Disclaimer – This article is intended as general information and education only. It is not financial or legal advice. Every insurance policy has its own wording, exclusions and assessment processes. If your TPD or insurance claim has been rejected, obtain tailored advice from a superannuation or insurance-claims lawyer.
Few things feel worse than opening a letter from your insurer to find that your Total and Permanent Disability (TPD) or insurance claim has been rejected. After already dealing with illness, injury or loss of work, the safety net you were counting on is pulled away.
The reality: insurers reject claims more often than most people realise. But in many cases, rejections are technical, based on poor or inconsistent evidence, or open to challenge.
This guide explains the five main reasons insurers reject TPD and insurance claims — and how to avoid or contest them.
1. Not Meeting the Policy Definition of TPD
Why insurers reject:
- Most super-based TPD policies use the strict “any occupation” test.
- You must prove you cannot return to any job suited to your education, training or experience, not just your previous role.
- Insurers often argue you could retrain, work part-time, or do “light duties.”
Case Study:
Michael, a carpenter, injured his back and could not return to heavy labour. His insurer rejected his claim, arguing he could work as a site supervisor. On appeal, with vocational evidence showing his pain levels and lack of retraining options, the claim was approved.
2. Insufficient or Inconsistent Medical Evidence
Why insurers reject:
- Reports too vague (e.g. “unfit for work at the moment”).
- GP and specialist opinions don’t align.
- Doctors fail to state explicitly that the condition is permanent.
Example:
Sarah, a nurse with depression, had her claim denied because her GP only wrote she was “currently unfit for work.” With a psychiatrist’s report confirming her condition was chronic and ongoing, the insurer approved the claim.
Tip: Detailed, consistent and permanent medical evidence is the cornerstone of every successful claim.
3. Non-Compliance with Treatment
Why insurers reject:
- Claimants are accused of not following “reasonable treatment.”
- Common issues include:
- Missed therapy appointments.
- Not trialling recommended medication.
- Declining surgery without medical justification.
Example:
Tom’s claim was rejected because he hadn’t tried a specific medication. His doctor later confirmed the drug was inappropriate for his condition, and the rejection was overturned.
4. Policy Exclusions and Waiting Periods
Why insurers reject:
- Pre-existing condition exclusions (injuries or illnesses before cover started).
- Mental health exclusions in older policies.
- Self-inflicted injury exclusions.
- Failure to meet the waiting period (commonly 3–6 months of being off work).
Case Study:
Lisa’s PTSD claim was rejected under a mental health exclusion in her policy. Her lawyers argued the clause was discriminatory and secured a partial settlement.
5. Administrative & Technical Reasons
Why insurers reject:
- Incomplete claim forms or missing employer statements.
- Policy cancelled or lapsed (e.g. after 16 months of inactivity under the Protecting Your Super laws).
- Claim lodged outside the strict policy time limits.
Example:
John’s claim was denied because his super-linked insurance was cancelled after 16 months of no contributions. With evidence of contributions, his cover was reinstated and the claim paid.
Common Pitfalls Claimants Make
- Assuming their old job description applies under an “any occupation” test.
- Submitting vague medical certificates without firm wording.
- Failing to provide key supporting documents (e.g. employer statements, tax returns).
- Missing strict claim deadlines.
- Giving up after one rejection — many successful claims are won on appeal.
Fast-Track Checklist: Avoiding Rejection
| Action | Why It Matters | Evidence Needed |
|---|---|---|
| Review your PDS early | Know definitions, exclusions and waiting periods. | Policy document. |
| Get consistent medical reports | Prevents contradictions between GP and specialists. | GP & specialist reports. |
| Prove permanency | Insurers won’t pay for temporary incapacity. | Detailed medical certificates. |
| Confirm waiting period | Avoid lodging too early. | Sick leave or employment records. |
| Check cover is active | Many policies lapse with inactive super. | Superannuation statements. |
FAQs
If my claim is rejected, can I appeal?
Yes. Options include an internal review, a complaint to AFCA, or legal proceedings.
How long do I have to appeal?
Generally up to 2 years to lodge with AFCA, but always act quickly.
Do I need to be totally unable to work?
Usually yes for TPD — but wording varies between policies.
Can insurers keep requesting more evidence?
Yes, but requests must be reasonable. Unfair delays can be challenged.
Key Takeaways
- Insurers most often reject claims for definitions, poor evidence, exclusions, waiting periods, or technical errors.
- Rejection is not final — many claims succeed on review or appeal.
- Strong, consistent medical evidence is the foundation of any claim.
- Always check your policy wording, waiting period, and cover status before lodging.
- Seek legal advice early to protect your position.
Having your TPD or insurance claim rejected is disheartening — but it’s not necessarily the end. Most rejections fall into predictable categories and can be successfully challenged with stronger evidence or legal support.
At TPD Claims Lawyers, we help Australians every day to overturn insurer rejections and recover the benefits they are entitled to. If your claim has been denied, contact us for a free, no-obligation assessment.
Last updated: 3 September 2025