90%
Of declined TPD claims we
receive lack crucial evidence
receive lack crucial evidence
90%
Success rate on appeals
with proper support
with proper support
13
Weeks average timeframe
from our resubmission to success
from our resubmission to success
CLEAR GUIDANCE CONFIDENT CLAIMS
Your TPD Claim Was Declined?
We're here to help you navigate the appeal process with confidence and clarity.
Don't lose hope just yet. Declined TPD claims are far more common than people realize. Insurance companies have strict criteria, and even seemingly straightforward claims can be rejected for a variety of reasons. We're here to help you navigate the appeals process.
HOW TO APPEAL
Our 5-Step Appeals Process
Appealing a declined TPD claim requires meticulous attention to detail. Click any step to learn more.
1
Review Rejection Letter
2
Gather Documentation
3
Build Your Case
4
Submit Appeal
5
Negotiate & Resolve
1
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.
2
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.
3
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.
4
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.
5
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.
UNDERSTANDING DECLINATIONS
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.
FREQUENTLY ASKED QUESTIONS
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.
Can I go to AFCA if my internal review is unsuccessful?
+Yes, the Australian Financial Complaints Authority (AFCA) provides free independent dispute resolution for insurance complaints. You can lodge a complaint with AFCA after completing the internal review process with your insurer.
AFCA can make binding determinations up to $1.085 million for TPD claims, making it a powerful option for resolving disputes without going to court.
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.
"A declined claim is not a final decision. With the right support and evidence, many appeals result in successful outcomes."
Start Your Appeal TodayOur Guiding
Principles
Clear Guidance Confident Claims
Support That Makes a Difference
Trust and Confidence During Stressful Times
Navigating Complexity, Focusing on You
Client-centred Philosophy
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Contact
TPD Claim Support Office
Brisbane – Sydney – Melbourne
Head Office Address
Mezzanine Level, Aspley Hypermarket
59 Albany Creek Rd, Aspley QLD, 4034
Operating Hours
Mon - Fri: 9am - 5pm
Sat - Sun: Closed