Why Insurers Deny Valid TPD Claims
Australian insurers reject 16% of first-time TPD claims (ASIC Report 2023). After analysing 200+ denied cases, these are the most frequent excuses – and how we’ve beaten them:
1. “Insufficient Medical Evidence”
*Insurer’s Play: Reject GP-only reports
* Fix: Get specialist reports stating:
“It is unlikely [Name] will EVER work again in any occupation”
* Case Win: $450k for mechanic after adding orthopaedic surgeon assessment
2. “Missed Deadlines”
* Insurer’s Play: Cite super fund’s 2-year rule
* Fix: Prove continuous incapacity with:
* Dated medical certificates
* Centrelink disability pension records
* Case Win: Backdated claim for teacher with MS after 26 months
3. “Pre-Existing Condition”
* Insurer’s Play: Blame old injuries
* Fix: Show substantial worsening via:
* New MRI scans vs old X-rays
* Workplace incident reports
* Case Win: $380k for warehouse worker despite “prior back pain”
4. “Can Work Alternative Jobs”
* Insurer’s Play: Suggest unrealistic retraining
* Fix: Submit vocational assessment proving:
* Age/skills make retraining impossible
* Local job market data
* Case Win: $620k for 58yo truck driver
5. “Incomplete Forms”
* Insurer’s Play: Bureaucratic delays
* Fix: Use our TPD application checklist:
✅ Section 7 completed by GP
✅ Original signatures (no scans)
✅ Certified ID documents
Final Advice: Act Now
TPD claims take 6–24 months. The sooner you start, the sooner you get paid.
Need Help? Book a free policy review with WKB Lawyers on 1800865225.