AustralianSuper’s decision to tighten up its TPD definitions will result in more of its members having their claims denied, argues plaintiff law firm Shine Lawyers.
For all TPD claims lodged after 1 November 2014, the $82 billion industry fund – via its insurer TAL – will be closely scrutinising the amount of retraining, reskilling and rehabilitation undertaken by members.
AustralianSuper members can expect to be held to account on “What re-skilling, training or voluntary work” they have already done; “any retraining or reskilling [they could] reasonably … be expected to do”, and “any rehabilitation [they] have done already or any rehabilitation [they] reasonably could be expected to do”.However, speaking to InvestorDaily, Shine Lawyers partner Will Barsby said the main beneficiary of the changes to the definitions will be TAL rather than AustralianSuper members.
The point of the new TPD definitions is to limit the amount of successful claims, Mr Barsby said.
Multiple court judgements have found insurers and the superannuation funds they partner with tend to ‘cherry pick’ evidence in order to deny claims, he said.
For example, there may be 10 reports that unilaterally say a person is disabled and has no prospect of returning to work, Mr Barnsby said.
“[But instead] they’ll rely upon some rogue report that was obtained during the treatment phase which has indicated that there may be some ability to return to work to justify declining [the claim],” he said.
“The end result is more lawyers will have to get involved because there will be more people who are being declined initially who need representation."
AustralianSuper product manager for insurance, Richard Weatherhead, said that the industry fund will “wherever possible, work with the member to seek their rehabilitation back into the workforce”.
“That said, retraining or rehabilitation is not obligatory in order to be eligible for a TPD benefit,” he said.
“If a member chooses not to undertake retraining or rehabilitation, then their claim will still be considered on its merits, although their potential for retraining/rehabilitation will be taken into account when assessing the claims,” Mr Weatherhead said.
Mr Barsby, however, said the suggestion that AustralianSuper would work with members to nurse them back to being able to return to working is “misleading”.
“There’s no obligation at all for these superannuation funds to fund the rehabilitation or retrain them,” he said.
“They’ll just tell you: ‘We’re declining your claim. Good luck with that!’,” Mr Barsby said.
If funds like AustralianSuper were “really serious” about protecting their members and protecting the integrity of group insurance they would “make the whole claims process easier", he said.
Shine Lawyers currently represents 900 clients who have had their TPD claims denied, Mr Barnsby said.
Two hundred of those clients are AustralianSuper members, but the “biggest fund that we pursue for clients that have been unable to return to work” is SunSuper, he said.
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