Delivering outstanding TPD and income protection insurance claims results

Rejected / Disputed Claims & AFCA Complaints

If your superannuation or insurance claim has been rejected, reduced, or delayed, you may still have strong options to challenge the decision. Our legal team assists with insurer disputes, internal reviews, and complaints to the Australian Financial Complaints Authority (AFCA), so you can focus on recovery while we fight for your entitlements.
Challenge Your Rejected Claim

Has your insurance or super claim been rejected or delayed?

We’ll help you dispute unfair outcomes — reviewing insurer decisions, strengthening your medical and policy evidence, and managing AFCA complaints so you know exactly what to expect at each stage.
Dispute Your Claim
Our Process

Making the Dispute Process Clear and Supportive

We guide you through each stage — from reviewing the insurer’s decision and collecting stronger evidence to managing negotiations and AFCA complaints — with clarity, care, and expertise, so you feel supported and confident throughout. – content

Confirm Your Full Entitlement

01. Eligibility Review
We assess your rejected claim by reviewing the insurer’s decision, policy wording, and supporting evidence. This confirms if you have grounds to challenge before moving ahead.
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Gather Policy & Evidence

02. Document Collection
We compile crucial evidence, including medical reports, income details, and policy records. This strengthens your position and addresses the gaps that led to your claim being rejected.
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Build Your Case for Review

03. Claim Preparation
We prepare a strong dispute submission with detailed medical evidence, thorough policy analysis, and supporting records to clearly demonstrate your entitlement and challenge the insurer’s decision.
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Lodge & Finalise Dispute

04. Claim Management
We lodge your dispute or AFCA complaint, handle all communication with the insurer or fund, and follow up until a fair outcome is reached. You’ll be kept informed at every stage of the process.
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We provide dedicated legal services to help individuals challenge rejected or disputed superannuation and insurance claims. Our team ensures the process is managed with clarity and care, from the first review of the decision through to final resolution.

Our experienced lawyers guide you through each stage of the dispute — from assessing the insurer’s reasoning to lodging an AFCA complaint — tailoring our approach to your circumstances and working to secure the financial support you are entitled to.

Understanding Claim Rejections

When a superannuation or insurance claim is rejected, it can be overwhelming and confusing. Knowing why insurers or super funds refuse claims is the first step to successfully challenging their decision and protecting your entitlements.

What is a Claim Rejection?

A claim rejection occurs when an insurer or superannuation fund decides not to pay benefits, either in full or in part. This may be due to policy definitions, medical evidence, procedural issues, or administrative errors.

Why is Understanding Rejections Important?

Identifying the exact reason for a rejection is critical to determining the next steps. It allows you to gather stronger evidence, correct misunderstandings, and decide whether to pursue an internal review, lodge an AFCA complaint, or escalate to legal action.

Common Challenges in Claim Rejections

  • Vague explanations: Insurers often provide generic reasons that do not clearly explain why benefits were denied.
  • Medical disputes: Differences between treating doctors and insurer-appointed examiners can create uncertainty.
  • Policy interpretation: Complex or restrictive policy wording may be applied unfairly against claimants.

Why Choose TPD Claims Lawyers?

  • Expertise: We analyse rejection letters and policy wording to pinpoint weaknesses in the insurer’s decision.
  • Guidance: We explain your options in plain language and outline the best strategy for moving forward.
  • Results: Our intervention helps turn rejections into approvals by addressing the insurer’s concerns directly.

Our Services Include:

  • Reviewing rejection letters and explaining the insurer’s reasons in clear terms.
  • Analysing policy wording to identify misapplications or unfair interpretations.
  • Advising on next steps, including internal reviews, AFCA complaints, or legal proceedings.

By working with TPD Claims Lawyers, you gain a clear understanding of why your claim was rejected and the strongest pathway to securing your rightful benefits.

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Common Reasons for Disputes

Superannuation and insurance claims are often disputed due to disagreements about medical evidence, policy definitions, or the insurer’s interpretation of your circumstances. Understanding the common reasons for disputes helps you anticipate challenges and prepare a stronger case.

What are Disputed Claims?

A disputed claim arises when an insurer or super fund refuses to pay benefits, reduces the amount payable, or delays a decision beyond a reasonable timeframe. These disputes can involve Total & Permanent Disability (TPD), Total & Temporary Disability (TTD), death benefits, or trauma/critical illness cover.

Why is Identifying Dispute Reasons Important?

Knowing why your claim has been challenged gives you a clear starting point to build your response. Each dispute reason requires different evidence and legal strategy, whether it’s clarifying medical capacity, addressing exclusions, or correcting financial records.

Common Challenges in Disputed Claims

  • Medical disagreements: Insurer-appointed doctors may downplay incapacity compared to treating specialists.
  • Policy exclusions: Insurers may rely on pre-existing conditions or narrow definitions to reject claims.
  • Incomplete documentation: Missing or inconsistent records can provide insurers with grounds to dispute.

Why Choose TPD Claims Lawyers?

  • Expertise: We understand the most frequent dispute tactics and know how to counter them effectively.
  • Guidance: We explain why your claim has been disputed and what evidence is needed to overcome it.
  • Results: Our strategies help resolve disputes quickly, ensuring your benefits are paid without unnecessary delay.

Our Services Include:

  • Reviewing dispute letters and identifying the insurer’s reasoning.
  • Gathering additional medical or financial evidence to close gaps.
  • Advising on whether to proceed with internal review, AFCA complaint, or court action.

With TPD Claims Lawyers, you gain the insight and support needed to address disputes head-on and secure the benefits you are entitled to.

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Challenging Insurer Decisions

When an insurer or superannuation fund rejects or reduces your claim, you have the right to challenge their decision. With the right evidence and legal strategy, many unfavourable outcomes can be overturned or renegotiated in your favour.

What Does Challenging a Decision Involve?

Challenging a decision means identifying the weaknesses in the insurer’s reasoning, supplying additional evidence, and formally requesting that the claim be reassessed. This process may involve internal review, negotiation, or escalation to the Australian Financial Complaints Authority (AFCA).

Why is It Important?

Insurers do not always get it right. Incorrect application of policy definitions, reliance on biased medical opinions, or administrative errors can unfairly impact your claim. Challenging the decision ensures your rights are protected and that you receive the benefits you are entitled to.

Common Challenges When Contesting Decisions

  • Limited transparency: Insurers often provide vague or incomplete reasoning for their decisions.
  • Evidence imbalance: Insurer-appointed medical reports may be prioritised over treating doctor evidence.
  • Delays in response: Internal review processes can be slow, creating financial stress while waiting for a resolution.

Why Choose TPD Claims Lawyers?

  • Expertise: We know how to dismantle insurer reasoning by exposing errors, gaps, or unfair interpretations.
  • Guidance: We prepare submissions with targeted evidence and arguments that directly address the insurer’s decision.
  • Results: Our involvement increases the chances of a successful outcome at internal review or AFCA complaint level.

Our Services Include:

  • Analysing insurer decision letters to identify weaknesses and errors.
  • Preparing dispute submissions with medical, financial, and policy-based evidence.
  • Negotiating with insurers to resolve disputes before escalation.
  • Escalating matters to AFCA when internal reviews do not achieve fair results.

With TPD Claims Lawyers on your side, you can challenge unfair insurer decisions with confidence and secure the benefits you deserve.

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Internal Review Process

If your superannuation or insurance claim has been rejected or disputed, the first step is usually an internal review. This process allows the insurer or fund to reconsider their decision before you escalate the matter externally.

What is the Internal Review Process?

An internal review is a formal request for the insurer or super fund to reassess your claim using additional evidence, clarifications, or legal submissions. It provides an opportunity to address errors, challenge medical opinions, or resolve misunderstandings without proceeding to AFCA or court.

Why is It Important?

Internal reviews can resolve many disputes more quickly and with less stress than external complaints or litigation. A successful review may result in benefits being paid without the need for further escalation.

Common Challenges in Internal Reviews

  • Limited transparency: Insurers may not clearly explain how they reassess evidence during the review.
  • Short deadlines: Timeframes to submit additional information are often strict, placing pressure on claimants.
  • Biased reassessments: Some reviews rely heavily on the original decision-maker’s findings, reducing objectivity.

Why Choose TPD Claims Lawyers?

  • Expertise: We know how to frame internal review submissions to directly address the insurer’s reasoning.
  • Guidance: We gather medical reports, financial evidence, and policy analysis to strengthen your case.
  • Results: Our approach increases the likelihood of a successful outcome without the need for external dispute resolution.

Our Services Include:

  • Preparing comprehensive internal review submissions.
  • Identifying errors or unfair reasoning in the insurer’s initial decision.
  • Gathering additional medical and financial evidence to support your claim.
  • Negotiating with insurers to resolve disputes efficiently.

TPD Claims Lawyers ensures your internal review is handled thoroughly and strategically, giving you the best chance to overturn a rejection before escalation.

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AFCA Complaints & Resolution

When internal reviews fail to achieve a fair outcome, the Australian Financial Complaints Authority (AFCA) provides an independent avenue to challenge insurer and superannuation fund decisions. This process is designed to resolve disputes without the need for costly court proceedings.

What is an AFCA Complaint?

An AFCA complaint is a formal dispute lodged with the Australian Financial Complaints Authority, a free service that independently reviews decisions made by insurers and super funds. AFCA can require insurers to pay benefits, correct errors, or reassess claims where policy terms support the claimant.

Why is It Important?

AFCA offers a quicker, more accessible way to resolve disputes than going to court. It ensures that claimants have an impartial body reviewing the fairness of an insurer’s decision, giving individuals the opportunity to have their case heard and corrected if necessary.

Common Challenges in AFCA Complaints

  • Strict time limits: Complaints must be lodged within AFCA’s timeframes, usually within two years of an internal review decision.
  • Complex submissions: Preparing a complaint requires detailed evidence and strong arguments against the insurer’s reasoning.
  • Insurer resistance: Some insurers dispute AFCA’s findings or provide overwhelming amounts of technical material.

Why Choose TPD Claims Lawyers?

  • Expertise: We have extensive experience preparing AFCA complaints and know how to frame arguments for maximum impact.
  • Guidance: We handle all communications with AFCA and the insurer, ensuring your case is presented clearly and thoroughly.
  • Results: Our clients benefit from higher success rates, fairer outcomes, and faster dispute resolution.

Our Services Include:

  • Lodging AFCA complaints on behalf of clients.
  • Preparing detailed submissions that address policy terms, medical evidence, and financial records.
  • Responding to insurer arguments and AFCA requests for further information.
  • Advising on next steps if AFCA resolution is unsuccessful, including court proceedings.

TPD Claims Lawyers ensures your AFCA complaint is managed with precision and care, giving you the strongest chance of overturning a rejected or disputed claim.

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Managing Insurer Delays & Tactics

Insurers and superannuation funds sometimes delay claim decisions or use tactics that frustrate and discourage claimants. Understanding these strategies and knowing how to respond is key to keeping your claim or dispute on track.

What Does Managing Delays Involve?

Managing delays means actively monitoring the progress of your claim, pushing back against unreasonable requests, and holding insurers accountable to their obligations under the Life Insurance Code of Practice and Australian law. It ensures that your case continues moving forward rather than stalling indefinitely.

Why is It Important?

Unchallenged delays can create financial stress and prolong uncertainty at a time when you need support the most. Proactively managing insurer tactics ensures fair treatment, faster outcomes, and protects your entitlement to benefits.

Common Challenges in Insurer Delays

  • Repeated requests: Insurers may ask for the same documents multiple times to stall progress.
  • Independent medical exams: Delays often occur while arranging assessments by insurer-appointed doctors.
  • Poor communication: Claimants may struggle to get clear updates or timelines from insurers.

Why Choose TPD Claims Lawyers?

  • Expertise: We know the common tactics insurers use to delay claims and how to counter them.
  • Guidance: We handle all communications with insurers, ensuring requests are appropriate and responses are timely.
  • Results: Our proactive approach keeps claims moving, reducing delays and securing faster resolutions.

Our Services Include:

  • Tracking insurer timeframes and demanding compliance with industry codes.
  • Responding to repeated or unreasonable requests that cause unnecessary delay.
  • Escalating stalled claims to AFCA where delay tactics breach obligations.
  • Keeping clients informed of progress so they feel supported at every stage.

With TPD Claims Lawyers on your side, you can overcome insurer delay tactics and achieve a timely, fair outcome for your claim or dispute.

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Gathering Stronger Evidence

Strong, consistent evidence is the cornerstone of successfully overturning a rejected or disputed claim. Insurers and superannuation funds rely heavily on medical, financial, and occupational records, and gaps in these areas are a common reason for disputes.

What is Gathering Stronger Evidence?

This process involves identifying weaknesses in the evidence provided with your original claim and supplementing it with additional documentation. It may include updated medical reports, detailed capacity assessments, financial statements, or expert opinions to address the insurer’s concerns.

Why is It Important?

Insurers often reject claims due to “insufficient evidence.” By gathering stronger, targeted documentation, you can directly respond to their reasons for refusal and significantly improve your chances of success at review, AFCA, or court level.

Common Challenges in Evidence Gathering

  • Incomplete medical reports: Doctors may provide brief certificates that don’t fully explain work restrictions.
  • Conflicting opinions: Differences between treating doctors and insurer-appointed examiners can weaken claims.
  • Missing financial data: Gaps in income records, employment history, or superannuation contributions can create dispute grounds.

Why Choose TPD Claims Lawyers?

  • Expertise: We know the exact type of evidence insurers look for and how to present it effectively.
  • Guidance: We work with treating specialists, independent experts, and financial professionals to fill evidence gaps.
  • Results: Our evidence-led approach helps convert rejected claims into successful approvals.

Our Services Include:

  • Reviewing existing claim files to identify evidence gaps and weaknesses.
  • Obtaining detailed medical reports and functional capacity assessments.
  • Coordinating financial and employment records to prove entitlement.
  • Preparing comprehensive submissions that link evidence to policy definitions.

With TPD Claims Lawyers, your case is backed by strong, targeted evidence that directly addresses the reasons for rejection or dispute.

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Legal Representation in Disputes

Navigating rejected or disputed superannuation and insurance claims can be complex and stressful. Having experienced legal representation ensures your case is presented clearly, strategically, and with the strongest possible chance of success.

What is Legal Representation in Disputes?

Legal representation involves engaging a lawyer to manage your dispute with an insurer or super fund, from reviewing the initial decision to lodging submissions, negotiating outcomes, and representing you before AFCA or the courts if required.

Why is It Important?

Insurers have experienced claims teams and legal advisors working to protect their interests. Without representation, claimants may struggle to challenge unfair decisions. Skilled lawyers level the playing field and give you the advantage of expert knowledge and advocacy.

Common Challenges Without Legal Support

  • Complex policy wording: Understanding exclusions, definitions, and offsets can be overwhelming without legal expertise.
  • Evidence presentation: Claimants may not know how to structure evidence to meet policy definitions.
  • Power imbalance: Individuals often feel pressured when negotiating directly with insurers’ lawyers or claims teams.

Why Choose TPD Claims Lawyers?

  • Expertise: We specialise in superannuation and insurance disputes, with deep knowledge of AFCA and court processes.
  • Guidance: We manage every stage of the dispute, explaining your options in clear language and reducing your stress.
  • Results: Our representation has helped many clients overturn rejections and secure the benefits they deserve.

Our Services Include:

  • Reviewing rejection or dispute decisions and advising on your options.
  • Preparing and lodging submissions for internal reviews and AFCA complaints.
  • Negotiating directly with insurers to resolve disputes where possible.
  • Providing strong representation in court proceedings when necessary.

By choosing TPD Claims Lawyers, you gain dedicated legal representation that protects your rights and works tirelessly to resolve disputes in your favour.

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Eligibility & Factors

Key Criteria for Rejected / Disputed Claims & AFCA Complaints

  • Grounds for Dispute: There must be a valid reason to challenge the insurer’s decision, such as errors in policy interpretation, unfair reliance on medical evidence, or administrative mistakes.
  • Internal Review First: Most disputes must go through the insurer’s internal review process before escalating to AFCA.
  • Time Limits: AFCA complaints generally need to be lodged within two years of the insurer’s internal review decision.
  • Supporting Evidence: Strong medical, financial, or policy documentation is required to back up your dispute.
  • Policy Coverage: The rejected claim must fall under a superannuation or insurance policy that AFCA has jurisdiction over.
  • AFCA Jurisdiction: AFCA can only review disputes that meet its rules and monetary limits, which cover most superannuation and life insurance matters.
  • Legal Representation: While not mandatory, engaging a lawyer strengthens your case and ensures the complaint is properly framed.
  • Causation: The dispute must relate directly to the illness, injury, or event covered under the relevant policy.
Why Choose TPD Claims Lawyers

Supportive. Focused. Proven.

We help you access TPD, income protection, and death benefit payouts — with expert guidance and real results.

  • Fast Response Times
  • Specialist Legal Team
  • No Win, No Fee
  • Clear Legal Guidance
  • Trusted Claim Process
  • Client-Focused
2
days
Average time to complete an initial claim review.
10
hrs
Average response time to new client enquiries.
80
%
TPD Claims Approved
Core Values

Guided by experience, driven by results

We are dedicated to helping Australians access their full insurance entitlements with clarity, compassion, and persistence. Our values shape how we approach every claim and how we support every client.
Our Mission

TPD Claims Lawyers is a specialist legal team dedicated to helping Australians access their full insurance entitlements when injury or illness prevents them from working. As part of the Carter Capner Law group, we proudly carry on a tradition of legal excellence that spans over 75 years.

Our mission is to apply our deep knowledge of TPD, income protection, and death benefit claims to deliver legal outcomes that truly support our clients’ financial recovery and peace of mind. We aim to simplify complex processes and provide guidance every step of the way.

We are committed to acting with compassion, integrity, and precision — anticipating obstacles and addressing them with strategy and care to achieve the best result possible for every client.

Our Approach

Exceptional legal service is about more than just lodging forms — it’s about supporting you through one of life’s most difficult moments with clarity, compassion, and experience.

We understand that every person’s situation is unique. Whether you’re navigating a Total and Permanent Disability (TPD) claim, pursuing income protection benefits, or seeking a death benefit after losing a loved one, we take the time to learn about your circumstances in full. We don’t just process claims — we listen, investigate, advise, and act in your best interests at every stage.

Our firm is built around a simple but powerful idea: people first. We take a compassionate, client-focused approach that makes legal processes less overwhelming. We cut through complexity and communicate in plain language — not legal jargon — so you feel informed and empowered from start to finish.

To ensure your matter progresses efficiently, we use up-to-date case management systems that allow our team to provide real-time updates. You’ll never be left wondering where your claim stands — and we’re always available to answer questions when you need us.

frequently asked questions
A rejected or disputed claim happens when your insurer or superannuation fund refuses to pay benefits, reduces the amount, or delays a decision. These can involve TPD, TTD, death benefits, or trauma/critical illness cover.
Yes. You can request an internal review, provide stronger evidence, or escalate the matter to the Australian Financial Complaints Authority (AFCA) for independent resolution.
Timeframes vary. Internal reviews can take weeks to months, while AFCA complaints may take several months depending on complexity and evidence required.
Policyholders, beneficiaries, or superannuation members whose claims have been rejected or delayed can lodge disputes. In some cases, family members or representatives may also be eligible.
Typically, medical reports, financial records, policy documents, and correspondence from the insurer are required. Additional evidence may be needed to address the insurer’s reasons for rejection.
If internal review does not succeed, you can escalate to AFCA. If AFCA is unsuccessful, court action may be an option. Legal advice is critical to understand the best path forward.
Yes. AFCA complaints usually need to be lodged within two years of the insurer’s internal review decision. Missing deadlines may prevent you from pursuing the dispute further.
While you can dispute a claim yourself, engaging a lawyer increases your chances of success. Lawyers ensure deadlines are met, evidence is strong, and arguments are framed correctly.
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