The cost of Total Permanent Disability (TPD) superannuation insurance claims has been prominent in the press recently, with the Association of Superannuation Funds of Australia (ASFA) running a campaign to discourage super fund members from using a lawyer when making a claim on the TPD insurance under their policy. In particular, the super fund industry has claimed that lawyers advertising TPD services has led to increased claims and rising costs. However, if you have a potential TPD claim, can you really afford not to use a lawyer? Karina Heywood, Superannuation Team Leader at Stacks Goudkamp, explains why it’s wise to get a lawyer on your side when making a claim.
“Total and permanent disablement cover is arguably one of the most valuable insurance benefits that people hold under their superannuation policy, but many injured people do not even realise that they have it”, Ms Heywood explains.
“Alarmingly, many people who suffer an injury during the course of their employment, in a motor vehicle accident, or in a public place only become aware of their entitlement to bring a TPD claim under their superannuation policy once they start a compensation claim and their legal representative alerts them to their potential entitlements”.
Ms Heywood therefore sees the increase in legally represented TPD clients linked to an increased awareness of personal injury lawyers to look for superannuation benefits that clients might have.
However, Ms Heywood also sees that personal injury firms such as Stacks Goudkamp have a role to play in educating the public about their legal rights under their superannuation policies. She continues:
“One of the most concerning truths is that many do not know when they can bring a claim due to a lack of awareness as to how the insurance cover operates”.
“It is important to note that to bring a TPD claim under your superannuation policy, you do not need to demonstrate that somebody else is at fault. This is quite unlike the features of fault based personal injury claims such as CTP claims following motor vehicle accidents. This is one of the key misunderstood features of the insurance cover”.
Essentially, if you suffer from a medical condition, be it an illness or injury, and as a result of this medical condition you are unable to return to work, you may be entitled to make a claim under the TPD cover in your superannuation policy. However the policy wording varies between insurers, and there are usually strict criteria that you have to meet to be successful. This is where many potential claimants get unstuck, and why it is helpful to get a lawyer on your side.
“Many clients find the claims process to be overwhelming and unclear,” Ms Heywood commented. “Although you are able to lodge the claim yourself, too often we find that clients are frustrated by the delays caused by the fund or their insurer, or are declined through a misunderstanding of the policy documents. Insurers also need firm medical evidence to be satisfied that you meet the wording of the policy, and the reports that clients’ doctors provide usually do not suffice until we ask them to write a report which answers tailored questions according to the client’s specific circumstances”.
Ms Heywood and the team at Stacks Goudkamp have had countless success stories where TPD insurers have rejected claims submitted directly by the client, but reversed their decision when Stacks Goudkamp were instructed and gathered the necessary evidence to support the claim. For example, just last week the team received a decision from a superannuation insurer to pay a victim of medical negligence over $700,000 in TPD benefits in a claim that had previously been rejected.
Whilst Ms Heywood welcomes superannuation benefits being in the public eye, she is critical that unfortunately the ASFA education campaign does not educate members on the legalistic language contained in the lengthy claim forms required to lodge a claim, the definitions interpreted by the court contained within the relevant policy definitions, nor that both the fund and the insurer often use their own internal lawyers throughout the claims process. Stacks Goudkamp offer TPD claim services on a “no win, no pay” basis, so if your super fund or insurer is using a lawyer, can you really afford not to?
If you have any queries in relation to a TPD claim or your potential entitlements please do not hesitate to contact Karina Heywood, Superannuation Team Leader at Stacks Goudkamp, on 1800 25 1800 or make an online enquiry.