A rejected TPD claim is not a dead end — it's a specific problem with a specific solution. Successful resubmissions and appeals turn on one thing: identifying exactly why the claim was rejected and submitting evidence that directly addresses that reason.
Step 1: Understand the exact grounds for rejection
Read the rejection letter carefully. The insurer must give specific reasons. Common grounds include:
- Medical evidence insufficient to establish permanence
- Claimant doesn't meet the "any occupation" definition (alternative jobs identified)
- Pre-existing condition exclusion applied
- Claim not lodged within the required period
Every additional step you take should respond to these specific grounds — not just submit more of the same evidence.
Step 2: Request the insurer's file
You are entitled to see the evidence the insurer relied on — including any IME reports or vocational assessments they obtained. Request this in writing. Understanding what their expert said is essential to building a targeted response.
Step 3: Obtain targeted additional evidence
- If rejected on permanence grounds: obtain a detailed specialist report specifically addressing long-term prognosis and why recovery is unlikely
- If rejected on any-occupation grounds: commission an independent vocational assessment demolishing the insurer's alternative job proposals
- If rejected on an exclusion: obtain specialist evidence showing the current disability is not caused by the excluded condition
Step 4: Lodge an IDR complaint
Submit your IDR complaint to the super fund trustee — not the insurer — with your new evidence and a clear written argument addressing each rejection ground. See our IDR guide.
Step 5: AFCA if IDR fails
If IDR is unsuccessful, escalate to AFCA. Many claims succeed at AFCA that failed at IDR. See our AFCA guide. Start with a free eligibility check.