Having a TPD claim rejected is stressful, especially when you're already dealing with illness or injury. But a rejection is often not the final answer. Many initially-declined claims are later approved on review or dispute.
Why TPD claims get rejected
- Insufficient medical evidence — the most common reason. The insurer says your documentation doesn't prove permanence.
- The wrong definition was applied — e.g. assessed under "any occupation" when "own occupation" should apply.
- Disputes about your work capacity — the insurer believes you could do some form of work.
- Non-disclosure allegations — claims that you didn't disclose a pre-existing condition.
- Policy or timing technicalities — cover lapsed, premiums unpaid, or deadlines missed.
Step 1: Get the reasons in writing
Ask the insurer or super fund for a full written explanation of why the claim was declined, plus copies of the documents and medical reports they relied on. You're entitled to this.
Step 2: Identify the gap
Rejections usually hinge on one or two specific points. Once you know the exact reason, you can target it — often with additional or stronger medical evidence.
Step 3: Gather better evidence
This might mean updated specialist reports, a functional capacity assessment, or statements from treating doctors that directly address the insurer's concerns.
Step 4: Lodge a dispute or complaint
If internal review fails, you can escalate — for example to the Australian Financial Complaints Authority (AFCA), which handles many superannuation and insurance disputes at no cost to you.
Rejected claims are frequently overturned. The key is understanding precisely why it was declined and responding with the right evidence.
Get a second opinion
If you've been knocked back, a free review of your situation can help you understand whether the rejection is worth challenging — and what it would take to succeed.