Mental Health
Percentage of Claims 24%
Musculoskeletal Disorders
Percentage of Claims 23%
Accidents and injuries
Percentage of Claims 19%
Nervous system disorders
Percentage of Claims 10%
Percentage of Claims
Cancer
Percentage of Claims 9%
Cardiovascular conditions
Percentage of Claims 5%
Other
Percentage of Claims 10%
Medical Evidence
This is the most critical part of a TPD claim.
TPD Claim Outcomes Approval vs Rejection
Outcome Percentage
Approved 88%
Declined 12%
- Of the 12% declined, the most common reasons were: not meeting the policy definition (e.g. still able to work).
- Not enough medical evidence and Pre-existing condition exclusions
According to data from ASIC, the acceptance rate for Total and Permanent Disability (TPD) claims varies by condition
-
Mental health conditions: Approximately 67% acceptance rate, with a decline rate of 27.5%.
-
Injury or fracture conditions: Approximately 83.9% acceptance rate, with a decline rate of 16.1%.
-
Disease-related conditions: Approximately 90.3% acceptance rate, with a decline rate of 9.7%.
These figures indicate that TPD claims related to disease conditions have the highest acceptance rates, while those for mental health conditions face higher decline rates.
- The "mental health" category is the largest single category and has the highest rate of claim disputes and declines.
- Group policies through superannuation (most common) typically have higher approval rates than retail or direct insurance policies.
Based on data collected by ASIC from insurers.