Trevor (pseudonym) came to us at the end of 2021 because he had tried to return to work after a period of being unable to work due to mental illness and drug addiction. But because of his ongoing struggles with his health, he was unable to hold down a job and provide for his family. It was these same mental health issues that eventually led to Trevor’s incarceration. We helped Trevor claim on his TPD and income protection insurance, years after he stopped working.
Background to the TPD and income protection claims
Trevor originally ceased work in 2013 because of his major depressive disorder and post-traumatic stress disorder (PTSD). From that point in time, Trevor continued to struggle with drug addiction and for further periods, found himself couch-surfing and at times, sleeping on the streets, essentially homeless.
Trevor seeks legal assistance from a TPD lawyer
Trevor had heard from a friend that Berrill and Watson could assist with looking into his superannuation entitlements, particularly TPD and income protection.
When first reaching out, Trevor’s intention was to try and withdraw his superannuation balance. But he was surprised to learn, after some investigation from his legal team, that he held disability insurance for both total permanent disability (TPD) and income protection when he last worked.
After learning of his insurance cover, and the potential benefits if his claim was successful, together with the knowledge that we would act for him on a “no win no fee” basis, we lodged both of Trevor’s claims.
Strategy to address the reasons the insurer used to reject the TPD and IP claims
After we did our initial work collecting and collating the relevant medical and other materials (many of which were historical), we submitted the claim for Trevor.
Shortly after, the insurance company told us that they wanted to reject Trevor’s claim because, in their opinion, Trevor had not been receiving constant medical treatment from a practitioner for periods of time after he had ceased work.
We knew that the insurer’s position was wrong because it was not reasonable for the insurer to expect Trevor to be seeking appropriate medical treatment in the periods where he was homeless and unable to afford such treatment. Their position was too harsh and, therefore, unfair and unreasonable.
We lodged a complaint (internal dispute resolution with the insurer) arguing that in the periods that Trevor was able to afford to see a medical practitioner, Trevor made every effort to ensure that he got the appropriate treatment.
We strengthened our position with the use of statutory declarations from Trevor’s family and friends. These statutory declarations assisted in certifying that Trevor’s struggles with his mental health had indeed amounted to periods of homelessness.
The insurer accepted our position regarding Trevor’s homelessness but then queried if Trevor’s medical treatment had been ongoing, even after his incarceration.
To pay out a TPD benefit, the insurer needed proof that Trevor’s claimed condition was still being treated and preventing him from returning to work. We were able to successfully argue that the course of medication that Trevor had been on since his incarceration was sufficient ongoing treatment for his claimed conditions.
Big win sees $200,000 in TPD and income protection benefits paid out
Ultimately, we were able to secure a TPD benefit payment for Trevor in the amount of $157,800.00 and a lump sum income protection (IP) back payment benefit in the amount of $40,392.24 for the 2 years after he ceased work.
Get help from a TPD and income protection lawyer
For the past few years leading up to this outcome, Trevor had been worried about how he would provide for his children since his disability had made it impossible for him to maintain employment. Trevor now has some peace of mind as he has been able to put the money into a long-term savings account to grow, and when the time comes, he can put it towards his children’s education.
This successful win, years after stopping work, is not uncommon. If you’ve stopped work, recently or years ago, due to injury or illness, you should consider what disability insurance you have. We will review your policy free of charge and act for you “no win no fee”.
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