Declined Total Permanent Disability Claims
Appealing Rejected Total Permanent Disability Claims
What is Total Permanent Disability Cover?
Total Permanent Disability cover (TPD cover) is typically an ‘additional benefit’ that is attached to a Critical Illness policy. Generally, it should pay a lump sum if you’re unable to work again due to an illness not covered under your Critical Illness.
Different types of cover?
Depending on the type of policy you have, you could be covered for:
- Own Occupation. This means the policy should pay out should you be unable to do your current role with your employer.
- Any Occupation. The policy will only pay-out if you’re unable to do any ‘suited occupation’, meaning that you will have to be unable to do any occupation or role that matches your experience and qualifications
You may also have what’s known as Loss of Independent Existence ‘LOIE’. This type of cover pays out if you are unable to carry out a certain amount of ‘daily/living tasks’. Typically, you would need to be unable to do 3/6 or 4/8 listed tasks and this must be likely to be permanent (life-long).
Why are Claims Rejected?
According to the ABI figures just under 4 in 10 TPD claims are rejected. This means that over £1,200,000 per month of Total Permanent Disability claims are declined. Around 20-30% of all cases we receive related to TPD claims.
The barriers people face to making a successful Total Permanent Disability claim can vary and depend on the reason/condition being claimed against. For example, customers who have been diagnosed with conditions such as CFS and Fibromyalgia are likely to have lifelong symptoms and therefore, lifelong treatment for the condition. We have found insurance companies refusing to pay claims as treatment is ongoing. This obviously is frustrating as it would likely mean that the policy would never pay-out. People often go through a long-drawn-out process simply to be rejected on this basis.
Some people have intermittent conditions that ‘flare-up’ then get better for a short period of time. We have seen insurance companies in these circumstances claim people can work when they are feeling well. In reality, very few employers would tolerate that level of absence.
Another issue can be relating to ‘own’ and ‘any’ occupation meanings. We have had the situation where an insurance company expected someone who was a bricklayer to obtain an admin role in an office. This is obviously not a ‘suited occupation’ and was successfully challenged.
What can I do?
You can always make a complaint yourself, free of charge, to your financial service provider or the Financial Ombudsman Service. You may also search on the internet for “Insurance claim solicitor” or “insurance complaint company”.
When appealing a declined Total Permanent Disability claim it’s important to take an evidenced based approach. At Resolute Claims we have experts in various areas of insurance including TPD claims. We also have extensive experience in a wide range of ill health conditions including:
- Mental health issues
- Rheumatoid Arthritis
- Multiple/Inter-related health diagnoses
We have already helped customers successfully appeal their rejected Total Permanent Disability claim. You can visit our case study section of our website to see how we’ve helped.
How Can We Help?
Resolute Claims can provide free information and support if you feel let down by your insurance provider. When you call us, you will be assigned an expert in that area of insurance. We will be able to provide you with free help and guidance in helping you to make a claim. We can even write to your insurance company and provide you with our opinion and the likelihood of success.
If you decide to use our service, you will be formally assigned a case manager. Your case manager will specialise in Total Permanent Disability claims and have extensive knowledge of the processes involved in making a successful claim.
We will investigate the claim which normally involves looking at the policy terms, medical information and precedent cases.