Having your Total and Permanent Disability (TPD) claim declined can be devastating when you’re already dealing with serious health challenges. Understanding why claims get rejected helps you avoid common pitfalls and secure the benefits you deserve.
At TPD Helpline, we’ve helped thousands of Australians since 2016 to achieve a 97% success rate. If you’re concerned about your TPD claim, call us immediately on 1300 679 222.
Understanding TPD Claim Rejections
According to ASIC and APRA data, 13-16% of TPD claims face rejection. Most rejections happen due to avoidable mistakes rather than genuine ineligibility. With professional assistance, many initially declined claims succeed on appeal.
Top 5 Reasons TPD Claims Get Rejected
1. Insufficient Medical Evidence
The leading cause of rejection is inadequate medical documentation. Insurers need comprehensive evidence proving you cannot work, not just that you have a condition.
Common failures:
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Medical evidence older than 3 months
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Missing specialist reports
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Generic reports that don’t address your TPD definition
Solution: Obtain current specialist reports explicitly stating why you cannot work. Update evidence regularly during the claims process.
2. Misunderstanding Policy Definitions
Many claimants don’t understand their policy’s TPD definition, leading to inadequately prepared claims.
Key definitions:
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Own Occupation: Cannot work in your trained profession
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Any Occupation: Cannot work in any suitable job
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Activities of Daily Living: Must be unable to perform two daily activities (60% acceptance rate per ASIC)
3. Pre-Existing Conditions
Insurers aggressively use pre-existing conditions to reject claims, especially where non-disclosure issues arise.
Solution: Obtain specialist opinions differentiating your current disability from past health issues. Prove progression that couldn’t have been predicted.
4. Employment Verification Problems
Documentation issues around employment trigger rejections.
Critical errors:
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Income claims not matching tax returns
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Any work activity during the claim period
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Missing employment documentation
5. Timing and Procedural Errors
Missing deadlines causes preventable rejections. While many policies don’t specify strict deadlines, some include ‘prejudice clauses’ requiring timely notification.
What if Your Claim is Declined?
Your Appeal Options
Internal Dispute Resolution (IDR)
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Free first appeal
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45-day response time for super claims
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30 days for direct insurance
AFCA
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Free independent assessment
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Must lodge within 2 years of IDR response
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Binding on insurers up to $500,000
Legal Action
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For claims over $500,000
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Complex legal issues
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When AFCA can’t help
Why Expert Help Matters
APRA data shows professionally prepared claims have 83% acceptance rates versus lower rates for self-lodged claims. TPD Helpline provides:
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Policy interpretation
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Medical evidence coordination
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Documentation preparation
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Direct insurer negotiation
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No-win, no-fee arrangements
Take Action Today
Don’t let a TPD claim rejection define your future. Since 2016, TPD Helpline has helped thousands of Australians successfully claim their benefits.
Whether preparing your initial claim or fighting a rejection, our experienced team provides comprehensive support. We know exactly how to overcome every type of rejection and insurer tactic.
Contact TPD Helpline today on 1300 679 222 for expert assistance with your TPD claim.
