Resolute Claims has seen an increase in customers complaining about their Total Permanent Disability claim rejected. TDP cover (as it’s known) is normally part of your Critical Illness Cover. Resolute have identified customers that have been asked for excessive and invasive medical evidence from their insurance provider.
So what is TPD cover? Most often TPD cover is taken as an additional benefit through a life or Critical Illness policy, much like the waiver of premium option. In short TPD cover pays out if you have been left totally unable to work again (either your own occupation or any occupation depending on your own policy). We typically see chronic pain and fatigue conditions where people are often not though as ‘Critically Ill’ but the severity of their condition leaves them unable to work. TPD insurance typically pays out the value of your policy.
A successful TPD claim can often be the difference between being financially secure and not. The impact of a rejected Critical Illness Claim or rejected Total Permanent Disability claim can be significant.
Customers who engage us at Resolute in relation to TPD claims seem to around the amount of medical information required, time taken to assess the claim and the burden of proof of what ‘permanent’ is. When a claim is submitted under a TDP policy confirmation is sought from your GP and/or consultant to confirm that a diagnosis has taken place. Insurance companies will ask questions about what treatment you have received, what treatment has been planned/being considered and what the likelihood of your return to work. Ideally insurance provider would receive this information and made a prompt decision on the claim.
The people that Resolute Claims speak with unfortunately do not receive this type of service. Due to the excessive information insurance companies request this could possibly take up to eight months.
Several months ago a client who had their TPD claim rejected due to the insurance company not believing their condition was not ‘permanent’ enough. Despite multiple health concerns which included mental health and CFS. The customers consultants had confirmed there was no further treatment that would have been effective and that it was more likely that this would be permanent. The insurance company wanted 100% certainty that the condition was permanent (which no consultant would provide). Resolute Claims were successful in overturning the insurance companies initial decision as we were able to prove the likelihood of the customer returning to work was less likely then them returning to work.
But what does permanent mean? Can you insurance provider wait indefinitely? It certainly seems like it from some insurance companies. We have been successful in overturning a large amount of wrongly declined TPD claims by using ABI guidelines, legal framework, and previous FOS decisions as benchmarks.
At Resolute Claims we offer a methodical and bespoke approach to every case. We are able to identify, for free, if someone has had an insurance claim rejected or unfairly. If you are looking for some guidance or where to turn next, get in touch.