Declined TPD Claim?It's Not The End.
Clear Guidance · Confident Claims · 71/71 Declined Claims Overturned
My TPD Claim Was Declined — What Do I Do Next?
A decline isn't the end of the road. Before you decide anything, get an independent read on your insurer's letter and check how long you've got to appeal, most policies give you 60–90 days.
Read the decline letter carefully
Find the specific reason(s) your 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. Miss it, and your options narrow.
Get an independent assessment
Before anything else, have someone outside the insurer look at your decline letter and tell you honestly whether it's worth appealing.
Gather updated evidence
Recent specialist reports, functional capacity evaluations, and your employment history often make the difference in a resubmission.
A declined TPD claim is a submission problem. Not an eligibility problem.
Insurers decline TPD claims for specific, addressable reasons. In our experience it's rarely about whether you're eligible, it's about how the claim was put together the first time. The most common gaps are:
- Medical evidence that doesn't fully support the claim
- A submission that doesn't address your policy's exact TPD definition
- Gaps in your employment history
None of these are reasons to give up.
You'll get a full review of your decline letter, a plain-English explanation of exactly why it was refused, and a resubmission built to answer each of the insurer's reasons directly. We've done this 71 times. We've won 71 times.
The free assessment takes under 15 minutes and tells you clearly whether your decline can be challenged, and what happens next.
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's not a marketing claim, it's our record. A declined TPD claim is the starting point, not the final word. The question is whether you've got 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 plan ahead for what's required and make sure the evidence is complete before we resubmit." — Trevor Battersby, Founder
Our 5-Step Appeals Process
Here's exactly what happens once you get in touch. Click any step for the details.
Review Rejection Letter
You'll get a clear picture of exactly why your claim was declined. We go through your policy, your medical records, and the insurer's decision letter to find the real reason behind the refusal.
Gather Documentation
You won't need to chase this yourself. We coordinate with your doctors to get updated medical assessments, specialist reports, and functional capacity evaluations, whatever's needed to close the gaps the insurer flagged.
Build Your Case
Your appeal is built to answer the insurer's stated reasons directly, point by point, using the strongest available evidence and what we know about how these claims get assessed.
Submit Appeal
We handle the paperwork and lodge a full internal review with your insurer, making sure every requirement and deadline is met so nothing slows your claim down.
Negotiate & Resolve
We deal with the insurer directly from here. Where it makes sense we negotiate a settlement, and if needed, we take the matter to AFCA to get it resolved.
Common Reasons for TPD Claim Denials
Knowing which of these applies to you shapes exactly how we build 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 you, we've appealed it before, successfully.
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 policies give you 60–90 days from the decline decision to lodge an internal review. Missing this window can limit your options, so it pays to act quickly.
Contact us as soon as you receive a decline letter and we'll make sure every deadline is met and your appeal is properly prepared.
Should I just go straight to AFCA instead of appealing internally?
+The Australian Financial Complaints Authority (AFCA) offers free, independent dispute resolution for insurance complaints. Even so, we usually start by reviewing your decline letter, identifying exactly why the claim was refused, and building a resubmission that directly answers each of the insurer's reasons. We've taken 71 declined TPD claims to appeal this way, and overturned all 71.
A properly prepared internal review also builds a stronger record of medical and policy evidence, one that works in your favour if the matter does need to go further. The free assessment will tell you exactly where you stand and what we'd recommend for your decline specifically. No cost, no obligation.
What new evidence can strengthen my appeal?
+Strong appeals usually include updated medical assessments, specialist reports, functional capacity evaluations, and a clear account of how your disability affects your daily life and work.
We coordinate with the right medical professionals to get evidence that speaks directly to why your claim was declined, and shows the permanence and severity of your condition.
Do I need a lawyer to appeal a declined TPD claim?
+You don't need a lawyer to appeal, but having someone experienced in your corner makes a real difference. Insurance policies and medical evidence get complicated fast, and insurers have full teams handling these cases.
Our experience with TPD appeals means we know how to work through the process, gather the right evidence, and present your case as strongly as possible.
Why is my TPD claim being declined?
+TPD claims are usually declined for one of a few reasons:
- Insufficient medical evidence
- A condition that doesn't meet your policy's specific TPD definition
- A pre-existing condition exclusion
- Gaps in employment history
- A missed waiting period
- The insurer deciding you can still do other work
In our experience, a decline is a submission problem far more often than an eligibility problem. Most of these can be addressed directly in a resubmission or appeal.
What if my TPD claim is denied?
+If your claim is denied, you generally have three options:
- Request an internal review with the insurer, usually within 60–90 days of the decline
- Lodge a free complaint with AFCA if the internal review doesn't resolve it
- Pursue legal action as a last resort
Start by finding out exactly why the insurer declined the claim. The right next step depends on their 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
- The insurer assessing that you retain capacity for other work
Most claims are declined for one or two of these specific, addressable reasons, not a genuine lack of eligibility.
A decline is not
the last word.
We've overturned 71 out of 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 →