Whether your disability insurance claim has been denied by a private insurer or super fund, there are ways to appeal the decision and boost your chances of being approved the second time.
First, you need to understand why your application was denied in the first place.
Common Reasons Why Disability Insurance Claims Are Denied
Your Insurance provider or super fund may reject your claim if they believe:
- You incorrectly fill out the application form – either by mistake, or your insurance agent did not properly explain how to do it.
- You did not meet the minimum work history requirements of your policy – i.e. show 12 months of employment, be employed full time, or work a minimum amount of hours.
- You don’t have enough evidence to prove that your depression or other mental illness has left you unable to work.
- You can still perform the minimum amount of ‘daily activities’ (i.e. bathing, getting dress, using the bathroom).
- Your disability was due to a pre-existing condition not covered under your policy.
- You still have the capacity to work – either in your existing occupation, a new position, or an entirely new industry.
- You have the capacity to work ‘light duties.
- You have reached ‘maximum medical improvement’ – i.e. you’ve reached a state where your condition can no longer improve.
Of course, the criteria for each deciding factor differs from policy to policy. For instance, one policy may require you to work for at least 12 months before you’re eligible, while another policy may simply require that you work full-time.
Be sure to re-read the terms of your insurance policy – or have an expert lawyer help you make sense of the policy – to ensure you fully understand what you’re covered for.
After all, there’s always a chance that you misunderstood a certain aspect of your policy.
Disability insurance claim denied? Contact McDonnel Schroder today for a FREE consultation.
How to Appeal the Decision
Don’t feel that just because your application was rejected that your efforts end there.
For starters, you need to understand why your claim was rejected in the first place. Contact your insurance provider or super fund directly for clarification. They should give you a clear reason why and advise you on how you may be able to rectify the issue.
If you don’t agree with the reason, the next step is to file a complaint.
File a Complaint
The good news is, most insurance providers and super funds have their own Internal Dispute Resolution (IDR) procedure in place. This enables you to submit an official complaint and have your case reviewed by a team of experts.
Typically, the team who reviews your complaint will not be the same department who denied your initial disability insurance claim. This way, you can relax knowing the review process will be fair and unbiased.
To write a letter of complaint, make sure you include the following details in writing:
- Explain, in your own words, why you personally feel the rejection is unjustified.
- Written evidence that supports your counter-argument – i.e. additional medical evidence, testimonials, and government records.
From there, you’ll have to wait for a response.
Average Waiting Periods
For insurance providers, expect a response to your complaint within 30-45 days of your submission. For super funds, expect a response to your complaint within 90 days of your submission.
Keep in mind, your insurance agent or super fund must make an effort to contact you after receiving your submission, and then maintain contact throughout the review process.
Take it to the Regulatory Authorities
If your claim is rejected again, or they fail to respond within the minimum waiting period times, you can take your case to the relevant regulatory authorities.
Regardless of who your provider is, the best place to file a complaint is the Australian Financial Complaints Authority (AFCA). At no cost to you, they can independently review your case and – if they believe your case is strong – go through the appropriate dispute resolution process to reach a satisfactory outcome.
Of course, there’s still no guarantee of success. So in the unfortunate chance the AFCA rules against your favour, you may wish to take independent legal action.
Seek Independent Legal Advice
At McDonnel Schroder, we can independently review your case and advise you on your likelihood of success.
If your case is strong, we can help you lodge a dispute against your insurer or super fund to appeal a rejected claim. And, if the appeal is unsuccessful, we can help you take the matter to court.
Most importantly, you’re guided each step of the way. Everything will be explained to you in clear, easy to understand terms. Plus, you’ll be carefully navigated through the appeal and court process, so that you know exactly what to expect.
On top of this, your first visit with us is free and comes with no commitment. It costs you absolutely nothing to get the advice you need to take the next step.
If your insurance disability claim has been denied, contact McDonnel Schroder today. One of our expert lawyers will gladly book a suitable day and time for your FREE consultation.