financial Complaints Authority (AFCA) if the internal review doesn't resolve it, or pursue legal action as a last resort.
Start by identifying exactly why the insurer declined the claim, since the strongest next step depends on their stated reasons.
What's the TPD claim appeal process in NSW or Victoria?
+The TPD appeal process is governed by federal law (including the Corporations Act and AFCA's rules) rather than state legislation, so the core steps — internal review, then AFCA complaint if needed, then legal action if necessary — are the same whether you're in NSW, Victoria, Queensland, or elsewhere in Australia.
What can differ by state is which specialists or legal representatives are practically available to you, and, in some cases, which state-based tribunal applies if a matter proceeds to litigation rather than AFCA.
What are the most common reasons TPD claims get rejected?
+The most common reasons are insufficient medical evidence, the condition not meeting the policy's specific TPD definition, pre-existing condition exclusions, incomplete employment history, a missed waiting period, and the insurer assessing that you retain capacity for alternative work.
Most claims are declined for one or two of these specific, addressable reasons rather than a genuine lack of eligibility.
A decline is not
the last word.
We have overturned 71 from 71 declined TPD claims. Before you accept the insurer's decision as final, speak with us. The assessment is free, takes less than 15 minutes, and will tell you clearly whether an appeal is worth pursuing and what it would involve.
No obligation. No upfront cost. If we take your appeal on, our fee arrangement is agreed in writing before we start. See how we work →
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