When a TPD claim is rejected, the insurer may cite a policy exclusion. Sometimes this is legitimate — but exclusions are often applied too broadly, and understanding exactly what your policy excludes is crucial to challenging a wrongful rejection.
Common TPD policy exclusions
- Pre-existing conditions — conditions known and treated in a look-back period before cover started (typically 5 years). Note: this doesn't exclude all prior health history, only specified conditions.
- Self-inflicted injury — injuries or conditions intentionally self-caused are typically excluded
- War or terrorism — disability resulting from active participation in war
- Criminal acts — injury sustained while committing a criminal offence
- Non-disclosure — for retail policies outside super, failing to disclose relevant health information at the time of application
What is NOT excluded (despite what some insurers suggest)
- Mental health conditions are generally not excluded in standard default super TPD policies
- Conditions that developed gradually over a working career
- Disabilities caused by non-work activities (sport, everyday life)
Challenging an exclusion
If an insurer applies an exclusion, request the specific policy wording. Exclusions must be clearly stated and the insurer must prove the exclusion applies. Many are challenged successfully at IDR or AFCA. Start with our free eligibility check.