When facing a debilitating illness or injury, a Total and Permanent Disability (TPD) claim can be a vital financial lifeline. Navigating the TPD claims process in Australia can be stressful when unexpected delays occur. At JI Solicitors & Associates, we understand how crucial timely outcomes are. This article discusses the common causes of TPD claim delays, your legal rights as a claimant, and what to do when insurers drag their feet.
What Is a TPD Claim and Why Timing Matters
A Total and Permanent Disability (TPD) claim provides a lump-sum payment to individuals who are permanently unable to work due to illness or injury. These benefits are tied to superannuation policies and are intended to support the claimant financially when returning to work is no longer an option.
While the definition of “total and permanent disability” may vary between policies, the wait for a decision places additional emotional and financial stress on already vulnerable individuals. It is not uncommon for claimants to wait months or even years for a resolution.
Top Reasons Why TPD Claims Are Delayed
1. Incomplete or Inaccurate Documentation
The most common cause of delay in a TPD claim is the submission of incomplete medical or employment records. TPD insurers require extensive documentation to evaluate whether the claimant meets their specific definition of “total and permanent disability.”
This includes:
- Comprehensive medical records
- Specialist assessments
- Employer records and work history
- Tax returns or payslips
- Functional capacity evaluations
Tip: Ensure all supporting documents are up-to-date and consistent. Even minor discrepancies can prompt an insurer to seek clarification, extending the timeframe.
2. Disputes Over Medical Evidence
Another major reason for delays is disagreement between medical professionals. If your treating doctor deems you permanently disabled, but the insurer’s independent medical examiner (IME) disagrees, the claim can stall while further assessments are ordered.
In many cases, insurers may use these conflicting opinions to question the severity of your condition in cases involving mental illness, chronic fatigue, or musculoskeletal injuries, where symptoms are subjective.
3. Insurer Requesting Additional Information
Even when all documents are submitted, insurers ask for:
- Additional reports from specialists
- Clarifications from your employer
- Extra details on your pre-existing conditions
Each request resets the clock, and claimants may feel like they’re caught in an endless loop. While insurers are entitled to investigate thoroughly, delays due to redundant or excessive requests can become grounds for a dispute.
4. Internal Processing and Bureaucracy
Behind the scenes, your claim may be passed between multiple departments within the insurer’s organisation. A TPD claim is not always handled by one person; it could involve case managers, medical officers, financial analysts, and legal advisors.
This can create bottlenecks if the insurer is understaffed, dealing with system errors, or undergoing structural changes.
5. Insurer Acting in Bad Faith or Unreasonably
In some instances, delays occur not because of complexity, but because the insurer is stalling. This could be due to:
- Deliberate delay tactics to pressure claimants into withdrawing
- Internal cost-saving initiatives
- Poor communication or inefficient handling
When these tactics surface, it’s crucial to engage a TPD lawyer who can escalate the matter to the Australian Financial Complaints Authority (AFCA) or initiate legal proceedings.
How Long Should a TPD Claim Take?
There is no fixed statutory timeframe, but:
- A well-supported TPD claim should be assessed within 2 to 3 months.
- More complex cases may take up to 6 months.
- Anything longer than 12 months without a cause may indicate a breach of duty.
The Life Insurance Code of Practice suggests that insurers must inform you of their decision within 6 months, or explain the reason for the delay if that’s not possible.
Your Legal Rights When a TPD Claim Is Delayed
Australian law provides safeguards for claimants. If your TPD claim is being unnecessarily delayed:
1. You Can Lodge a Complaint with the Insurer
Under the Life Insurance Code of Practice, insurers must provide updates and give you reasons for delays. You have the right to request a formal internal review.
2. You Can Complain to AFCA
If the insurer fails to respond, you can take your complaint to the Australian Financial Complaints Authority (AFCA), an independent body that investigates insurance disputes and can direct insurers to pay out valid claims.
3. You Can Initiate Legal Action
With legal representation, you may file a breach of contract claim or pursue action under consumer protection laws. A qualified TPD lawyer can:
- Investigate delays
- Access insurer correspondence
- Negotiate on your behalf
- Initiate court proceedings if necessary
How TPD Lawyers Help Expedite Claims
At JI Solicitors & Associates, we assist clients by:
- Reviewing policy terms to confirm your eligibility
- Collecting and submitting documentation to avoid errors or omissions
- Communicating directly with insurers to prevent stalling
- Challenging unreasonable decisions or requests
- Taking legal steps to hold insurers accountable
Our team ensures your claim moves forward swiftly and you’re not left in the dark.
Common Red Flags of Unreasonable Delays
Be cautious if you encounter any of the following:
- Repeated requests for the same documents
- Unexplained silence for weeks or months
- Shifting the goalposts by changing their interpretation of “disability”
- Recommending you return to work without a solid basis
- Denial based on outdated or biased medical assessments
Tips to Avoid TPD Claim Delays
- Submit a complete application with verified medical and employment history
- Keep a record of all correspondence with the insurer
- Maintain ongoing treatment to support your medical condition claim
- Consider engaging a lawyer before submission for strategic guidance
- Act quickly on any insurer requests or complaints
Conclusion
Delays in TPD claims are frustrating, but they’re not always inevitable. With the right guidance, you can assert your rights, push back against unreasonable tactics, and secure the benefits you’re entitled to.
If your TPD claim is taking too long, or you’re feeling overwhelmed by the process, JI Solicitors & Associates is here to help. We specialise in TPD claims across Australia and can help you navigate delays, deal with insurers, and fight for your rightful compensation.
Speak with our experienced team today for clear advice and powerful representation. Let us help you get the compensation you deserve. Call 02 8896 6046 for a confidential, no-obligation consultation.