There are few things more gutting than getting a letter from your insurer or super fund to say your Total and Permanent Disability (TPD) claim was rejected.
After the trauma of becoming unwell or injured, your ability to work and earn a living is already significantly impacted. You were looking forward to financial support — and are now being told, often bluntly, that you don’t qualify.
The good news? A rejection letter is rarely the end of the story. Every year, thousands of Australians have their TPD claims overturned on review, appeal, or after legal action once the evidence is strengthened.
This guide will show you:
- The most common reasons insurers and super funds reject TPD claims.
- Steps you can take after a rejection.
- How reviews, AFCA complaints and legal claims work.
- Practical tips for strengthening your claim.
- Examples of real-life rejected claims that were later successful.
Why TPD Claims Get Rejected
Insurers investigate your claim against the strict definition of TPD in your policy. Common rejection reasons include:
1. Not Meeting the TPD Definition
- Most super funds use the “any occupation” definition — you must prove you can’t do any work suited to your education, training, and experience.
- If the insurer thinks you could work in an alternative role, or with adjustments, they may reject your claim.
2. Insufficient Medical Evidence
- Reports are vague, incomplete, or inconsistent.
- GP says you can’t work, but a consultant suggests part-time duties may be possible.
- Insurer argues your condition is not “permanent.”
3. Non-Compliance with Treatment
- Insurer alleges you didn’t attempt all reasonable treatment.
- Examples: missing therapy, refusing rehab, not trialling recommended medication.
4. Policy Exclusions
- Exclusions for pre-existing conditions or mental health.
- Failure to meet waiting periods (e.g. 3–6 months off work).
5. Administrative Errors
- Missing forms or incomplete employer statements.
- Cover cancelled due to low or inactive super balances.
First Steps After a Rejection
Don’t Panic
Rejection is common. Many claims are approved later on review or appeal.
Read the Rejection Letter
Identify exactly why the claim was refused — definitions, medical evidence, exclusions, or paperwork.
Gather All Correspondence
Keep copies of all forms, reports, letters, and emails.
Seek Advice Early
An early conversation with a lawyer can save time and mistakes. They can tell you whether the insurer misapplied the TPD definition, ignored evidence, or acted unfairly.
Options After a TPD Rejection
Option 1: Internal Review
- You have the right to ask the insurer or trustee to reconsider.
- Provide additional medical reports or evidence to clarify gaps.
- Many claims are approved once stronger evidence is provided.
Option 2: AFCA Complaint
- Lodge a complaint with the Australian Financial Complaints Authority (AFCA).
- AFCA is free for consumers and can require insurers to pay benefits if they misapplied the policy.
Option 3: Legal Action
- If AFCA can’t resolve it, legal action is the last step.
- Courts can review policy wording, insurer conduct, and evidence.
- Many cases settle before trial once insurers see the strength of your case.
How to Strengthen a Rejected Claim
To overturn a rejection, address the gaps the insurer relied on:
- Improve medical evidence – Ask your doctors to provide detailed reports on permanency and incapacity. Ensure GP and specialist opinions align.
- Get vocational assessments – Independent experts can show why retraining or “light duties” aren’t realistic.
- Show treatment compliance – Provide evidence of therapy, medication changes, and rehab attempts.
- Challenge exclusions – A lawyer can clarify whether an exclusion is enforceable.
- Counter unfair IMEs – If rejection relied on an insurer-appointed Independent Medical Examination, consider getting reports from your own treating specialists.
Real-Life Examples
Case 1: Depression Claim Rejected
Maria, 39, a teacher, had her TPD claim denied because her GP wrote she was “currently unfit for work.” The insurer argued this wasn’t permanent.
👉 With legal help, she obtained a psychiatrist’s report confirming chronic, ongoing depression. Her claim was later approved.
Case 2: Back Injury Claim Rejected
David, a construction worker, was told by his surgeon he could “retrain for admin duties.” His TPD claim was denied under the “any occupation” test.
👉 With vocational evidence proving he lacked the skills for desk work and couldn’t sit for long periods, his claim was approved.
Case 3: Administrative Error
Lisa’s insurance cover was cancelled after 16 months of inactivity. Her claim was denied.
👉 With legal help, she showed contributions had been made, her cover was reinstated, and her TPD claim paid out.
Common Mistakes After a Rejection
- Giving up after the first denial – Many successful claims start with rejection.
- Resubmitting the same evidence – You need stronger, more specific evidence.
- Missing deadlines – Reviews, AFCA complaints, and court claims all have time limits.
- Accepting insurer IMEs at face value – These can be challenged with counter-reports.
Tips to Improve Your Chances
- Obtain a psychiatrist or specialist report for mental health claims.
- Keep a symptom diary showing daily impacts.
- Get family or carer statements confirming your incapacity.
- Seek advice before appealing exclusions or offsets.
- Engage legal help early — insurers take claims more seriously when a lawyer is involved.
FAQs
Does rejection mean I’ll never be paid?
No. Many rejected claims are later approved with stronger evidence.
How long do I have to appeal?
Time limits vary — internal reviews within months, AFCA complaints within 2 years.
Can I get a second opinion?
Yes. Specialist reports can overturn insurer-appointed IMEs.
What if my super fund cancelled my cover?
Cancellations can sometimes be challenged if contributions were made or proper notices weren’t sent.
Do I need a lawyer?
Not always, but legal advice greatly increases your chances after rejection.
For most people, a rejected TPD claim feels like the end of the road. But in most cases, it isn’t.
Many rejections happen because of gaps in medical evidence, inconsistencies between reports, or insurers applying the policy definition too strictly. With the right advice and stronger evidence, rejections can be overturned.
At TPD Claims Lawyers, we help Australians every day challenge rejected claims — and win. If your claim has been denied, don’t give up. Contact us today for a free, no-obligation assessment to discuss your options.
