{"id":82664,"date":"2026-06-09T10:33:24","date_gmt":"2026-06-09T00:33:24","guid":{"rendered":"https:\/\/riskinfo.com.au\/news\/?p=82664"},"modified":"2026-06-12T12:01:51","modified_gmt":"2026-06-12T02:01:51","slug":"advisers-cautioned-on-tpd-claims-strategy","status":"publish","type":"post","link":"https:\/\/riskinfo.com.au\/news\/2026\/06\/09\/advisers-cautioned-on-tpd-claims-strategy\/","title":{"rendered":"Advisers Cautioned on TPD Claims Strategy"},"content":{"rendered":"
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Our report on claims specialists cautioning advisers on the risk of rushing to lodge TPD claims emerged as a standout topic for readers this week… <\/h3>\n<\/div>\n<\/div>\n

Claims specialists speaking at the recent Entireti Risk Summit Roadshow events cautioned advisers that rushing to lodge TPD claims quickly can create significant litigation risk, client dissatisfaction, and costly delays.<\/p>\n

In a panel discussion led by Aaron Zol<\/strong>, Entireti\u2019s Head of Business & Insurance Growth, Trevor Battersby<\/strong>, Founder of TPD Claim Support, and veteran claims consultant Col Fullagar<\/strong>, Principal of Integrity Resolutions, said advisers need to adopt a far more strategic approach to submitting TPD claims on behalf of clients.<\/p>\n

Battersby said one of the biggest problems he sees is the tendency to \u201csubmit and hope\u201d, where claims are lodged before medical evidence, occupational definitions, and permanency requirements have been properly assessed.<\/p>\n

According to Battersby, advisers and clients often underestimate how quickly frustration escalates once a claim is submitted, followed by apparent radio silence.<\/p>\n

\u201cAt the six-month mark, if you\u2019re not getting traction, there\u2019s definitely something not working,\u201d he said.<\/p>\n

We\u2019re looking at how to future forecast everything required to put the claim in…<\/p><\/blockquote>\n

\u201cAt the 12-month mark we see a significant spike where clients get fed up and start hearing from family, friends or legal firms telling them to get a lawyer.\u201d<\/p>\n

Battersby said the industry was seeing identifiable \u201ctrigger points\u201d where claims increasingly move toward litigation, particularly after 12 to 18 months of delays.<\/p>\n

He argued that many of those disputes could be avoided through stronger upfront preparation and pre-assessment work before a claim is formally lodged.<\/p>\n

He outlined an 11-step pre-assessment process used by his team, including:<\/p>\n

    \n
  • Eligibility testing<\/li>\n
  • Review of original applications<\/li>\n
  • Occupational analysis<\/li>\n
  • Social media reviews<\/li>\n
  • Medical evidence assessment<\/li>\n
  • Policy definition analysis<\/li>\n<\/ul>\n

    \u201cWe\u2019re looking at how to future forecast everything required to put the claim in a box with a ribbon on it to avoid those long delays,\u201d said Battersby.<\/p>\n

    One major issue, he added, was confusion between diagnosis and permanency.<\/p>\n

    \u201cA lot of claimants think, \u2018I\u2019ve been diagnosed, I want my claim\u2019,\u201d said Battersby. \u201cBut diagnosis is not a permanency test.\u201d<\/p>\n

    He said many claims are lodged before specialists have confirmed a claimant is unlikely to return to work, leading to procedural fairness disputes and extended delays.<\/p>\n

    \"Entireti
    Entireti panel debate on claims management featuring (L-R) Col Fullagar, Principal of Integrity Resolutions; Zane Westbrook-McIntyre, Customer Resolution Consultant Risk Unit, Entireti, Trevor Battersby, Founder of TPD Claim Support, and leading the debate is Aaron Zol, Entireti\u2019s Head of Business & Insurance Growth.<\/figcaption><\/figure>\n

    Mental health<\/strong><\/p>\n

    Mental health claims were highlighted as a particular problem area. Battersby said many clients initially see psychologists under mental health treatment plans, but TPD definitions often require supporting evidence from a psychiatrist.<\/p>\n

    \u201cIt is amazing how many times we see that,\u201d he said.<\/p>\n

    The panel also discussed how occupational definitions can unintentionally undermine claims.<\/p>\n

    As a financial adviser there\u2019s a requirement in claims support to have competence…<\/p><\/blockquote>\n

    Battersby described cases where claimants undertook retraining or new study programs while waiting for claims to be assessed, only to create new \u201cskills and experience\u201d arguments insurers could later rely upon.<\/p>\n

    He warned advisers that poor communication and lack of client coaching during the claims process often created openings for litigation firms and complaints specialists regardless of whether you charged a fee or submitted at no cost. \u00a0Immaterial.<\/p>\n

    \u201cAs a financial adviser there\u2019s a requirement in claims support to have competence and maintain confidence as well as utilise a diligent documented claims and process,\u201d said Battersby.<\/p>\n

    \u201cThe minute you submit, as a financial adviser the client will assume they\u2019re going to get paid. A documented eligibility check is critical in managing expectations or addressing red flags before a submission.\u201d<\/p>\n

    Look for problems<\/strong><\/p>\n

    Fullagar said advisers and claims specialists needed to approach TPD claims by actively searching for potential weaknesses before submission.<\/p>\n

    \u201cTo be honest, I look for as many problems as possible,\u201d he said.<\/p>\n

    He described reviewing policy definitions, benefit limits, disclosure issues, occupational duties, and income structures before any claim is lodged.<\/p>\n

    In one example, he identified a potential exposure involving two TPD policies worth a combined $12m, where the insurer had a market maximum benefit limit of $10m.<\/p>\n

    \u201cHad both claims been lodged simultaneously, the adviser could have faced immediate litigation exposure,\u201d said Fullagar.<\/p>\n

    …don\u2019t answer the questions on the claim form if the question isn\u2019t worded correctly…<\/p><\/blockquote>\n

    He recommended a \u201chighly structured process\u201d for making claims, including carefully reviewing claimant declarations and ensuring medical evidence aligns with client statements before submission.<\/p>\n

    \u201cYou don\u2019t answer the questions on the claim form if the question isn\u2019t worded correctly,\u201d he said. \u201cYou give the insurance company the information they need rather than answering the question they ask. Change the question if you have to – it\u2019s only a form.\u201d<\/p>\n

    He also stressed the importance of synchronising to ensure consistency between claimant and doctor statements before forms are submitted. If any inconsistencies are found, the correct position should be identified and an explanation provided.<\/p>\n

    \u201cIt\u2019s very easy to change your statement,\u201d he said. \u201cBut it\u2019s much more difficult to change the doctor\u2019s. Get the fact base first (i.e. the doctor’s statement) and ensure consistency in the submission.”<\/p>\n

    Fullagar argued that advisers should not automatically panic when errors occur, including cases involving lost insurance cover.<\/p>\n

    \u201cSimply because you might have made a mistake doesn\u2019t mean someone else hasn\u2019t also made a mistake,\u201d he said.<\/p>\n

    He urged advisers to investigate insurer processes, lapse procedures and historical underwriting issues before conceding liability.<\/p>\n

    The panel also discussed the growing role of specialist claims consultants, with Battersby arguing many disputes escalated unnecessarily because claims moved too quickly into formal legal channels instead of being reworked and resubmitted.<\/p>\n

    Key takeaways<\/strong><\/p>\n

      \n
    1. Avoid \u201csubmit and hope\u201d TPD claims strategies<\/li>\n
    2. Pack, formalise an eligibility checklist and document the conversation where you\u2019ve addressed any components that don’t confirm the eligibility<\/li>\n
    3. The importance of collating medical evidence and research with the relevant PDS is critical prior to a submission<\/li>\n
    4. If in doubt scope out and seek professional advice<\/li>\n
    5. Treat TPD claims as a structured advice process, not an administrative exercise<\/li>\n
    6. Separate diagnosis from permanency when assessing claim readiness<\/li>\n
    7. Pay close attention to occupational definitions, retraining and post-disability work activity<\/li>\n
    8. Review original applications and disclosure history before submission<\/li>\n
    9. Align claimant statements and medical evidence before lodgement<\/li>\n
    10. Be especially careful with mental health claims where psychiatrist evidence may be required<\/li>\n<\/ol>\n","protected":false},"excerpt":{"rendered":"

      Our report on claims specialists cautioning advisers on the risk of rushing to lodge TPD claims emerged as a standout topic for readers this week… Claims specialists speaking at the recent Entireti Risk Summit Roadshow events cautioned advisers that rushing to lodge TPD claims quickly can create significant litigation risk, client dissatisfaction, and costly delays. […]<\/p>\n","protected":false},"author":23,"featured_media":82682,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[241,6994,3,8291],"tags":[],"class_list":["post-82664","post","type-post","status-publish","format-standard","has-post-thumbnail","category-conferences-and-events","category-education","category-general","category-story-of-the-week"],"_links":{"self":[{"href":"https:\/\/riskinfo.com.au\/news\/wp-json\/wp\/v2\/posts\/82664","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/riskinfo.com.au\/news\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/riskinfo.com.au\/news\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/riskinfo.com.au\/news\/wp-json\/wp\/v2\/users\/23"}],"replies":[{"embeddable":true,"href":"https:\/\/riskinfo.com.au\/news\/wp-json\/wp\/v2\/comments?post=82664"}],"version-history":[{"count":0,"href":"https:\/\/riskinfo.com.au\/news\/wp-json\/wp\/v2\/posts\/82664\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/riskinfo.com.au\/news\/wp-json\/wp\/v2\/media\/82682"}],"wp:attachment":[{"href":"https:\/\/riskinfo.com.au\/news\/wp-json\/wp\/v2\/media?parent=82664"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/riskinfo.com.au\/news\/wp-json\/wp\/v2\/categories?post=82664"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/riskinfo.com.au\/news\/wp-json\/wp\/v2\/tags?post=82664"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}