Generally, there is no legislation that binds superannuation funds or insurers to make a decision within a certain time frame. Depending on your superannuation, life and TPD insurance claim type, it could take from a matter of weeks up to 12-18 months, though sometimes it can take longer. Read on to find out average time frames for your type of claim.
At Main Lawyers, we are experts in winning compensation for our clients in Queensland and New South Wales. You can bring your matter to us in a free initial consultation where we can provide you with a more accurate estimation of time frames based on your specific situation.
How long does a TPD claim take?
The severity of your situation is likely to impact on the time frames concerning how long your TPD claim may take. Once your initial claim forms are submitted, you will most likely need to attend at least one independent medical exam. You may also need to supply further evidence, such as specialist reports.
For Total and Permanent Disablement (TPD) claims, the decision on the outcome usually comes between 12-18 months after the lodgement of the claim forms though there are some circumstances where the decision might come earlier.
What happens if my TPD claim is declined?
If your TPD insurance claim is declined, we may need to gather more medical evidence and seek a further decision. An alternate method may require going ahead with court proceedings, which we’ll discuss with you in advance.
Court processes carry very strict time frames for TPD lawyers to comply with. From the beginning of the court process to a trial can take a couple of years and depends on a number of factors. Thankfully, less than 2% of all TPD claims ever end up in a courtroom.
If your TPD claim has been rejected, reach out to our experienced team to find out if it’s feasible for you to proceed with claiming the compensation you may be entitled to.
How long does an Income Protection (IP) Claim Take?
There are no legislative time frames involved however the process of approving Income Protection claims is much more straightforward than TPD claiming matters.
This is because IP is a payment for a temporary incapacity for an injury or illness that is preventing you returning to your own employment. TPD is, generally, a larger payment for permanent incapacity for an injury or illness that is preventing you returning to any employment within your education, training or experience.
That’s why payment for IP matters often begins sooner despite a waiting period of at least 28 days. Once your IP claim has been reviewed and approved by the superannuation fund and insurer, payments are generally processed within a few days. In order to sustain IP payments, there is also often a requirement to provide updated medical evidence from your doctors every month.
How long does a Life Insurance or Death Benefits Claim take?
Death claims to a Superannuation fund can be processed within a matter of weeks or months in relatively straightforward cases. It all depends on the circumstances of the person’s death.
When a person passes away, their superannuation fund and insurer will require a copy of the death certificate and most recent will. If there is a valid and binding beneficiary nomination, the account balance would usually be paid to the person nominated.
A binding beneficiary nomination is a written direction given to a superannuation fund by the person whose name is on the account. In the event of their death, this nomination will determine who is to receive the person’s superannuation amount (and insurance death benefits). Generally, the nominees are the person’s dependents and/ or their legal representative.
If the deceased has a valid and current binding beneficiary nomination, the superannuation fund will generally process the death claim within months.
If there is no valid binding beneficiary nomination, by law, a death benefit can only be paid to any one or more dependants of the deceased member and the Legal Personal Representative (LPR) of the deceased member’s estate.
A dependant can include:
A Spouse
Spouse means a person who lives with you and is in a genuine domestic relationship as a couple. It does not matter whether you are married or not, or whether the person is the opposite sex or the same sex. Spouse can include a former spouse (although a former spouse will only be treated as a dependent if they are financially dependent upon you).
A Child
Child means any child, natural, posthumous, step or adopted, who is under the age of 18. However, note that the death of a step parent may mean that the child is no longer a dependant for death benefit payment purposes unless the child has been formally adopted.
Financially dependent child over the age of 18
This definition covers children over the age of 18 who are students and who are financially dependent. Children over the age of 25 will no longer comply with this definition.
Anyone else who is financially dependent on the member at the date of death
This covers disabled adult children, parents, former spouses and anyone else who is financially dependent at the date of death. Financial dependence means the deceased member contributed necessary financial support to maintain the dependent.
If no one is nominated, who is legally entitled to receive the death benefits?
As you would appreciate, there may be a number of dependants that have an interest in the superannuation account balance. Each potential dependant is usually contacted and information sought regarding their dependence upon the deceased person.
In complex cases, this process can take more than 12 months.
The only time someone else can receive the death benefits and superannuation balance is if there are no dependents or Legal Personal Representatives. The deceased member’s circumstances, any documented wishes and other people who relied on the deceased member for support at the date of death will all be considered in the decision of who will receive the funds.
For this reason, death claims can be complex and the time frames depend on whether there is a valid binding beneficiary nomination, the number of dependants (or potential dependants) and the return of information from those dependants.
If you do not agree with the superannuation fund’s decision regarding who to pay, there are avenues of appeal open to you. In a free initial consultation, our expert life insurance lawyers can assess your situation and what further action is viable for you.
How long does a trauma claim take?
Generally, trauma insurance policies provide a lump sum payment in the event of a major injury or illness (such as cancer, stroke or brain damage).
If you have medical support from a medical practitioner specialising in the specific injury or illness, a trauma insurance claim ought to be processed within 3 – 6 months of the claim being lodged. Occasionally, your doctor or GP is not specific enough with their diagnoses.
Sometimes an independent medical examination may be needed. In more complex trauma cases, usually a decision is made in no longer than 12 months.
Are there any time limits that apply to TPD, IP, death and trauma claims?
There are strict time frames (known as limitation dates) that operate on any action in Queensland and New South Wales. For insurance claims that is six (6) years from the cause of action arose.
It is sometimes arguable that a cause of action in these cases can only arise when an insurer has made a decision to decline a claim. That is, the limitation date arguably doesn’t start at the date you ceased employment because of an injury or illness.
Further, when your insurance is held within a superannuation fund, the limitation date is 12 years from the date the cause of action arose (as such claims involve a Trust).
The best advice is to consult an expert superannuation and life insurance lawyer as early as possible following the cessation of employment due to an injury or illness.
Related Tags: Insurance Lawyers Gold Coast, Insurance Claim Lawyers Gold Coast