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      Sally wins TPD payout despite insurer’s claims of incomplete treatment

      Sally wins TPD payout despite insurer’s claims of incomplete treatment

      Sally

      At just 42, Sally, a registered nurse, was forced to stop work due to a severe mental health condition. When her insurer claimed she needed to exhaust all treatment options before securing a TPD benefit, we harnessed extensive expert evidence to show she was entitled to a payout now.

      Investigating Sally’s TPD policy, we found it required her to undergo all ‘necessary and reasonable’ treatment options. Her treating psychiatrist recommended EMDR, leading the insurer to argue that she hadn’t exhausted her treatment options and her potential to return to work was still unclear.

      To challenge their decision, we needed to prove that further treatment wouldn’t improve Sally’s condition. We obtained records from her psychiatrist, evidence of her history of resistance to treatment, and reports from other psychiatrists on the success rate of EMDR in patients like Sally.

      Our approach also involved extensive communication with her psychiatrist to discuss the reasonableness of EMDR for Sally. Upon further assessment and understanding of the TPD requirements, her psychiatrist concluded that EMDR wouldn’t be a reasonable treatment option and was unlikely to substantially improve her symptoms. We also secured a supporting medical report from her GP.

      Armed with this evidence, relevant case law and legislation, we prepared detailed submissions arguing Sally’s case. In the end, Sally’s claim was approved just one month after the initial objection from her insurer. She received a lump sum payment of $460,000.

      Compensation received

      $460,000

      Claim type

      Total and Permanent Disability

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