How TPD claims are assessed

The insurer is not asking whether you are unwell. It is asking whether your condition satisfies a written definition of total and permanent disability, and permanence is a forward-looking judgement about a person who may still be undergoing treatment. That is why these claims take time, and why they generate more disputes than any other type of personal insurance claim.

Understanding the sequence removes a lot of the frustration. There is a waiting period, then a gathering of medical evidence, then an assessment of whether the definition is met, and often a period of watching and waiting to see whether capacity returns. Each stage is legitimate. Each stage also takes longer than anybody expects.

The practical implication is that TPD is not a product that solves a short-term cash problem. A household relying on TPD alone can be a year into a disability with no money having arrived. That is one of the strongest arguments for holding income protection alongside it.

1. 1

   Notification and the waiting period

   You notify the insurer and the waiting period begins — commonly three or six months of continuous total disability. Some policies date it from when you stopped work, others from the date of diagnosis.

2. 2

   Claim forms and authorities

   You complete a claim form, your treating doctors complete medical reports, and you sign authorities allowing the insurer to obtain your medical records and, where relevant, ACC and employment information.

3. 3

   Medical evidence

   The insurer gathers specialist reports. It may appoint an independent specialist for its own assessment. Where treatment is ongoing, it will usually wait to see the outcome before considering permanence.

4. 4

   Occupational and vocational assessment

   Under an any occupation definition the insurer considers what work you could reasonably do given your education, training and experience. This can involve a formal vocational assessment and, in some cases, a rehabilitation plan.

5. 5

   Underwriting review

   The insurer checks the application against your medical history. On a large claim, and particularly within the first few years of the policy, non-disclosure is examined closely.

6. 6

   Decision

   The claim is accepted, declined, or deferred pending further evidence or the outcome of treatment. A deferral is not a decline, and a declined claim can be reviewed, disputed, and escalated to the insurer’s dispute resolution scheme at no cost.

These are the details that decide whether the cover does what you expected. Read them before you compare on price.

• When the waiting period starts running, since this differs between policies.
• Whether the definition applied is the one in force at the date of disability or the date of claim.
• Whether the insurer can require an independent medical examination, and who pays for it.
• Whether a rehabilitation or retraining plan can be required before permanence is accepted.
• How the policy treats a return to part-time work during assessment.
• The complaints path if the claim is declined — the insurer first, then its dispute resolution scheme.

Every New Zealand insurer writes tpd insurance in new zealand to its own wording, and the words are where the money is. Two policies that look identical on price can pay very differently when it matters. Closing that gap is the entire job of an adviser.

• Advisers who have run TPD claims know what evidence the insurer needs, and can ask the specialist to address the policy definition rather than write a general letter.
• Where a claim is deferred pending treatment, an adviser can keep the file moving and diarise the review rather than letting it drift.
• An adviser can identify where income protection or a trauma benefit on the same plan should be claimed first, so money arrives while the TPD assessment continues.
• If a claim is declined, an adviser can help assemble the request for review before it goes to the dispute resolution scheme.

There are three ways to buy life cover in New Zealand, and they are not equivalent. You can buy direct from one insurer, which means you see one product range and one underwriting appetite. You can buy through your bank, which usually means a single insurer’s product sold under the bank’s brand, often with narrower definitions. Or you can go through an adviser, who quotes several insurers at once and is required to put your interests first.

The premium you pay is the same either way. Insurers build adviser commission into their pricing whether or not an adviser is involved, so going direct does not get you a discount — it just removes the person whose job is to argue your corner at application and at claim time.

• An adviser can see which insurer is currently taking your health history on standard terms, and which one will load or exclude it.
• An adviser can structure cover across two insurers if that produces a better outcome than putting everything with one.
• An adviser handles the underwriting back-and-forth, and is the person who chases the claim when a family is least able to.
• An adviser has to document why the recommendation suits you, which is a written record you can hold them to.

We are a referral service, not an insurer. We do not quote premiums and we do not sell policies. What we do is put you in front of one licensed New Zealand adviser who can compare the market properly.

1. 1

   You tell us what you are looking at

   The form takes about a minute. Nobody asks for your medical history on a web form — that conversation happens with the adviser, properly, and only once you have decided to proceed.

2. 2

   An adviser calls you

   A licensed New Zealand adviser talks through your situation: who depends on you, what you owe, what you already have in place, and what you are actually worried about.

3. 3

   They compare the market

   The adviser quotes across the major insurers, checks which of them will take your health history on the best terms, and puts the options side by side in writing.

4. 4

   You decide, in your own time

   There is no obligation and no cost to you. If the answer is that you already have enough cover, a good adviser will tell you that.