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Adviser demands answers from Media Super

A financial adviser has publicly called on the chief executive of Media Super to explain why a total and permanent disability claim for a very vulnerable client has been indefinitely delayed.
ClaimRight founder and Financial Planning Association of Australia board member William Johns wrote to Media Super acting chief executive Tony Griffin last week in a private message on LinkedIn.
His message to Griffin said one of Media Super’s members, a client of Johns’, was at risk of suicide after having a TPD claim through the fund (with group insurer Hannover Re) declined.
Following the declined TPD claim Johns sent a full appeal. That was in June and there has since been no correspondence from the insurer or the fund.
Johns received no reply to his private message to Griffin, so he decided to make a public post.
“I  finally sent you Tony Griffin a personal message urging you to take action because the member is so badly mentally injured she is suicidal and at risk of homelessness,” Johns said in the post.
“This was a desperate plea from me to you to intervene. I labelled the message clearly. What do I get from you? Nothing. Are you too busy to care Media Super ?”
Financial Standard reached out to Griffin for comment. He said: “You can understand that the fund can’t comment on the details of individual insurance claims.”
“There are many factors that can determine the timeframe in which a claim is processed and subsequently paid. The fund is continuing to review the matter.”
Johns, meanwhile, said he has still had no response from the fund and is only growing more worried about his client.
The client has been diagnosed with post-traumatic stress disorder (PTSD) and lost her job with the justice system as a direct result of her PTSD.
Media Super has already granted the woman access to her roughly $80,000 in retirement savings, acknowledging her inability to work.
But, the TPD claim for $110,000 was declined on the basis that the client had demonstrated an ability to work by babysitting one of her neighbours’ children.
“They’re claiming that looking after a child next door is gainful employment. It’s utterly false. When you’re not on any income you do what you can to sustain yourself and neighbours and friends might help you out by paying you,” Johns said.
“Even Centrelink acknowledges there should be times when people can make $100 here and there. We expect as a society that the system doesn’t prohibit people from doing that.”
Johns said his client has been a victim of crime in the past and is at risk of homelessness. Centrelink acknowledged the clients’ vulnerable situation and escalated its processes to push her payments ahead – something that is very rare in Centrelink claims, given the volume the agency deals with.
“I think it’s really hard to communicate what it really is like unless you have dealt with someone who is very vulnerable. You know it doesn’t take much to tip them over the edge,” Johns said.
“She is very vulnerable and Centrelink acknowledged that and approved her for the disability support pension. To get that pension is a much harder test than a TPD claim.”
He added that the fund has already essentially admitted that the client meets the threshold of total and permanent disability by opening up her superannuation account to her under the Superannuation Industry (Supervision) Act provisions for permanent incapacity.
Johns said he hopes the apparent administrative delays aren’t a result of the pending merger between Cbus and Media Super.
“Can you imagine how many other people are suffering if the merger is impacting that? Our experience of Cbus has been good in terms of claims. I hope that if they do merge it might result in better outcomes for people who are very vulnerable,” Johns said.
 
Source: www.financialstandard.com.au
Frequently Asked Questions
What do you do after a car accident in Australia?A: If you’ve had a motor car accident, stop your vehicle and turn on your hazard lights. Make sure nobody is injured, and if so, call emergency 000 and remain at the scene of the accident. If it’s a minor incident you don’t need to call the police, but move the damaged cars if possible. Never admit responsibility even if you think you were at fault. Collect name, address, registration number and insurance details from the other parties and get witness details if possible.How long does it take to make a motor vehicle accident compensation claim?A: Motor accident compensation claims are normally finalised after you’ve recovered, or your injuries have stabilised. It can take some people longer to recover than others – from days to years – which determines the length of time it can take to finalise a claim. Also, your injuries may not always appear immediately after the accident and can take some time to appear, in some cases, years.Who is at fault in a car park accident?
A: In a carpark, anyone driving in the lanes has the right of way, so if you’re the one pulling out of the car space and hit another motor vehicle, you are likely to be the majority at fault in the accident. However, since both cars are moving, both drivers might hold some responsibility. But if you hit a parked car, you are likely at fault.
How long after a car accident can you claim in Australia?A: When lodging a claim for compensation after a motor vehicle accident it’s best to do it as soon as possible. However, it isn’t always feasible if you were severely injured and couldn’t file a claim straight away. There are time limits, however, so get someone to call a lawyer at PK Simpson for you to lodge a claim at least within six months of the crash.How long do you have to make a personal injury
A: The length of time you have to make your claim depends on the jurisdiction.
For instance:

TPD claims – these may be commenced up to 10 years after you’ve stopped work. TPD claims are very technical and you may have more than one TPD claim.
Car accident claims – A personal injury claim form should be filled in and sent to your CTP insurer as early as possible, but must be no later than six months from the date of your accident. HOWEVER, out of time claims may be made. New NSW CTP laws have made it difficult for injured people and many law firms still do not understand how to run new claims under these laws – so call us at PK Simpson Sydney as soon as possible.
Workers compensation claims – You should contact a lawyer within six months of the accident. But remember, out of time claims can be handled by PK Simpson Sydney. We can help you get the treatment required to build your claim.
Slip ‘n’ fall/occupiers liability claims – Your claim must be lodged usually within three years of the date of your accident.

Medical Negligence – within three years of the date of when the cause of action was discoverable to our client OR 12 years from the time of the act or omission which caused the injury through negligence.
How much does it cost me to make a motor vehicle accident compensation claim?A: At PK Simpson compensation lawyers we operate on a no-win, no-fee basis. However, for detailed information on the legal costs that can be charged for statutory benefits CTP Insurance car accident claims in NSW click on this link.
The post Adviser demands answers from Media Super appeared first on PKSimpson.

Sunsuper Assist and Sunsuper TPD Claims

As of 2020 Sunsuper has decided to make some potentially life changing amendments to all aspects of their superannuation policies. Already this year they have decreased their account keeping fees and overall costs.
As at 1st of January 2021 further changes will be made towards their growth, retirement and investment strategies.
Our focus is the updates being made to their definition of Total and Permanent Disability (TPD) cover for AIA insured Sunsuper for life corporate plans and Sunsuper for life business plans.
Members that have Total and Permanent Disability cover who experience a life changing accident or illness with no chance of being able to recover may be paid a  monetary lump sum amount with no waiting period. Some of the medical conditions that will be covered under Sunsuper’s Total and Permanent Disability insurance cover include Chronic Lung disease and Cardiomyopathy.
Previous to the 1st of October 2020 Sunsuper’s Total and Permanent Disability definition included the clause “Unable to do basic activities associated with work ever again.” This very onerous definition, known as the ADL definition, is almost impossible to satisfy and when superannuation funds apply this definition, a decline is almost inevitable as the requirements to satisfy it are not realistic.
The ADL definition was said to have applied to members who were not employed just before the date of their accident or illness. Simply because members were not employed meant they would be assessed under a much more stringent definition. This clause relates to the fact that members are not able to work again in their industry or occupation for which they are educated, trained or qualified but adding serious requirements related to daily living. The general definition does not take into account activities of daily living.
Sunsuper are wanting to improve and standardise the definition of Total and Permanent Disability (TPD).To achieve this they are removing from their policy “Unable to do basic activities associated with work ever again” to “Unable to do a suited occupation ever again” irrespective of the individuals employment status. This will make it fairer for fee paying members to claim a TPD benefit due to injury or illness regardless of their employment status.
Sunsuper is wanting to move towards a more progressive approach to how they manage their TPD clients by removing the restrictive definitions that have previously been in place for clients who have become disabled.
To provide better clarity there will now only be one definition of TPD. Sunsuper hopes this move helps members better see what they may be entitled too.
Moving forward all members will be assessed upon their relevant qualifications, skills and experience.
Sunsuper has previously made headlines for signing members up to policies where TPD benefits, if approved, are paid by installments over 6 years requiring members to obtain annual medical reports to continue the payments.
Dealing with superfunds and insurance companies can be tricky and legally complex. Total and Permanent Disability claims can often be difficult to navigate on one’s own due to policy changes and onerous requirements and the possibility you have multiple or lost accounts and more than one account with TPD cover.
PK Simpson is here to ease your burden. Our team of professional personal injury lawyers can conduct a Lost Super search on your behalf as well as make investigations with each super fund. Talk to us before contacting your fund so you get the right advice. Specific details are very important in a TPD claim.
We have offices all over Australia. Let one of our friendly solicitors in our Sydney, Melbourne, Brisbane, Darwin or Perth based office locations help you make a claim today so you can be assured that you receive the maximum benefit you are entitled too!
Contact us today to make a TPD claim on 1300 757 467 for a FREE consultation.
The post Sunsuper Assist and Sunsuper TPD Claims appeared first on PKSimpson.

MLC Life pays AFL footballer’s $1.4 million claim

MLC Life has paid a $1.4 million total and permanent disability (TPD) insurance claim to former AFL player Shaun Smith for brain damage caused by match concussions.
In a statement, the insurer says it received Mr Smith’s TPD claim in April.
“Following our assessment of his medical and employment circumstances we were pleased to admit his claim and make payment to his superannuation fund,” the insurer said.
“In reaching our decision, we considered the opinions of Mr Smith’s doctors about the impact of his medical condition and ability to return to work in the future and we were satisfied that Mr Smith met the relevant definition of TPD in the insurance policy.”
Mr Smith, 51, who played for North Melbourne and Melbourne, told ABC News the “historic” payout could make people take concussion in the sport more seriously.
He says his brain injury affected his moods and damaged his memory.
“I’m a pretty easy-going guy, and I was getting pretty angry at the drop of a hat,” he told the ABC. “Then I started forgetting a lot of things – my short-term memory especially was not flash.
“It doesn’t make it much fun for people living around me.”
The AFL Players’ Association told insuranceNEWS.com.au it is pleased Mr Smith “was able to access significant financial support through an individual insurance policy he bought many years ago”.
“The players’ group insurance through superannuation is currently provided by Resolution Life, but players have the option to decide the best policy for their individual situation,” GM Legal and Player Affairs James Gallagher said.
“We’re currently in the process of conducting a review of our current policy to secure the best possible group coverage for our members.”
 
Source : insurances.com.au
Frequently Asked Questions
What do you do after a car accident in Australia?A: If you’ve had a motor car accident, stop your vehicle and turn on your hazard lights. Make sure nobody is injured, and if so, call emergency 000 and remain at the scene of the accident. If it’s a minor incident you don’t need to call the police, but move the damaged cars if possible. Never admit responsibility even if you think you were at fault. Collect name, address, registration number and insurance details from the other parties and get witness details if possible.How long does it take to make a motor vehicle accident compensation claim?A: Motor accident compensation claims are normally finalised after you’ve recovered, or your injuries have stabilised. It can take some people longer to recover than others – from days to years – which determines the length of time it can take to finalise a claim. Also, your injuries may not always appear immediately after the accident and can take some time to appear, in some cases, years.Who is at fault in a car park accident?
A: In a carpark, anyone driving in the lanes has the right of way, so if you’re the one pulling out of the car space and hit another motor vehicle, you are likely to be the majority at fault in the accident. However, since both cars are moving, both drivers might hold some responsibility. But if you hit a parked car, you are likely at fault.
How long after a car accident can you claim in Australia?A: When lodging a claim for compensation after a motor vehicle accident it’s best to do it as soon as possible. However, it isn’t always feasible if you were severely injured and couldn’t file a claim straight away. There are time limits, however, so get someone to call a lawyer at PK Simpson for you to lodge a claim at least within six months of the crash.How long do you have to make a personal injury
A: The length of time you have to make your claim depends on the jurisdiction.
For instance:

TPD claims – these may be commenced up to 10 years after you’ve stopped work. TPD claims are very technical and you may have more than one TPD claim.
Car accident claims – A personal injury claim form should be filled in and sent to your CTP insurer as early as possible, but must be no later than six months from the date of your accident. HOWEVER, out of time claims may be made. New NSW CTP laws have made it difficult for injured people and many law firms still do not understand how to run new claims under these laws – so call us at PK Simpson Sydney as soon as possible.
Workers compensation claims – You should contact a lawyer within six months of the accident. But remember, out of time claims can be handled by PK Simpson Sydney. We can help you get the treatment required to build your claim.
Slip ‘n’ fall/occupiers liability claims – Your claim must be lodged usually within three years of the date of your accident.

Medical Negligence – within three years of the date of when the cause of action was discoverable to our client OR 12 years from the time of the act or omission which caused the injury through negligence.
How much does it cost me to make a motor vehicle accident compensation claim?A: At PK Simpson compensation lawyers we operate on a no-win, no-fee basis. However, for detailed information on the legal costs that can be charged for statutory benefits CTP Insurance car accident claims in NSW click on this link.
The post MLC Life pays AFL footballer’s $1.4 million claim appeared first on PKSimpson.

Stonemason with ‘incurable’ silicosis denied lump sum payout by insurer

Garry Moratti was diagnosed with an “incurable” and deadly workplace illness. But there’s a shocking reason he’s been denied a payout.

When Queensland stonemason Garry Moratti was diagnosed with silicosis in 2017, the message from his doctor was clear – either give up work or die.

So Mr Moratti was forced to abandon the career he had enjoyed from the age of 15 as he battled the lethal lung disease, which has left him with a life expectancy of just four to five years.
But while the incurable workplace illness – which is becoming increasingly common among Australian stonemasons – is horrendous enough, Mr Moratti and his family have also been dealt another blow.
Mr Moratti is a Sunsuper member, and he assumed he would be eligible for total permanent disability (TPD) insurance, which is usually a lump sum payout awarded to a client who has been permanently disabled and is unable to work again.
But earlier this year he learned the company had switched to a “drip feed” policy in 2016, meaning eligible clients now receive six instalments across six years instead of one large payment.
Sunsuper is the only insurer in the country with this policy, which drip feeds claimants and requires them to be continually assessed – even when their conditions are terminal.
Mr Moratti, who shared details of his illness on The Sunday Project last year, told news.com.au the situation was devastating, and that a lump-sum payment would help him enjoy the time he had left and help prepare his wife and three children for his death.
While the 51-year-old had $93,000 in total permanent disability insurance, Sunsuper’s policy means he is only paid in $15,000 instalments, made worse by Mr Moratti not having income protection insurance.
He said the policy was “ridiculous” and “cruel” and urged other Sunsuper members to “triple check” their own policies.
“How can they be the only company that does this?” he said.
“My stress levels have gone through the roof and since being diagnosed, mainly because when I do go, I want to know at the back of my mind that my family are set – but I can’t do that because of this drip feed policy.
“It’s just not fair. It’s my money.”
A Sunsuper spokeswoman confirmed in a statement Mr Moratti was not eligible for a lump-sum payment.
“Total and permanent disability assist is a policy that offers protection and ongoing support to members if they were to become permanently disabled,” the statement reads.
“In early October 2019, Mr Moratti’s total and permanent disability assist claim was assessed and approved by Sunsuper and the first annual payment (first of six across five years) was made in late October 2019.
“Mr Moratti’s medical condition does not meet the conditions for a single lump sum benefit payment under the terms of this insurance policy.
“As a profit-for-members fund, our sole purpose is to act in the best interests of our members, and we will continue to support Mr Moratti under the terms of his insurance policy into the future.”
But Melissa O’Neil, Shine Lawyers superannuation insurance expert, told news.com.au she had “never seen anything as absurd and unfair” as this Sunsuper TPD assist policy.
“How can someone diagnosed with a terminal illness not be entitled to their total and permanent disability payment in full when they have worked tirelessly and contributed to their super fund for decades to cover them for exactly this sort of unexpected illness?” she said.
“It has been a devastating double blow for Garry and his family who are doing it incredibly tough financially while also trying to process the fact that Garry suddenly has a life expectancy of four to five years.
“All he wants to do now is enjoy the time he has left with his family, but instead he is suffering extreme psychological distress trying to work out how he can provide for his family.”
Ms O’Neil said she believed Sunsuper had “failed in its obligations to act in the best interests” of clients, and said there were likely thousands of other Australians who had the same policy without realising.
“As part of this ridiculous policy Garry is being drip fed small annual payments, and there is no certainty as to whether the next one will actually be paid – he has to reapply and be reassessed. For a fellow with a terminal illness, this is just insanity,” she said.
“This poor fellow has silicosis. He should be receiving the money in full and left alone with some financial certainty to enjoy what time he has left with his family.”
However, Mr Moratti isn’t the only Australian to be stung by this policy.
Last year, news.com.au spoke with former boilermaker and Sunsuper member Glenn Dickson, who was also denied a lump-sum payment even after losing a leg in a horrific shark attack.
According to Mr Dickson, Sunsuper’s policy meant he “couldn’t afford a wheelchair”, a decent prosthesis or other medical bills, let alone modify his home to make it disability-friendly.
WHAT IS SILICOSIS?
The progressive, irreversible lung disease is caused by long-term exposure to silica dust, which is created when artificial or engineered stone is cut.
Symptoms can include shortness of breath, cough, fever, cyanosis (bluish skin) and frequent chest infections that can eventually lead to lung transplants and death.
While silicosis deaths are dropping globally, there has been an alarming spike in cases among Aussie tradies believed to be linked to cutting engineered or artificial stone products used to make kitchen benchtops.
The toxic dust has been dubbed “the new asbestos”, and a 2017 Queensland Parliamentary inquiry into coal workers’ pneumoconiosis (black lung) was told silica was “more dangerous than coalmine dust”.
The condition is so devastating the Queensland Government ultimately banned the dry-cutting of engineered stone benchtops, which exposes workers to the illness.
If you are concerned about silicosis and are based in Queensland, where the majority of cases have been diagnosed, contact WorkCover on 1300 362 128 to arrange a health screen.
Source here:https://www.news.com.au

Frequently Asked Questions
What do you do after a car accident in Australia?A: If you’ve had a motor car accident, stop your vehicle and turn on your hazard lights. Make sure nobody is injured, and if so, call emergency 000 and remain at the scene of the accident. If it’s a minor incident you don’t need to call the police, but move the damaged cars if possible. Never admit responsibility even if you think you were at fault. Collect name, address, registration number and insurance details from the other parties and get witness details if possible.How long does it take to make a motor vehicle accident compensation claim?A: Motor accident compensation claims are normally finalised after you’ve recovered, or your injuries have stabilised. It can take some people longer to recover than others – from days to years – which determines the length of time it can take to finalise a claim. Also, your injuries may not always appear immediately after the accident and can take some time to appear, in some cases, years.Who is at fault in a car park accident?
A: In a carpark, anyone driving in the lanes has the right of way, so if you’re the one pulling out of the car space and hit another motor vehicle, you are likely to be the majority at fault in the accident. However, since both cars are moving, both drivers might hold some responsibility. But if you hit a parked car, you are likely at fault.
How long after a car accident can you claim in Australia?A: When lodging a claim for compensation after a motor vehicle accident it’s best to do it as soon as possible. However, it isn’t always feasible if you were severely injured and couldn’t file a claim straight away. There are time limits, however, so get someone to call a lawyer at PK Simpson for you to lodge a claim at least within six months of the crash.How long do you have to make a personal injury
A: The length of time you have to make your claim depends on the jurisdiction.
For instance:

TPD claims – these may be commenced up to 10 years after you’ve stopped work. TPD claims are very technical and you may have more than one TPD claim.
Car accident claims – A personal injury claim form should be filled in and sent to your CTP insurer as early as possible, but must be no later than six months from the date of your accident. HOWEVER, out of time claims may be made. New NSW CTP laws have made it difficult for injured people and many law firms still do not understand how to run new claims under these laws – so call us at PK Simpson Sydney as soon as possible.
Workers compensation claims – You should contact a lawyer within six months of the accident. But remember, out of time claims can be handled by PK Simpson Sydney. We can help you get the treatment required to build your claim.
Slip ‘n’ fall/occupiers liability claims – Your claim must be lodged usually within three years of the date of your accident.

Medical Negligence – within three years of the date of when the cause of action was discoverable to our client OR 12 years from the time of the act or omission which caused the injury through negligence.
How much does it cost me to make a motor vehicle accident compensation claim?A: At PK Simpson compensation lawyers we operate on a no-win, no-fee basis. However, for detailed information on the legal costs that can be charged for statutory benefits CTP Insurance car accident claims in NSW click on this link.
The post Stonemason with ‘incurable’ silicosis denied lump sum payout by insurer appeared first on PKSimpson.

Hostplus ups income protection premiums by 73%

The $45 billion industry fund for hospitality, sport and tourism has increased optional insurance premiums for some members by up to 73.7%.
Non-default salary continuance insurance premiums for Hostplus members will increase from 1 October 2020. Salary continuance will also be renamed income protection at the start of October.
The biggest increase will hit those with non-default salary continuance policies with a ‘to age 65′ benefit period – these premiums will increase by 73.7%.
Non-default salary continuance premium rates for a two year benefit period will increase by 22.3%.
Hostplus said in a significant event notice to members that the changes to premiums were necessary because the Putting Members Interests First and Protecting Your Super reforms had reduced the number of members with insurance.
“The introduction of these reforms has resulted in a significant decrease in the number of members covered by our group insurance policy,” the fund said.
“Considering the reforms, changes to membership demographics and an increase in disability claim volumes, we have had to increase the cost of our non-default Salary Continuance insurance.”
Death and total and permanent disability premiums did not change.
Hostplus’ group insurer is MetLife and the super fund had an arrangement that includes a Premium Adjustment Mechanism. It utilised this mechanism in setting the premium rates that will apply from October.
“The use of this payment has enabled us to maintain the current death and TPD premium rates and limit the increases to the non-default salary continuance premiums as much as possible,” it said.
The fund will also introduce a Salary Continuance five-year benefit period from October 1.
There was also a significant change for members in the Hostplus Choiceplus investment option. This option allows direct investments in companies in the S&P/ASX300 index, ETFs and LICs. It’s offered as part of the existing investment menu.
Hostplus introduced some new terms and conditions which allow the fund to sell out of investments that Choiceplus members hold if those investments sit outside the list of available investments or the maximum investment threshold.
“Hostplus retains the right at its discretion to redeem an investment and credit the proceeds to your transaction account and you will be taken to have given us a standing instruction to do so in these circumstances,” the new clause reads.
“Such decisions will not be made lightly and will be made in accordance with our trustee responsibility of acting in the best interests of Hostplus members. We will try to contact you prior to selling any of your holdings in Choiceplus.”
Hostplus said in a statement: “These changes are broadly in line with recent competitor and market changes and will impact about 3% of Hostplus’ members.”
Hostplus group executive, member experience Paul Watson said that in the context of the current environment and challenging group life and income protection market, the renewed three year guarantee broadly represented a good outcome for the fund’s 1.2 million members and has been secured at a time when a number of other funds and their insurers have had to increase insurance premiums or are likely to do so in the near future.
See original post here at the Financial Standard Website.

Frequently Asked Questions
What do you do after a car accident in Australia?A: If you’ve had a motor car accident, stop your vehicle and turn on your hazard lights. Make sure nobody is injured, and if so, call emergency 000 and remain at the scene of the accident. If it’s a minor incident you don’t need to call the police, but move the damaged cars if possible. Never admit responsibility even if you think you were at fault. Collect name, address, registration number and insurance details from the other parties and get witness details if possible.How long does it take to make a motor vehicle accident compensation claim?A: Motor accident compensation claims are normally finalised after you’ve recovered, or your injuries have stabilised. It can take some people longer to recover than others – from days to years – which determines the length of time it can take to finalise a claim. Also, your injuries may not always appear immediately after the accident and can take some time to appear, in some cases, years.Who is at fault in a car park accident?
A: In a carpark, anyone driving in the lanes has the right of way, so if you’re the one pulling out of the car space and hit another motor vehicle, you are likely to be the majority at fault in the accident. However, since both cars are moving, both drivers might hold some responsibility. But if you hit a parked car, you are likely at fault.
How long after a car accident can you claim in Australia?A: When lodging a claim for compensation after a motor vehicle accident it’s best to do it as soon as possible. However, it isn’t always feasible if you were severely injured and couldn’t file a claim straight away. There are time limits, however, so get someone to call a lawyer at PK Simpson for you to lodge a claim at least within six months of the crash.How long do you have to make a personal injury
A: The length of time you have to make your claim depends on the jurisdiction.
For instance:

TPD claims – these may be commenced up to 10 years after you’ve stopped work. TPD claims are very technical and you may have more than one TPD claim.
Car accident claims – A personal injury claim form should be filled in and sent to your CTP insurer as early as possible, but must be no later than six months from the date of your accident. HOWEVER, out of time claims may be made. New NSW CTP laws have made it difficult for injured people and many law firms still do not understand how to run new claims under these laws – so call us at PK Simpson Sydney as soon as possible.
Workers compensation claims – You should contact a lawyer within six months of the accident. But remember, out of time claims can be handled by PK Simpson Sydney. We can help you get the treatment required to build your claim.
Slip ‘n’ fall/occupiers liability claims – Your claim must be lodged usually within three years of the date of your accident.

Medical Negligence – within three years of the date of when the cause of action was discoverable to our client OR 12 years from the time of the act or omission which caused the injury through negligence.
How much does it cost me to make a motor vehicle accident compensation claim?A: At PK Simpson compensation lawyers we operate on a no-win, no-fee basis. However, for detailed information on the legal costs that can be charged for statutory benefits CTP Insurance car accident claims in NSW click on this link.
The post Hostplus ups income protection premiums by 73% appeared first on PKSimpson.

TPD Claims Resulting From Car Accidents and Work Accidents

Have you got a current CTP claim or Workers Compensation claim anywhere in Australia?
Then your solicitor should also have opened or investigated a superannuation TPD claim on your behalf. If he/she hasn’t, then you could be missing out on an extremely valuable benefit provided to injured or ill people Australia wide.
John (not his real name), a 37 year old labourer, had a car accident in mid-2018. John was employed as a builder / labourer and had his own ABN due to the nature of his work. One day, whilst driving to work in Sydney, John was involved in a car accident. His car was rear ended and violently smashed into the car in front of him at a set of traffic lights. The car was a ride off. The police and ambulance turned up but no one was taken away in an ambulance. Like many car crash victims, John still managed to make it to work that day.
John was feeling a little sore and as his supervisor was aware of the car accident, recommended he do light duties and attend to traffic control on the site. It wasn’t until later that day that John began to feel the effects of the car accident on his back and neck. John left work early that day and attended his GP. The GP mentioned that John should contact a car accident lawyer and referred him to PK Simpson.
After a few scans, it became apparent that John had suffered injuries to his lower back, specifically the L5 region as well as nerve damage and nerve pain travelling down both hips and legs. John was also suffering from depression and anxiety due to the nature of the injury and the impact of it on his daily life.
John’s Superannuation / TPD Claims
Not long after John’s CTP claim was on foot, his solicitor investigated a superannuation TPD claim as John had not returned to work, a part from a few attempts at light duties. John said he had a superannuation fund but had no idea if he had that sort of insurance and also said he had very little super in his account balance. A TPD solicitor from PK Simpson contacted John and soon had everything necessary to commence a TPD claim with his superannuation fund who turned out to be CBUS Super. John had TPD cover of $145,000. It was also explained to John that regardless of his account balance, he would be covered as long as the account was active at the time of the accident.
Total and permanent disability (TPD) insurance is a benefit within superannuation funds which is paid out to members when they can prove they cannot return to any form of work for which they are educated, trained or experienced.
CBUS Super is a superannuation fund used predominantly by people in the building industry and we have made many, many TPD claims against them.
John had been off work for the required 6 months to enable a TPD claim to be pursued. Special medical reports were obtained by his solicitors which unequivocally proved that due to his injuries, it was unlikely John would be returning to any form of manual labour employment. This was the only type of work John had done his entire life. Although they tried to fight the claim, CBUS Super soon had no choice but to approve the TPD claim based on the strong evidence PK Simpson provided. John was paid out a lump sum of $145,000. The TPD claim was finalised before his CTP claim which was extremely pleasing to John.
John’s NSW CTP Claim
Under the new NSW CTP laws John had to wait the required time frame before finalising and settling the claim. By having PK Simpson involved early on, John had all the necessary medical treatment and reports to support his CTP claim against Allianz Insurance. The car accident claim was finalised shortly after the TPD claim resulting in over $450,000 being awarded to John as a result of his injuries, both physical and psychological, suffered in the car accident
Superannuation / TPD and Compensation Solicitors in Australia
Most firms in Australia have very little experience in superannuation TPD claims and therefore will not be aware of when a client is eligible, especially when they are caught up in the legal intricacies of a workers compensation claim. And many Australians who have had a compensation claim will often never return to work but have not been informed of their superannuation benefits. With the right advice and guidance many people who have had an accident and remain off work can make successful TPD claims.
For many people, a TPD benefit payout can often amount to more than what they receive for a workers compensation claim, CTP claim or negligence claim.
PK Simpson Superannuation & TPD Lawyers are experts in superannuation law and their sole job is to help people, Australia wide, claim TPD benefits.
PK Simpson TPD Lawyers are contacted by injured and/or ill people from every state and territory in Australia.
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Slip and Fall Compensation Claims in Shopping Centres and Supermarkets

What is a slip and fall claim?
A slip, trip or fall can happen anywhere anytime. A slip and fall injury is one where someone slips and falls on a food substance or spill on the ground. These types of claims are most often made against supermarket chains like Woolworths, Aldi and Coles and major shopping centres like Westfields. Accidents also happen at many other business like cafes and restaurants; Starbucks, Gloria Jeans, McDonalds, KFC, Hungry Jacks, department stores; Ikea, David Jones, Bunnings, Big W, Target, and especially in and around food malls located in shopping centres. The most common cause is due to poor cleaning and maintenance by cleaning staff.
Establishing a claim:
Slip and fall claims need to have these 4 basic elements:

A duty of care existed on behalf of the negligent person/ business and the injured person;
The negligent person breached their duty of care responsibilities;
Injury or damage was suffered due to a negligent act or failure to exercise the duty of care;
A compensation claim for damages is established.

Can you make a claim?
You may be able to make a claim if the following applies to your slip and fall accident:

The fall was due to the failure of the owner of the premises to take reasonable care for your safety whilst on the premises; and
You have sustained injury as a result of the fall.

Just because you have slipped and fallen does not entitle you to compensation automatically as your injuries need to be substantial enough to warrant compensation.
If your injuries are not significant it may not be economically viable to make a claim. However if you have had to take time off work or pay for medical bills then it may be worth pursuing a claim. It’s best to talk to a compensation expert at PK Simpson to find out your rights.
Is it worth it?
The average slip and fall claim falls between $40,000 and $100,000 depending on the severity on your injuries.
Unfortunately, it’s often the elderly who slip and fall. Injuries are almost always sustained and a compensation claim is usually successful. However, younger people also have accidents and this usually prevents them from earning an income over a period of time therefore increasing their lump sum compensation.
Damages
Three are two forms of economic loss referred to as Damages in negligence claims that can be paid:

Non-economic loss is a lump sum payment for loss of enjoyment of life
Economic loss refers to payments awarded for loss of income.

Damages are to be paid at the end of a claim in a lump sum for both types of loss as determined by a table under the civil liability act.
How is a claim finalised:
There are two ways in which a negligence claims are finalised in NSW.

An agreement with the negligent party (99% of claims)
An Order from the Court

Are there time limits in regards to making a claim?
Yes, as a broad rule you should make a claim within 3 years of the accident/incident date. However, in some cases it might be possible to claim up to three years from becoming aware of your injury. If you’re a minor or a person with a disability you have six years from the date of injury.
How can we help you?
Here at PK Simpson we are a NO WIN – NO FEE practice. We cover all disbursements related to the personal injury claim until your case is won. If your claim is unsuccessful, we foot the bill.
Proving you have a claim is not always straight forward. Negligence law can be complex. We are experts in personal injury occupiers’ liability negligence law and committed in helping you overcome insurance companies.
How we win your slip and fall compensation claims:

Building a strong case
Finding the correct defendant / party(ies to sue
Establishing contact with the other party(ies) and negotiating skilfully
Advising you on whether to accept a settlement or take your case to trial
Maximising your compensation with the correct evidence and expert reports
Drafting legal documents
Ensuring that you collect your judgment promptly
Communication with medical professionals and other experts
Obtaining statements from witnesses
Communication with insurers and opposing legal teams

We are trained to help slip and fall victims in NSW maximize their compensation. If your goal is to win the maximum compensation settlement for your slip and fall injury, we can help you!
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Do You Have TPD Claims in Your Lost Super?

Keep track of your Super, You could be richer than you think

Like many thousands of Australians you may have lost, inactive or even multiple superannuation accounts where you still hold insurance cover and an account balance.
If you have changed your personal details, moved jobs, switched careers or relocated to another state or country it is more than likely you have multiple superannuation accounts.

Your Super account is extremely important as it’s a form of savings which you can access when you retire. Super funds can also hold insurance cover such as income protection or TPD which you can claim in circumstances where you cannot work due to an injury or illness.
Multiple accounts can be difficult to keep track of. They can even reduce from your overall balance through the cost of account keeping fees. Locating your accounts and consolidating them into one can save you money and time as well as maximising funds for your future.
However before you consolidate any of your super funds you should enquire into whether you will lose any possible benefits or insurance cover attached to your accounts. You must also decide which super fund is the best fit to merge all your accounts into.
What is ‘lost super’ and ‘unclaimed super’?
You may have Lost Super as you have been Uncontactable (they could not get hold of you for the period of 12 months or more) or Inactive (no contributions have been made for the last 5 years). Your account can also be deemed Insoluble (where they don’t have enough personal information to link you to the account in question).
Unclaimed Super differs from lost super. Unclaimed Super is when you have funds that can be drawn out of the account but your fund has been unable to get in contact with you. Unclaimed super can include; Members over 65, deceased members or former temporary residents.
The ATO website provides much valuable information on how to manage and merge your superannuation accounts as well as having all the latest up to date legislation in regards to your entitlements.
How to deal with lost super accounts and TPD claims
Superfunds can be tricky and difficult to deal with. To ease your burden PK Simpson can conduct a Lost Super search on your behalf as well as make investigations with each super fund. We’ll find out exact dates of your insurance cover and whether you can make a claim. You could have multiple TPD claims with super funds you’ve lost track of or income protection which can result in lump sum back payments to cover your loss of wages. PK Simpson will make sure you receive your maximum benefit and insurance entitlements.
Making a TPD claim against your superannuation fund(s) is legally complex. For example, small print in the policy can exclude you from claiming TPD from other funds, therefore requiring careful consideration of how to proceed if you have multiple TPD claims. Policies also have TPD specific definitions which requiring careful consideration.
We are the only superannuation law firm with a client services department dedicated to making sure you are 100% happy and informed from the moment you contact us and all the way through your claim.
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Man amputates own leg in horror workplace accident

A 51-year-old man accidentally amputated his own leg while cutting down a tree in Wilberforce, in NSW’s Hawkesbury on Friday morning.

The man, who was working as an arborist at the time, had a length of rope wrapped around his leg, which got caught in a woodchipper, cutting off his limb.
Careflight’s rapid response helicopter was called to the scene just before 11.30am, and crew were led to the man by NSW Police, who had managed to stem the man’s bleeding.
He was put into an ambulance, where he received a blood and plasma transfusion, and taken to Westmead Hospital in a stable condition.
In a moment of ingenuity, paramedics were able to preserve the man’s leg by stopping at a petrol station to purchase ice on the way to hospital.

See post original source:
https://www.news.com.au
Frequently Asked Questions
What do you do after a car accident in Australia?A: If you’ve had a motor car accident, stop your vehicle and turn on your hazard lights. Make sure nobody is injured, and if so, call emergency 000 and remain at the scene of the accident. If it’s a minor incident you don’t need to call the police, but move the damaged cars if possible. Never admit responsibility even if you think you were at fault. Collect name, address, registration number and insurance details from the other parties and get witness details if possible.How long does it take to make a motor vehicle accident compensation claim?A: Motor accident compensation claims are normally finalised after you’ve recovered, or your injuries have stabilised. It can take some people longer to recover than others – from days to years – which determines the length of time it can take to finalise a claim. Also, your injuries may not always appear immediately after the accident and can take some time to appear, in some cases, years.Who is at fault in a car park accident?
A: In a carpark, anyone driving in the lanes has the right of way, so if you’re the one pulling out of the car space and hit another motor vehicle, you are likely to be the majority at fault in the accident. However, since both cars are moving, both drivers might hold some responsibility. But if you hit a parked car, you are likely at fault.
How long after a car accident can you claim in Australia?A: When lodging a claim for compensation after a motor vehicle accident it’s best to do it as soon as possible. However, it isn’t always feasible if you were severely injured and couldn’t file a claim straight away. There are time limits, however, so get someone to call a lawyer at PK Simpson for you to lodge a claim at least within six months of the crash.How long do you have to make a personal injury
A: The length of time you have to make your claim depends on the jurisdiction.
For instance:

TPD claims – these may be commenced up to 10 years after you’ve stopped work. TPD claims are very technical and you may have more than one TPD claim.
Car accident claims – A personal injury claim form should be filled in and sent to your CTP insurer as early as possible, but must be no later than six months from the date of your accident. HOWEVER, out of time claims may be made. New NSW CTP laws have made it difficult for injured people and many law firms still do not understand how to run new claims under these laws – so call us at PK Simpson Sydney as soon as possible.
Workers compensation claims – You should contact a lawyer within six months of the accident. But remember, out of time claims can be handled by PK Simpson Sydney. We can help you get the treatment required to build your claim.
Slip ‘n’ fall/occupiers liability claims – Your claim must be lodged usually within three years of the date of your accident.

Medical Negligence – within three years of the date of when the cause of action was discoverable to our client OR 12 years from the time of the act or omission which caused the injury through negligence.
How much does it cost me to make a motor vehicle accident compensation claim?A: At PK Simpson compensation lawyers we operate on a no-win, no-fee basis. However, for detailed information on the legal costs that can be charged for statutory benefits CTP Insurance car accident claims in NSW click on this link.
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Non-Minor Injury Car Accident & CTP Claims in NSW

NSW CTP laws introduced in December 2017 means injured people now find it harder to make a compensation claim.
What changed?

The NSW government prevented the making of compensation claims to injured people who are assessed as ‘minor’ meaning their physical injuries are not greater than 10% permanent impairment.
Compensation can only be claimed by people who are ‘non-minor’ and have a permanent impairment of 11% or greater.
Damages are only awarded for economic loss and non-economic loss to injured people with 11% or more permanent impairment.
No damages are awarded to injured people who are 10% or less.

What does this mean and why will it affect me?
This means doctors will have to assess your claim according to a scale of damages. The more injuries you have, the more likely a doctor will assess your permanent impairment as being 11% or greater. The process is very technical and the insurer puts on evidence to argue that your injuries are not permanent.
It affects all people injured in traffic accidents in NSW, as people whose injuries are on the cusp will likely not reach 11% without the care and skill of a compensation lawyer who knows the new CTP law system.

You now need experienced doctors to assess your claim. PK Simpson obtains the right medical treatment/evidence to make sure your claim has the best possible chances of a lump sum payout. 

What sorts of accident are covered?
CTP laws cover accidents on the road whether you’re a pedestrian, passenger in a bus or a driver of a private vehicle. It also covers forklift accidents and other vehicles and automobiles you’re more likely to see in warehouses.
What are my entitlement?
Injured people with ‘minor injuries’:

Limited to 26 weeks of weekly payments of statutory benefits.

Injured people with ‘non-minor’ (degree of permanent impairment is greater than 10%) injuries:

Up to 206 weeks of weekly payments;
Payments for medical treatment;
Commercial attendant care;
Damages for economic loss;
Damages for non-economic loss;

Therefore, every injured person is better off talking to PK Simpson before moving forward with a traffic accident compensation claim.
What can you do?
Continue to seek treatment from your doctor and talk to PK Simpson if your doctor hasn’t referred you to us.
Benefits of having PK Simpson on your side include:

Up front payment of all medical reports required to bolster your claim.
We obtain the right medical evidence before you are medically assessed.
We will fight the insurer when they say your claim is ‘minor’.
We will seek maximum compensation for loss of earning capacity for you, now and into the future.
We will seek compensation for your injuries sustained.
You may not be able to work and therefore have a TPD Superannuation claim.
Client services who are dedicated to making sure you are up to date and every query answered.
Online services so that you don’t have to leave your house to talk to us.
Located in Sydney alongside the insurers making the the claim process efficient.

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Finding the Right Team For Your TPD Claim

As an Australian worker, you automatically have Total and Permanent Disability (TPD) and death lump sum insurance cover through your default superannuation fund, called MySuper accounts. This protects you and provides affordable cover in case you have to stop working for any medical reason such as injury or illness. A life insurance policy provided by your employer or membership of your union, financial institution or bank may also cover you for TPD.
If you do need to make a TPD claim through any of the above policies, it’s vitally important that you have the right team of lawyers expert in this area of law to guide you through the process. Otherwise, you may lose your case and fail to receive your benefits and entitlements.
At PK Simpson, we are a law firm with a track record of success, and we have a team of lawyers who specialise in TPD, so they know exactly how to submit your claim and succeed in getting you the maximum benefits you deserve.

Our PK Simpson law firm has a team of expert TPD lawyers who help Australians to claim their benefits – you’re in safe hands with our law team and we’re big on keeping our clients informed and supported throughout the TPD process. 

How Do I Know What to Look For in a TPD Law Team?
For a start, since the changes to superannuation law by the Federal Government, it’s important that you look for a team of expert lawyers who have studied the Protecting Your Super Package Act 2019 and are up to scratch with the new claims system. There is a lot to know, for instance, you may lose your cover if your employer isn’t making your superannuation contributions, or your account balance goes below $6,000. Seek immediate help from a law firm and financial advice if you are in this category.
Then choose a law firm such as PK Simpson to handle your TPD claim. You need a law firm such as ours with specialists who are well-versed in TPD assessment and definitions to support a TPD claim.
Accurate and thorough medical evidence is crucial to winning your case and ensuring you receive the highest level of benefits available. Our lawyers are highly experienced in handling TPD claims, and our team specialises in practising TPD only.

At PK Simpson, we pay for all medical reports and maximise your results! 
Our friendly team of expert TPD lawyers will look after you and investigate every superannuation fund you’ve ever joined to see if you can make more than one claim.

Our Recent TPD WIns
Our specialist TPD lawyers have a long list of wins after helping claim TPD. For example, some recent wins include an Ädelaide truck driver who couldn’t drive trucks due to a bad back. He received a full TPD payout from SA Super. A woman in Melbourne aged in her 40s who suffered psychological injuries won her full BT Super TPD benefit. Again in Adelaide, a council worker suffering from arthritis and a bad back won full TPD benefit from Caresuper. A disability support worker in Sydney made a claim on her First State Super TPD insurance and was granted more than $300,000, which was her full benefit. These and many more. Make sure your claim is counted among our wins!
If you have suffered an injury or illness that has affected your ability to work, our team of TPD law experts will help to identify whether you have insurance cover and may be able to act to access it and make a TPD claim for you. You can contact our PK Simpson superannuation insurance team by calling 1300 358 057, faxing (02) 92624497 or email [email protected]

Frequently Asked Questions
What is classed as TPD?
If you haven’t been able to work in your usual job for three to six months due to an injury or illness, you are likely to be classed as TPD.
Each superfund has their own TPD definition and this must be satisfied for the TPD claim to be approved. Common factors which are assessed in each claim are the members work history (education, training and experience), suitable jobs, and medical evidence.
Your TPD entitlements are set out in the contract (a.k.a. policy, or product disclosure document) you have with your insurer. Therefore, the definition of TPD will vary between policies and insurers.
Can you claim TPD more than once?
Yes, you can have multiple TPD claims providing your insurance policies or super funds are independent of each other. Bear in mind that, unlike other personal injury claims, when you make a TPD claim, you do not have to prove that the illness or injury was work-related or caused by somebody else.
How do you successfully claim TPD?
A successful TPD claim can never be 100 per cent guaranteed, but you are much more likely to win your claim if you contact a TPD specialist lawyer at PK Simpson to discuss your situation. There is a minimum level of evidence required to support your claim, which must be provided to your insurer and your super fund. This includes your claim form, a signed authority, certified ID, and two medical reports from your treating doctors showing that you can never return to work. These will need to be reviewed by a lawyer to ensure all the correct boxes are ticked, and that the evidence strongly supports your claim for TPD.
Often, terms and conditions specific to your policy need to be analysed in order to make sure the fund cannot decline your claim.
Superannuation funds will often require specialist reports. Superfunds do not pay for treatment throughout the claims process. However, PK Simpson pay for all medical reports needed to support your claim.
Can you claim TPD for depression?
Yes, you can. People are now becoming more aware of depression and other mental illnesses, and while there’s a way to go before the stigma is lifted, we’re talking about it more often. Around one in four Australians suffer from a mental illness each year. However, insurers are wary of mental illness disability claims, and it can be quite hard to get cover. But what many people fail to recognise is that the automatic TPD insurance you have through your superannuation fund can pay out much-needed benefits and funds if you cannot work due to depression or any other mental illness.
Mental illness can often be a lingering side effect of a physical injury, even after full physical recovery.
How long does TPD take?
Most claims are paid out and finalised within three to six months, but it all depends on how complicated the claim is, and how much good evidence you have about your injuries. There is also the matter of whether you fulfil all the criteria set by your insurer. This is why it’s crucial to have a specialist TPD team on your side when you make a claim for TPD for any reason.
As lawyers we will make sure your claim is assessed by the superfund in a timely manner. Delay tactics are deployed by funds to prolong and frustrate TPD claimants who are not legally represented.
Can you claim TPD for cancer?
Yes, you can. If you’re diagnosed with a serious cancer that has an impact on your ability to work, you may not realise you are entitled to claim insurance benefits through the insurance provided through your superannuation. These benefits may include income protection if your disablement is temporary, and TPD if your condition is long-term and serious. If your condition is terminal, you will be eligible for a terminal illness payment.

If you or anybody you know has ceased work due to illness or injury and they cannot return for at least six months they could be eligible to claim TPD benefits. Call PK Simpson specialist TPD lawyers today on 1300 358 057 or email [email protected]

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When Am I Paid My Full TPD Benefit?

If you are sick or injured and unable to work, you can make a TPD benefit claim. A TPD benefit is a lump sum of money paid out to you, on top of your superannuation account balance. Your benefit is calculated in a number of different ways which are described below.
The Usual Superannuation TPD insurance policy
Most people in Australia have TPD cover but know nothing about it. This is because it’s automatically given to you by your super fund under a group insurance policy. A group insurance policy covers a group of members.
In group insurance policies, the dollar value TPD amount provided is linked to your age. Usually, as you get older or closer to your retirement age, the benefit will decrease. Super funds also use other classifications to determine your cover, such as whether you are in ‘high risk employment’ and this can be divided into further categories such as ‘white collar’ and ‘blue collar’.
People can increase their TPD benefit and can also ask for a specific amount of insurance cover. This means you would be paying monthly premiums. As you get older, the TPD benefit can increase or decrease or stay the same.
Where people have customized their insurance cover, the super fund would usually request some information on your health and employment before granting a higher amount.
Retail Policies / Retail Life Insurance Policies and Separate TPD Insurance Policies
Many people in Australia have TPD insurance which sits outside of a super fund. Usually, a financial advisor has helped set it up. These sorts of insurance benefits are much larger as they have been calculated to cover the cost of living comfortably if you are unable to work. The insurance premiums are higher and therefore not particularly desirable for most people. Some insurance companies which offer insurance like this are AMP, BT Super, MLC and TAL.
The amount paid out will be what you and your financial advisor decided you needed. It is often around the million dollar mark.
Due to the high amount, insurers scrutinize these claims closely and will have their lawyers oversee the claims process. Often minor details in the initial application or in a medical report can be relied upon to reject the claim. It’s a very good idea to have experienced legal representation.
How do I know how much I am covered for?
On your superannuation statement you will see, “TPD Benefit” and a dollar amount. This is the amount for which you are covered in that period. It’s important to note that the amount of TPD you are covered for is linked to your last day worked.
Therefore, if you stopped work 2 years ago, this year’s statement will not be an accurate description of the TPD benefit you are able to claim.
Also, your membership with a super fund may have ceased since you stopped work. This does not necessarily mean you have no TPD cover. As long as the membership was active on the last day you worked, you can still have TPD insurance.
Will I be paid the whole benefit?
A successful TPD claim means that you get the full lump sum TPD benefit, as well as the option to withdraw your full account balance. Nearly all claims are paid in full.
Some super funds, like MTAA, will approve 80% of your benefit if you satisfy the ‘general’ TPD definition and require the further 20% to be assessed against a much more stringent definition.
Funds like Hesta will only pay TPD benefits in installments requiring they’re members to re-satisfy the TPD definition for the rest of their lives which is very onerous.
In rare instances, super funds are unwilling to pay the full amount. They may believe they have a strong case to decline your claim or they may be playing ‘hard ball’. Where other lawyers will walk away, we increase the pressure. We specialize in situations where the super fund is unwilling to pay the full amount by forcing the super fund and insurer to the negotiation table. Never accept your claim being declined until talking to PK.
Unable to work? Call PK.
Injured and sick people from all over Australia have claimed their TPD benefits with our help. We lead the field in the uptake of technology so that claims are run efficiently and our clients kept up to date. Our main office is located in Sydney, along with all the major super funds and insurance companies.
 
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TPD Time Frame & Process

TPD, or Total and Permanent Disability, is a lump sum payment that you may receive from your superannuation fund insurance if you have suffered an injury or illness that affects your ability to return to your usual job. There are two types of TPD insurance cover, so you need to know which one you have […]

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TPD Time Frame & Process

TPD, or Total and Permanent Disability, is a lump sum payment that you may receive from your superannuation fund insurance if you have suffered an injury or illness that affects your ability to return to your usual job. There are two types of TPD insurance cover, so you need to know which one you have before you can make a claim. There is a process you will have to go through and a time frame in which to make your claim for TPD.
The types of TPD policies:
Own occupation: 
This insurance policy provides a definition of TPD as satisfied if you cannot perform in your own occupation. An example would be a mechanic with a spinal injury. However, the mechanic might be able to do another type of job that doesn’t require the same physical effort.
Any occupation: 
This policy covers you if you are deemed unfit to work in your usual occupation for up to six months, and if you are unlikely to ever be able to work in any job that you are trained, educated and experienced to do.
 

Our experienced TPD lawyers are old hands at processing super or other insurance TPD claims and we’ll take on the stress, keeping you in the loop about your case at all times. 

 
The TPD Insurance Claims Process
TPD claims processing is often different from the usual personal injury claims. The differences are in the entitlements available as stated in the contract you have with your superannuation fund or insurance company.
The crucial factors in the contract generally refer to the time frame in which a TPD claim can be made, the entitlements or benefits payable, and the definition of the TPD, which differs with each of the policies.
The claims process is usually as follows:

Definition and time limits: Our lawyers will review your insurance contract before filing your claim to make sure the medical evidence meets the TPD definition and that any possible mandatory time frames are met (depends on your policy).
Gather evidence and make the claim: This involves medico-legal expert reports to support your TPD claim. These reports should establish that your claim has met the criteria in your insurance policy.
Considering the insurance company’s response: Insurance companies generally want TPD claims assessed by their medico-legal experts. This will be in your contract. After the doctors examine you and send their report back to the insurer, the insurance company will either accept or decline your TPD claim.
What if the insurer rejects the TPD claim? In this case, you should allow PK Simpson to try to dispute the decision in either a court or the Superannuation Complaints Tribunal.  You will have two years in which to make a complaint to the Tribunal, and the legal proceedings must commence within six years of your insurer denying liability.

 

Let PK Simpson specialist TPD lawyers handle the application, any time frame issues and the process of making your claim so you need not stress. 
Your experience with your superannuation fund can be hassle-free with PK Simpson TPD Claim Lawyers on your side.

 

The TPD Time Frame
The time frame for lodging a TPD claim after your injury or illness, most allow years, but some policies or superannuation fund rules require claims to be made before you cease your employment and others want claims made within a specified period your employment ends.
Superannuation funds and insurers are usually not legally bound to make TPD decisions within a certain time frame. The time it takes to deal with your case will depend on your TPD superannuation insurance claim type. This means it could be resolved in a matter of weeks or up to 18 months or longer.
The TPD claim time frame and processing also depends on the severity of your injury or illness. Once we’ve submitted your initial claim forms, you are likely to need to have at least one independent medico-legal examination. You could also be asked to supply more evidence, like specialist reports. TPD claim decisions usually arrive within 12 to 18 months after the claim forms have been lodged.
At PK Simpsons, we are experts at winning TPD benefits for our clients in NSW. Bring your matter to us so we can get the ball rolling as soon as possible. Once we understand your situation we can give you a more accurate estimate of the TPD time frame and process. As mentioned, should your claim be denied, you have two years to dispute the decision and make a complaint to the Superannuation Complaints Tribunal and six years to mount a legal case.
Call us at PK Simpson on 1300 358 057, fax: (02) 92624497, email [email protected] You can also fill in the online form and we’ll contact you.

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What to do if Your TPD Insurance Claim is Declined

Unfortunately, making a Total and Permanent Disability (TPD) insurance claim and receiving your benefits may not be a quick and simple process. Insurers and super funds often decline TPD claims and try to avoid paying the benefits. TPD is usually the injured or ill person’s lifeline, and after going through the ordeal of making a claim to then have it rejected can be a shattering experience. But it need not end there.
If you’ve recently tried to access your TPD insurance after suffering an injury or illness that has prevented you from returning to work in the same capacity and your insurer has denied your claim, call us immediately at PK Simpson so we can sort it out for you as soon as possible.
Some ask  “can you claim TPD more than once?” The answer is yes, you can have multiple TPD claims, providing your separate funds are independent of each other.
 

Are you no longer able to work due to injury or illness? The good news is your superannuation fund probably owes you a lump sum payment. Call us today at PK Simpson so we can get the ball rolling and get you the TPD Insurance benefits you deserve.

 
Why Are Some TPD Insurance Claims Rejected?
At PK Simpson, we have a high success rate and our properly prepared TPD claims are accepted by superannuation fund insurance. However, it’s now increasingly common for insurers to decline a claim the first time round, only to accept it later on review. This is why you ought to challenge an insurance company if they have denied your TPD claim.
While every insurance and superannuation policy has a different requirement, TPD claims are commonly declined because the insurer:

Decides you don’t satisfy the TPD policy definitions
Has medical evidence that denies your injury or illness
Believes you can carry out some form of work
You failed to meet the working requirements before you were injured or ill (e.g you worked 30 hours a week rather than full time)

Your TPD insurance policy is no longer active
You haven’t satisfied minimum waiting periods
There’s a dispute with your insurer regarding evidence

 

For more than 38 years, our injury compensation lawyers at PK Simpson have helped our valued clients receive the TPD benefits they deserve.
 We’ve successfully dealt with over 25,000 claims and helped thousands of people get their lives back on track. 
That is our speciality!

 

If Your TPD insurance Claim is Denied – Don’t Give Up
If your TPD claim is declined, denied or rejected outright, don’t despair and think you’ve lost and that’s the end of the matter. Don’t let anyone tell you there’s nothing more you can do and that no further action is worth it or even possible.
Once you fully comprehend why your insurer declined your TPD claim, you have plenty of options available to you. Seek urgent legal advice from PK Simpson injury compensation lawyers to discuss your next step and find out how you can lodge a review of your insurer’s decision. We can help you:

Lodge both a personal and official complaint to your superannuation insurance provider
Submit an official complaint to the insurer’s internal dispute resolution office
Submit a complaint to the Financial Ombudsman Service

Why Should I Try to Challenge the Insurer’s Decision?
No matter what reasons your TPD insurance provider has given for declining your claim, you ought to seek urgent legal advice to find out about your options. At PK Simpson we may be able to also do the following:

Refer your super fund  insurer’s the decision to the Australian Financial Complaints Authority (AFCA)
Begin court proceedings so your claim can be determined by a judge who may overturn the insurance company decision.

The importance of seeking legal advice cannot be overstated when it comes to TPD claims. The best advice is to let PK Simpson handle your case from day one of your injury or illness. Insurance companies have been known to reject TPD claims for little or no reason.
Some simply do a brief review of a file and then decide not to pay the TPD claim. Where the insurer does get medical or expert reports, they may fail to use the right professional, don’t ask the right questions or address TPD insurance policy definitions.
Call us at PK Simpson if your TPD claim has been declined and you want to know if you should challenge the decision made by your superannuation fund insurer. Phone 1300 358 057, fax (02) 92624497, email [email protected] You can also fill in the convenient online form and we’ll get back to you pronto!

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How to Contest a Will In NSW

“Contesting a Will” or “Challenging a Will” is a legal right we all have. People come to us for a variety of reasons which can include, when you believe you have been unfairly treated in the distribution of an inheritance, when you suspect that something fraudulent may have happened in the creation of the will, or […]

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Probate – Contest A Will due to suspicious circumstances and undue influence

Whilst losing a family member can be an incredibly difficult time, too often people are faced with will disputes between surviving family members regarding the validity of the deceased’s will. It’s not easy to contest a will and can be expensive if you don’t go with a no win no fee lawyer. We often come […]

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Can I Make a Total Permanent Disability Claim For Mental Illness?

If you have stopped work due to a mental illness, you can claim a little known benefit within your superannuation policy called a TPD insurance. TPD insurance covers you when you cannot return to work due to a psychological injury such as PTSD and other serious mental illnesses as well as other major depressive disorders.
 

If you’ve sustained a mental illness or injury and cannot work, you can most likely make a claim. At PK Simpson, you’re in safe hands with our firm’s team of specialist compensation lawyers.
We can help you receive the TPD entitlements you deserve.

 
How Do I Know If My Policy Covers Mental Illness TPD?
TPD covers all injuries, whether physical or psychological. More often than not, a physical injury affects your psychological health resulting in mental illness.
Checking your statements can clarify if you have TPD cover but you may also be covered by superannuation accounts that are closed or ones you have forgotten about. We can find all your TPD benefits and make multiple claims for a mental health injury.
If you’re still unsure whether or not you’re covered, get some legal advice from PK Simpson lawyers who are specialists in TPD. And before you make your claim, be sure to call us so we can ensure you have an airtight case, since you will need ironclad evidence to prove you’re unfit to return to work due to your mental health injury.
The bar for evidence of TPD mental illness claims has been set very high, and has led to many such claims often ending up in a dispute. Our experienced and highly skilled superannuation TPD lawyers at PK Simpson know everything there is to know about claims for mental illness. Medical treatment to diagnose your mental health condition and to support the claim is very important. We can obtain the correct evidence to support your claim.
 

We’re the only TPD superannuation law firm with a client services department whose members are dedicated, 100 per cent of the time, to making sure you are well served.

 

What Types of Mental Conditions Are Covered by TPD?
Any mental health condition which prevents you from returning to work can be used to support a claim for TPD insurance. Depression and anxiety are part of the range of illnesses that are part and parcel of PTSD but can also be a single diagnosis.
Depression
Depression is a debilitating illness with sufferers experiencing severe or chronic feelings of apathy, sadness, anger, despair and worthlessness, among others. Signs may range from feeling guilt, a lack of motivation, withdrawal, less energy and turning to drugs and alcohol. There may also be suicidal thoughts.
Anxiety
Anxiety includes strong feelings of fear, catastrophising, distress and long-term worry about perceived threats. Sufferers of this mental health condition can show signs of nervousness, panic and agitation, with symptoms including stomach ache, sleeping problems, dizziness, breathlessness and a pounding heart.
PTSD
PTSD is associated with a spectrum of major stress reactions and mental illnesses that can occur even years after a person has been a victim, was involved in, or witnessed a traumatic event. This can be one event or more, and strong, debilitating feelings of grief, anger and fear, with terrifying flashbacks and nightmares that can last for a long period. This can result in a sufferer being unable to work or enjoy a normal life.
Mental Health and TPD Claims
To make a TPD mental health claim, you must complete a claim form and provide your superannuation fund with further information including financial records, work experience details, education and supporting medical evidence. During this phase, the right advice is crucial to the success of your mental health TPD claim. Having solid legal advice about how to fill out the form will arm you with a stronger case so you receive the TPD compensation you deserve.
A mental health TPD claim for a psychological injury requires very clear and persuasive evidence and is an area that is unfortunately rigorously disputed by superannuation insurance providers. However, while often disputed, case studies show 91 per cent of claims are paid out.
Our experienced TPD lawyers will help you at every stage of the claims process to make sure you have every chance of receiving the maximum payout. Talk to one of our experienced TPD claims lawyers at our PK Simpson law firm today on 1300 757 467 or email [email protected]

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COVID-19 and your Superannuation

How the COVID-19 situation and your ability to work affects your Superannuation
The COVID19 crisis impact on the Australian people has been significant. Many businesses have been forced to shut down meaning millions of Australians have had to stop working. Some will receive leave entitlements whilst others will have to rely on Centrelink or their savings. For others, it may be a time in which they will need to gain access to money sitting in their superannuation accounts.
On what grounds can you gain access to your super?
There are two criteria outside the usual release of your super.
When do I usually get access to my super?
Super stays in your superannuation fund until you retire from the workforce. Retirement can be at age 55 or 60 if you are born after June 1964.
How to get early access to super.
Financial Hardship or Compassionate Grounds
Most funds will allow up to $10,000 per year to be released from a member super. Superfunds have different requirements but in the current circumstances they may be making it easier for members to access their super.
Also, the Federal Government has announced that members can access up to $10,000 of their super due to COVID19 restrictions.
You must meet one of the following criteria:

You are unemployed;
You are eligible to receive:         Job Seeker Payment, Youth Allowance, Parenting Payment (partnered and single), Special Benefit or Farm Household Allowance.

On or after 1 January 2020 you were made redundant;
On or after 1 January 2020 your working hours were reduced by 20% or more;
If you’re a sole trader, your business was suspended or there was a reduction in turnover of 20% or more.

Disability Benefits

Permanent Incapacity
Total and permanent disability
Temporary disability

Permanent Incapacity & Total and Permanent Disability
If you are unable to work due to corona virus or another health condition, you may be eligible to make a Permanent Incapacity Claim. You will gain full access to your super account balance.
If you have stopped work and unable to return due to you health conditions you may be eligible to make a TPD claim. A Total and Permanent Disability insurance lump sum benefit can be a 6 figure amount paid out to you when we can prove that you will not be returning to work due to your health conditions.
Temporary Disability (aka income protection)
If you are unable to work you may be able to claim income protection benefits for a two year period. The fund may pay your full income for two years or up to 85% of your salary.
Contact PK to find out your entitlements. Your superannuation company won’t contact you to let you know that you’re eligible to claim a $300,000 TPD benefit.
 
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How Long is Too Long For a TPD Claim?

There’s been a lot of bad press recently surrounding total and permanent disability (TPD) cover with some products offered by insurers less likely to bring payouts to sufferers. This is the case whether they have TPD injuries to their back, neck, or shoulders working as pickers or packers, or in warehouses; those with cleaning jobs, or who work in other areas. But delayed payouts have also been experienced by claimants, particularly those who have sustained an injury while working in jobs where they see traumas, such as the police, fire fighters, nurses and suffer from Post Traumatic Stress Disorder (PTSD) and other mental injuries and illnesses. Claimants have spoken out on television current affairs programs about the delays and battles they’ve had with insurers, with one insurance company using deliberate delaying tactics to drag out their process. Although this behaviour is totally unacceptable, unfortunately, it happens. So, how long does it take to get a TPD payout? More to the point, how long should it take?
 

At PK Simpson, we are experts in super and TPD claims – We help Australians nationwide claim their benefits – you’re in safe hands with us – We’re big on keeping our clients up to date and supported throughout their claims. 

 
When Your TPD Claim Goes According to Plan
Any TPD injury claim including e.g:

Physical injuries
Psychological injuries
Arthritis
Heart conditions
Spinal fusions
Operations on knees, hernias, arthritis etc.,

Any associated conditions caused by medicines including:

Digestion problems
Sexual or social issues

These should be resolved within two to three months of your insurer receiving the forms along with the documented medical evidence. For anyone suffering a TPD, this can seem like a very long time if they have no income. However, if you find yourself in this situation, it’s best to try to be patient while your insurer assesses your claim. You should ask your insurer for an update if you haven’t received an answer after three months. Be sure to follow any instructions given to you in applying for TPD benefits because this will make the process faster. Should you fail to provide documents or make errors in your application, it could cause major hiccups, although many claimants who are diligent still encounter delays.
 

PK Simpson is the only superannuation law firm with a client services department who are dedicated, 100 per cent of the time, on making sure clients are happy.

 

How Can I Get a Quicker TPD Claim Benefit?
The first thing to do if your TPD claim is taking longer than three months (some claims can drag on for years) is to get in touch with PK Simpson lawyers. We specialise in TPD claims and can help expedite your case. You can also follow this course if your original application was rejected, and you don’t agree with the decision.  At times, the mere threat of legal action can be enough of an incentive for the insurer to get on with accepting your claim without delay and providing the payout you deserve. If the insurer doesn’t budge, our experienced TPD claim lawyers can gather evidence for you and start court proceedings. A successful claim results in a lump sum payout and the insurer will likely have to pay your legal costs and interest.
 

If you’re unable to work due to an injury or illness, the friendly team of lawyers at PK Simpson will make sure you’re looked after, and every fund you’ve ever been a member of is looked into – You might have more than one TPD claim – 
We maximise results by obtaining required specialist reports, and we pay for all medical reports 

 
Why Do Insurers Often Delay TPD Claims?
Yes, it’s understandable that insurers need a reasonable time to make an assessment on a TPD claim, but some of them deliberately slow the process by asking for information bit by bit. Everyone knows insurers collect the highest premiums but pay out the lowest claims. This kind of unethical behaviour should be exposed, since insurers are obliged to treat claimants in good faith. Also, it’s against the law for insurers to frustrate or unreasonably delay a claim. Reasonable requests for information should be the norm, and insurers should send claimants for medical examinations as soon as possible. If your insurer fails to do this, they could be breaking the law which might entitle you to penalty interest. If you are in this category, do seek legal help because claimants who are not represented are usually the ones whose claims are delayed for years.
If you think your insurer is delaying your claim, find out what your rights are by contacting PK Simpson, TPD specialists, today on 1300 757 467 or email [email protected]

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