When Esther* went to a public hospital with groin pain, she underwent ultrasounds and x-rays, but the hospital failed to...
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Learn moreAdelle suffers from several debilitating and painful conditions, including Undifferentiated Connective Tissue Disease, Pre-Scleroderma, Fibromyalgia, and Functional Neurological Disorder. Unable to work, she attempted to make a TPD claim to help her financially.
Fortunately, the severity of Adelle’s conditions was undisputed. We obtained extensive medical evidence proving the nature and extent of her illnesses and their impact on her work capacity. All experts agreed that Adelle was unlikely to ever return to work. When we submitted Adelle’s claim, the insurer agreed she satisfied the TPD definition in her policy, with no additional requirements to meet.
Despite this, they stalled, claiming she hadn’t met the eligibility criteria under the Southern State Superannuation Act 2009 and supporting regulations. With our 25 years of TPD experience, we recognised this insurer tactic and refused to allow them to delay or deny Adelle’s claim unreasonably.
We filed a formal complaint with the fund, using additional medical evidence, legislation, and case law to prove the insurer was acting unfairly. The insurer caved to this pressure, approving and finalising Adelle’s claim for $300,000.
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