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Why has the insurer rejected my claim?

We see claims for disability benefits rejected by insurers and super funds because they believe:

  • You still have a work capacity
  • You need further treatment
  • You have not reached ‘maximum medical improvement’
  • You can do ‘light duties’
  • You can work in other jobs

If your claim has been rejected, contact us to speak to one of our dedicated insurance lawyers to help you challenge the insurers decision.

Strict time limits may apply to disputing Income Protection and Total and Permanent Disability decisions so you should contact us for advice as soon as possible.

Non-disclosure, alleged insurance fraud, and pre-existing conditions

Our lawyers often see cases where an insurer rejects a claim by saying that information was hidden from them during the insurance application. In many cases, we can fight to get the claim paid.

Why is the insurer trying to cancel my policy?

When applying for insurance, you have to tell the insurer everything they need to know to decide whether to give you insurance, and on what terms. If you do not tell them what they need to know, they might be able to cancel your policy after you make a claim, but not always.

We see cases where an insurer tries to cancel a policy:

  1. on the basis of a very minor previous illness or injury
  2. where an insurance agent was told about an illness or injury, but chose not to put it on the application form
  3. where an insurance agent did not explain the application form
  4. where the person did not understand the application form
  5. on the basis of a medical condition the person did not even know about

In all of these cases, the insurer may not be allowed to cancel the policy.

If an insurer tries to cancel your policy, you should get expert advice immediately.

What about a pre-existing condition?

Some policies say that you cannot claim for a pre-existing condition. The rules about pre-existing conditions can be complex, and often a pre-existing condition is not a reason for a claim to be rejected. You should get expert advice on whether a pre-existing condition is a problem for your claim.

What can we do for you?

Our rejected insurance claims lawyers can:

  • advise you on whether you have a good case

  • lodge a dispute with the insurer against your policy being cancelled, or against your claim being rejected

  • if the claim is not paid, take the case to Court.

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