Receiving a rejection letter for your TPD claim is devastating — but it's important to know that many initially rejected claims are later approved on appeal. Here's the structured process to follow.
Step 1: Understand the rejection reason
Read the rejection letter carefully. The insurer must explain their reasoning. Common reasons include:
- Doesn't meet the policy definition of "totally and permanently disabled"
- Medical evidence insufficient to establish permanence
- Pre-existing condition exclusion applied
- Claim lodged outside the time limit
Step 2: Gather stronger evidence
Target the specific gap the insurer identified. If they said there's no evidence of permanence, get a detailed specialist report specifically addressing long-term prognosis and work capacity. If they nominated alternative jobs, get a vocational assessment showing those jobs are unrealistic.
Step 3: Lodge an IDR complaint
Contact your super fund's complaints team in writing. State clearly why you believe the decision was wrong and attach your new evidence. The fund has 45 days to respond. See our IDR guide for details.
Step 4: Escalate to AFCA
If IDR doesn't resolve the matter, take your complaint to AFCA. See our AFCA guide. AFCA can make binding determinations and is free to use. Start with a free eligibility check if you haven't already.