Superannuation & TPD Claims
TPD Claim Refused? Fight Back and Get the Decision Reviewed
An insurer's refusal of your total and permanent disability claim is not the end of the road. Many TPD decisions are successfully overturned — with the right legal help. We connect you with specialist TPD lawyers who challenge insurer decisions through AFCA and the courts.
⚠ AFCA complaint time limits apply after a final insurer decision — submit your request now.
Does This Sound Like You?
Common situations we help with.
TPD claim refused by the insurer
You lodged a TPD claim and received a flat refusal, often with limited explanation. Insurers sometimes rely on selective medical evidence or narrow policy interpretations to deny claims. A specialist lawyer can analyse the refusal letter, identify flaws in the insurer's reasoning, and build a case for review or litigation.
The definition of "total and permanent disability" is being disputed
The insurer is arguing you do not meet the policy's definition of TPD. These definitions vary significantly between policies — some require you to be unable to work in any occupation, while others apply only to your own occupation. Understanding and applying the correct definition is central to many successful disputed claims.
Insurer says you can work in another occupation
A common basis for refusal is the insurer's claim that, even though you cannot return to your previous job, you are capable of working in some other occupation. This argument depends heavily on the policy wording and vocational evidence. Lawyers experienced in TPD disputes can challenge the insurer's occupational assessment with independent vocational reports.
Medical evidence not accepted by the insurer
The insurer has rejected or downplayed your treating doctor's medical reports, possibly relying instead on an independent medical examination arranged by the insurer. This is a significant issue in many disputed TPD claims. A lawyer can help you obtain additional independent medical evidence and challenge the insurer's medical position through AFCA or court proceedings.
Claim delayed for over 12 months with no outcome
Your claim has been with the insurer for well over a year and you keep receiving requests for more information with no final decision in sight. While some TPD claims are legitimately complex, excessive delays can constitute maladministration. A lawyer can write to the insurer demanding a decision and, if necessary, escalate to AFCA on the grounds of delay.
Internal review upheld the refusal
You requested an internal review of your TPD claim refusal and the insurer has maintained its original decision. This is not the end — you now have the right to escalate the matter to AFCA or to commence legal proceedings. Many claims that fail at internal review succeed at AFCA or in court, particularly where new evidence is introduced.
How It Works
Three steps to challenge your TPD decision
You don't have to accept an insurer's refusal. Our process connects you with a specialist TPD lawyer who can assess whether your claim can be overturned — at no upfront cost.
Submit Your TPD Dispute RequestSubmit your request
Tell us about your TPD claim refusal — the insurer, the policy, and the reason given. This takes about two minutes and is completely confidential.
Matched to a TPD specialist
We connect you with a lawyer experienced in disputed TPD claims in your state, including AFCA complaints and court proceedings against insurers.
Free consultation — know your options
The lawyer reviews your situation and provides honest advice on whether your claim can be challenged, the likely pathway, and the costs involved.
Many Reversed
TPD refusals that are overturned at AFCA or in court — an initial refusal is not the final word
All 8 States
Requests matched to specialist lawyers across every state and territory in Australia
Free
Initial consultation — understand your rights and options before committing to any action
No Win No Fee
Many TPD dispute lawyers offer no win, no fee arrangements — you pay nothing unless you succeed
Before You Appeal
Practical questions about disputed TPD claim decisions.
What is the difference between "own occupation" and "any occupation" TPD definitions? +
An "own occupation" TPD definition requires you to be permanently unable to return to the specific occupation you were working in at the time of disablement. An "any occupation" definition is more restrictive — it requires you to be permanently incapable of working in any occupation for which you are reasonably suited by education, training, or experience. Own occupation policies are generally more favourable for claimants. Most superannuation fund default policies use an "any occupation" definition, while retail policies often provide own occupation cover. The exact wording of your policy is critical.
How do insurers assess TPD claims — what are they looking for? +
Insurers typically assess TPD claims by reviewing your medical history, treating specialists' reports, and an independent medical examination they arrange. They will also consider your occupation, education, age, and work history through a vocational assessment. Insurers frequently look for evidence that you have either recovered or could work in an alternative role. Understanding what the insurer is focussing on allows your lawyer to address the weaknesses in your claim proactively.
What medical and vocational evidence helps win a disputed TPD claim? +
Strong TPD claims are supported by contemporaneous treating specialist reports, functional capacity assessments, independent medical examinations obtained by you (not the insurer), and independent vocational assessments addressing the specific occupations identified by the insurer. Psychological evidence is often important in claims involving mental health or chronic pain. The consistency and detail of the evidence — and its direct engagement with the policy definition — is often decisive in disputed claims.
How does the AFCA complaints process work for TPD disputes? +
After exhausting the insurer's internal review process, you can lodge a complaint with the Australian Financial Complaints Authority (AFCA). AFCA will first attempt to resolve the dispute through case management and conciliation. If unresolved, an AFCA panel will make a determination that is binding on the insurer if you accept it. AFCA considers whether the insurer's decision was fair and reasonable in all the circumstances. The process is free for complainants and can result in the claim being paid, additional evidence being considered, or an in-principle settlement being reached.
What are the likely legal costs for challenging a TPD decision? +
Many specialist TPD lawyers offer no-win, no-fee arrangements for disputed claims, meaning you pay no legal fees unless you are successful. In those cases, the lawyer's fee is typically a percentage of the benefit recovered. For AFCA complaints, the process is free. If the matter proceeds to court, costs will vary depending on complexity. Getting a clear costs agreement in writing before instructing a lawyer is important — reputable TPD lawyers will explain all costs arrangements during your initial free consultation.
What time limits apply to complain after an insurer's final TPD decision? +
AFCA generally requires complaints to be lodged within two years of the insurer's final written decision on your claim. For court proceedings, limitation periods under state legislation typically range from six years from the date of the insurer's breach, though the specific period depends on the state and the legal basis of the claim. Acting quickly is important — delays can result in loss of rights to a remedy. If you are concerned about time limits, seek legal advice immediately.
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