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QLD Am I Eligible for a TPD Insurance Claim?

Discussion in 'Insurance Law Forum' started by Naomi Garden, 1 June 2016.

  1. Naomi Garden

    Naomi Garden Member

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    Hi I am applying for a TPD insurance claim for the second time. The first time, they said it was too early to tell I am a patient with Leukemia and a year later have had ongoing problems from treatment. The insurers left my claim open to try again at a later date, so it wasn't knocked on the head.

    The insurers sent my doctor a medical update One of the questions was 'will I be able to return to work in my field as a part-time teacher's aide in education and training? To which he responded, 'It is unlikely that I will be able to return to any employment in the forseeable future'.

    Do you think this is enough? Is forseeable future in legal terms a grey area?

    Any help would be appreciated.

    Thank you
     
  2. Yevgeni

    Yevgeni Well-Known Member

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    Hi Naomi,

    Each superannuation TPD claim is different as it depends on the wording of each individual policy, so in order to see whether the doctor's opinion is sufficient it must be interpreted in light of the terms of the specific clause in the policy and I do not know, at this stage, what your policy says.

    Having said that, if this was a common law personal injury claim for damages as opposed to a TPD claim, then the opinion 'it is unlikely that [you] will be able to return to any employment in the forseeable future' would be strong evidence that on the balance of probabilities (i.e. greater than 50%), which is the requisite standard of proof, that you are not going to partake in your pre-injury employment in the future.

    Whether this opinion is sufficient for the purposes of your TPD claim depends on the wording of your the specific clause in your policy. Even if the insurer does not accept it and denies it (as insurers do from time to time), it sounds like a reasonable claim having regard to the nature of your condition and you may want to take it further

    Hope that helps.
     
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  3. Naomi Garden

    Naomi Garden Member

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    Thank you so much
     
  4. nis

    nis Well-Known Member

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    Not sure if you can help but I am just after some advice. I was paid out a TPD claim last February. The insurer originally declined my claim and my lawyer took it to court but it settled at a settlement conference in Feb 2016. In April 2016 i injured my hand and was working as a cleaner in a supervisory role, i retrained.

    I ended up having surgery and now my hand is stuffed and i am suffering from crps1, have spent last 14 months doing rehab to no avail I recently lodged a TPD claim for this permanent injury with my new fund of which I've been a member since august 2014. My solicitor called me last week saying the insurer has sent back a letter inquiring about my previous TPD claim which made me TPD for customer service and administrative roles hence why I worked as a cleaner.

    One of the insurance eligibility requirements is "a member cannot be eligible, applying for or have received a tpd payout from another fund" Is there any way around this? I feel like the fund isn't acting in my best interests with this clause and I had retrained to a different field and the 1st claim was actually lodged 10 years after i became ill.

    Any info would be greatly appreciated as i am quite concerned about my future and its quite distressing to think I am not eligible and I am unable to work.

    Thank you
     
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