SA Retrospective TPD Insurance Claim?

[SleeplessInSalisbury]

Hi Everyone,

Does anyone know if the decision of a super company to accept a retrospective TPD claim is based on their choice or guided by legislation? I would like to claim for a disability which occured in 2010. At the time, was not aware I had the TPD insurance and by the time I realised I was eligible. By the time I realised I could claim, the legislation regarding the definition of total and permanent disability changed and I was no longer eligible.

Any insight would be greatly appreciated.

 

[Owais]

Hi SleeplessInSalisbury,

I just recently joined Lawanswers and came across your query. Not sure if you have resolved this issue already but I will answer to your question just in case.

TPD claims work a little differently. When you initially received TPD insurance cover, you may have received an insurance policy. Within the policy you will find many TPD definitions. Now depending on your "Date of Claim", the insurer will determine the applicable definition and see whether your injury or illness meets that TPD definition.

The legislation refers to insurer following the definitions appropriately however the legislation does not contain any TPD definition. The definition is within the insurance policy.

Let me know if you still need any assistance regarding your potential TPD claim. I am actually a TPD solicitor who has worked with large Life Insurance companies in the past and have an in-depth knowledge regarding TPD regulation and laws.

I hope that helps. Feel free to get in touch.

Kind regards

 

[SleeplessInSalisbury]

Hi SleeplessInSalisbury,

I just recently joined Lawanswers and came across your query. Not sure if you have resolved this issue already but I will answer to your question just in case.

TPD claims work a little differently. When you initially received TPD insurance cover, you may have received an insurance policy. Within the policy you will find many TPD definitions. Now depending on your "Date of Claim", the insurer will determine the applicable definition and see whether your injury or illness meets that TPD definition.

The legislation refers to insurer following the definitions appropriately however the legislation does not contain any TPD definition. The definition is within the insurance policy.

Let me know if you still need any assistance regarding your potential TPD claim. I am actually a TPD solicitor who has worked with large Life Insurance companies in the past and have an in-depth knowledge regarding TPD regulation and laws.

I hope that helps. Feel free to get in touch.

Kind regards
Owais Shaheen

Hi owais,
Thank you for taking time out to respond to my inquiry. I have not resolved this actually. I had obtained the assistance from a TPD law firm and all they did was access my self represented claim from the super fund which was rejected. They then stated that they could not do anything as my new job is somewhat similar, ( totally different, I was a community midwife prior to brain damage.

I am now a Disability support worker which is basically a glorified chef and cleaner) I had to obtain additional training as my previous degrees were not applicable.

The TPD was packaged with super, not taken out in addition to.

 

[Owais]

Hi SleeplessInSalisbury,

Looks like not much effort was given to your matter by the previous solicitors. I am not sure which TPD definition was applicable to your case and on what grounds your claim was rejected. However, reviewing the limited information you have provided, I assume you were assessed under an ETE (Employment, Training and Education) definition where it refers to whether you can return to the same or similar occupation. Certain jobs may seem similar but they may be different in nature as you have noted above. I have seen many claims getting refused as the insurances consider two job roles to be same or similar in nature. Nonetheless, this is not always the case and certain claims can be approved with proper evidence and supporting documents.

I am happy to discuss further with you. Feel free to contact us as our details are verified by LawTap.

 

[SleeplessInSalisbury]

Hi Owais,
Again, I am very grateful for your response. I believe my claim was accessed under the new SA legislation which came in at 2013. Prior to 2013, SA's definition for TPD was the inability to return to your trained position/occupation. However, since 2013, the definition was changed to the inability to work in ANY position for more than 30%.
Because I can work and not considered at least 30% incapacitated, no other considerations are taken into account.
Let me know if there is a good chance to obtain a favourable outcome.
Once again, thanks.

 

[Owais]

Hi SleeplessInSalisbury,

Do you mind if you can email me your refusal letter received from the insurer? I want to see their reason for rejection and what legislation/policy they used to refuse your claim? You noted earlier that your disability occurred in 2010, therefore, your Date of Claim will be in 2010 and the applicable definition/policy/legislation that would be applied will also be from the year 2010 irrespective of if the definition was changed later in 2013.

However, I wouldn't be able to provide a complete answer until I have reviewed your refusal letter.

Feel free to contact us as our details are verified by LawTap.

Kind regards
Owais

 

[SleeplessInSalisbury]

Hi SleeplessInSalisbury,

Do you mind if you can email me your refusal letter received from the insurer? I want to see their reason for rejection and what legislation/policy they used to refuse your claim? You noted earlier that your disability occurred in 2010, therefore, your Date of Claim will be in 2010 and the applicable definition/policy/legislation that would be applied will also be from the year 2010 irrespective of if the definition was changed later in 2013.

However, I wouldn't be able to provide a complete answer until I have reviewed your refusal letter.

Feel free to contact us as our details are verified by LawTap.

Kind regards
Owais

Hi Owais,

Murphy's Law, of course, I am unable to locate the refusal letter. From what I remember, it basically quoted current legislation and how my injuries do not qualify as I am able to return to work and perform in alternative employment. No mention regarding the acknowledgement of my inability to resume my substantive occupation.

Does your law firm offer no win no fee work? Because you seem to get my unique circumstances and have the compassion in this area. I would be happy for you to peruse this for me but financially ruined because of the situation.

 

[Owais]

Hi SleeplessInSalisbury,

Yes, we do offer No Win No Fee services.

We can definitely speak with you and discuss the prospect of your claim. Feel free to contact us as our details are verified by LawTap.

Regards
Owais