Superannuation and Life Insurance Claims

$1.2 million

Pieta’s claim was rejected by her insurer. We got the decision overturned.

When Pieta was diagnosed with breast cancer in 2017, she attempted to claim a Total and Permanent Disablement (TPD) benefit through her superannuation. When her insurer rejected the claim, Pieta came to us. We immediately filed a dispute notice.

Challenging an insurer’s decision is difficult: they are well-resourced, and superannuation claims are more complex than many people realise. In Pieta’s case, we supported her claim using strong evidence, including medical reports. Our depth of evidence was even commended by the insurer.

Our strategy was well-planned, and drew on our expertise in disputed claims. In the end, we were successful in challenging the insurer, and their decision to reject Pieta’s claim was overturned. Both Pieta and our team were delighted with the outcome.

$1 million

Aaron tried to claim TPD under a strict insurance policy. We obtained additional evidence and secured his win.

When Aaron suffered a serious psychological injury, he attempted to claim a TPD benefit through his super fund. His policy, however, was very strict. At first glance, it seemed unlikely Aaron would be eligible to claim any compensation.

When Aaron came to us for assistance, we immediately knew that his case would prove a challenge. Claims like his rely heavily on solid medical evidence, so we prepared his application comprehensively. First, we engaged a group of leading independent Medical Examiners to prepare detailed reports on Aaron’s condition. We also paid for an Employability Assessment report — a form of extra evidence most of our clients cannot afford themselves. In many cases, it’s additional evidence like this that will make or break an application.

We successfully resolved Aaron’s claim, and he received a benefit of $1,000,000 within 4 months.

$550,000

13 years after his claim was rejected, we helped Jim overturn his insurer’s decision.

In 2006, Jim suffered a deep psychological injury. When he tried to claim a TPD benefit through his super fund, his application was declined.13 years later, Jim came to us for a second opinion. Two obvious challenges presented themselves: it was too late to lodge a claim, and Jim couldn’t legally begin court proceedings against his insurer.

Knowing the complexity of the law in this area, we assembled an expert legal team to work on Jim’s case. First, our lawyers reviewed recent court decisions that mirrored Jim’s case. We also used our own experience with similar cases. The insurer, when rejecting Jim’s original claim, had cited 15 reasons. Our submission addressed each of the 15 reasons individually.

Though it had been 13 years since the original decision, we successfully overturned the original decision made by the insurer in 2006. Our comprehensive approach turned a difficult case into a successful resolution. Jim was awarded $250,000 in TPD benefits, as well as an extra $300,000 in accrued interest. His payout totalled $525,000.

$310,000

John was bullied to the point of depression. Doctors and insurers insisted he could work again – but we proved them wrong.

After enduring persistent workplace bullying, John developed depression and anxiety. When trying to claim a superannuation benefit, he hit a roadblock. John’s policy required him to prove he was ‘unlikely ever’ to engage in any occupation within his education, training and experience.

Though his condition was serious, John’s treating doctors were not prepared to provide clear support for his claim. They suggested John retrain to find other forms of employment. The doctors’ belief that John could retrain gave his insurer cause to decline his claim.

Initially, John submitted his claim without legal help. Only when the insurer was due to make its decision did he seek legal advice.

We reviewed the case, noting problems in the submission and insufficient medical evidence.

We then asked the insurer for time to address these problems. We used court decisions from similar cases to strengthen John’s application. We argued that the intention of the policy was improperly considered in that it did not require claimants to retrain for a completely different occupation. John’s age and relative lack of education further strengthened our submission.

In the end, we secured John a $310,000 payment. This included his TPD benefits and interest accrued as a result of the insurer delaying acceptance of John’s claim.

$280,000

After a workplace accident, Alex’s TPD insurer insisted he could return to work. We found a loophole.

When a workplace accident left Alex unable to work, he lodged a TPD claim himself. At this same time, we were assisting Alex with a Workers’ Compensation claim.

Unfortunately, Alex’s TPD claim proved to be more complex than he thought. The insurer was relying on evidence from the Workers’ Compensation doctors, who believed Alex could return to work.

With his claim set to be declined, Alex came to us for help. To disprove the insurer’s evidence, we put an extensive strategy in place. We also found a loophole in the policy, allowing us to have Alex assessed under a more relaxed definition. Alex was not aware of this loophole, and his insurer had not informed him.

Our strategy was successful, and the insurer finally accepted Alex’s claim. He was awarded a benefit of $280,000.

$180,000

Sarah struggled to get medical support for her claim. We used our network of experts to win her case.

Sarah, a nurse, suffered chronic pain as a result of her Fibromyalgia and Complex Regional Pain Syndrome. Unfortunately, due to the lack of the medical testing and disagreements over diagnosis, the medical profession often disagrees on these conditions.

When we began work on Sarah’s case, we discovered her policy was stricter than most. It required Sarah to prove that she was ‘unlikely ever’ to return to her work. This was not easy to prove because Sarah was young and otherwise healthy.

Given the challenges, our lawyers dug deep — engaging independent medical experts who (despite difficulties in diagnosing Sarah’s condition) were able to provide detailed supportive medical evidence. We also found past court decisions to show Sarah’s condition satisfied the strict definition of the policy.

In the end, we secured Sarah a $180,000 payout as well as income support benefit paid over 10 years.

$180,000

Tony’s insurer claimed he could return to work. We used expert medical evidence to prove them wrong.

Since birth, Tony had suffered from both physical and psychological injuries. Unfortunately, his policy contained clauses excluding any claim for psychological condition. Tony was required to prove his physical conditions alone prevented him from working.

Tony’s insurer deemed his physical conditions too mild to prevent him from returning to work. When Tony came to us, two of our specialist doctors assessed him, providing support for his claim. We also used his government records to prove that Tony did, in fact, suffer from debilitating, long-term physical conditions.

We were able to successfully argue that Tony’s physical conditions met the insurer’s threshold and secured payment of his $180,000 benefit.