Can I claim on My Total Permanent Disability Insurance?

One of our most requested areas for help is Total Permanent Disability insurance. We often see people who have either attempted to claim on this insurance and been declined or are not sure of they can claim on the policy.

Before we discuss some of the issues we have encountered with Total Permanent Disability insurance (TPD) I’ll briefly cover exactly what it is.

TPD cover is often sold as an “add on” to either a life insurance or critical illness insurance policy. Critical Illness insurance pays out if you have been diagnosed with a medical condition that your insurance policy had pre listed.

PD cover is slightly different as it pays out depending on your ability to either:

• Do your own occupation again.
• Do any occupation again (any suited occupation).
• Do certain daily living activities.
• Do certain daily work tasks.

The criteria depends on the type of policy you have. Most people in employment will be assessed against own or any occupation conditions but this is dependant on your policy.

You will need to prove several aspects when appealing a decision or applying on your TPD policy. These are:

• Your condition is permanent and has no likelihood of improvement.
• The symptoms you experience will stop you from doing either a own/any occupation or daily living/work tasks.
• You have undergone all treatment that could be reasonably expected to improve your symptoms to a level where you could do the above.
• There is a minimal chance of recovery in symptoms.

Where Does It Go Wrong?

Recent ABI figures show that almost 40% of TPD claims are rejected by insurance companies. My honest opinion is that figure is low and believe that more then 70% are rejected by insurance companies.

This is because often insurance companies don’t reject claims but will say there’s not enough evidence, at the current time, to admit the claim.

The most common claims we see are for conditions like Chronic Fatigue Syndrome, Fibromyalgia and Chronic Pain Syndrome. These conditions can often have no identifiable underlying cause and the outcomes and prognosis vary greatly from person to person.

The most common reason a Total Permanent Disability claim is rejected is because the person is still undergoing treatment. Often insurance companies will state that as treatment has not been completed, they cannot say the condition and/or symptoms are “permanent”.

We come across this often and it’s completely unreasonable for insurance companies to state this considering the treatment for these conditions (and others) can be life long.

For example, we had a client who was rejected her TPD claim after being diagnosed with a Chronic Pain Syndrome almost five years previously. She had been attending a pain management clinic as part of her pain management programme.

The insurance company advised her that as she was still going through treatment, they could not confirm the condition was permanent.

Fundamentally, the insurance company wilfully ignored the what the aims of a pain management programme are. PMP’s are put in place for people to cope with the emotional and life impact of chronic pain. They are not to improve symptoms or functionality.

Often we have to obtain specialist medical reports from our in house consultants to support our clients.

In summary, TPD claims and appeals are amongst the most complicated and need to be property supported with relevant medical information.

We have seen claims take anything between 3 months and 4 years to get paid.

If you need help appealing a rejected Total Permanent Disability Claim please call us on 0333 050 8792 for more information.