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i have a claim in for wage protection insurance. the claim

was submitted on may one...
i have a claim in for wage protection insurance. the claim was submitted on may one this year. i have submitted all medical files seen doctors and specialists from both sides. is it normal for a claim to take this long. it is with a legal firm at the moment and has been for over three months. should i make a complaint or just continue to struggle without income as i have been for the last five months.
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Answered in 10 minutes by:
10/7/2013
Peter G.
Peter G., Solicitor
Category: Australia Law
Satisfied Customers: 767
Experience: Law degree from the University of Melbourne 1978, with thirty years of practice experience.
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Peter G. :

Hello. You are entitled to expect regular contact and advice from your solicitor.


This is fairly fundamental. You shouldn't really have to wait wonder – your solicitor should be keeping you informed of everything you should need to know.


I think the only thing you can do at this stage is to contact the solicitor and request an update – you could write a reasonably urgently sounding letter, or email so as to emphasise that you are experiencing some frustration.


Lack of contact can often mean that the solicitor has simply not got round to actioning the file.

Customer:

Hello Peter, Thank you for your prompt response.

Customer:

I do not have a solicitor representing me with this matter.

Peter G. :

Oh, I see, it is the solicitor for the insurer.

Customer:

Yes

Customer:

I have contacted the lawyer requesting updates. I feel that she is being short and saying she will follow up, however another week has gone by and still nothing

Customer:

I attended the insurance arranged medico legal examination four weeks ago and to date have not received any feedback from the insurance company

Peter G. :

Okay, thanks. There is no doubt that these things can take some time – the medical practitioner who has prepared the report is very likely to have had his report typed up and completed very quickly – they usually do it immediately. They may then send an account out the solicitor for payment and this payment process could take some time.


So, the collapse of one month is in reality probably not that unusual.


Nevertheless, you should expect some information from the solicitor – it is not very difficult to send you an email just saying what stage things have reached.


I would send an email, and in the email say that you will ring her if you don't hear anything within the next, say, two days. You should emphasise in the email that you need income, that you are not seeking to be difficult, it is just that you need the claim resolved.

Peter G. :

In purely legal terms – you have a contract of insurance and you have rights under that contract, and the insurer has legal obligations under the contract. Time is of the essence in such a contract and things should be progressed in a reasonable time. At the end of the day you can take legal action to enforce your rights – and you may have to do this in any event if you do not agree with the decision ultimately made by the insurer. You will certainly need to be satisfied that the insurer has complied with its obligations under the contract fully.

Peter G. :

These simple legal answer to your query is that you do have a right to take legal action against the insurer because it has not actioned your claim. You could say in your letter/email to the insurer that unless you can have a response, a satisfactory response, within a period of, say, two weeks, you will have no option but to consult a solicitor.


In practice, you don't want to have to do see a solicitor and get involved with any legal action – you want to get the matter resolved quickly without any complications. So at this stage you should keep pressing the solicitor is much as possible and if it comes to a point where nothing is happening, which is unlikely, you will have to see a solicitor.


What sort of amount is involved, in total?

Peter G. :

typo.... "...elapse of one month..." not collapse.

Customer:

that is the unanswered question. i have been off work for over twelve months. i was originally misdiagnosed with frozen shoulders. I did not improve and after further investigations I have been diagnosed as having Polymyalgia Rheumatica (PMR). The blurred lines will be the extent of the insurance companies liability. So we could be talking 85% of my yearly wage which would be over $100,000. I am not even trying to claim that

Customer:

I would be happy to receive my wage from when I submitted claim on year.May 1 this

Customer:

"May 1 this year"

Peter G. :

Okay, thanks. (I will assume that all workers compensation aspects have been considered).


You should at all times claim the full amount you are able to under the contract of insurance – you should only compromise at the end, if you wish to. The fact that you would be prepared to take something less than your full entitlement is a good negotiating point – but time this properly.


In your communications with the solicitor you should never display/indicate that you are so frustrated that you are likely to settle for anything offered. This would be very dangerous.


In any event, the amount you are claiming is quite substantial which ever way you look at it. I think I would now modify my communication with the solicitor and say that if you cannot have a satisfactory response within, say, two weeks, you will be seeing a solicitor. Insurance companies, as you are no doubt aware, can be tricky, and will want to resolve the matter in a manner favourable to them. Seeing your own solicitor may well be a cost-effective exercise.

Customer:

thanks you for your advice, i shall send them an e-mail this morning. if i receive a response from them can i chat to you about it in the next day or so. thank you again for your advice. alan.

Peter G. :

Thanks Alan. Best of luck. I think a further question may involve a further fee. And ask for me if there is a further question.

Peter G.
Peter G., Solicitor
Category: Australia Law
Satisfied Customers: 767
Experience: Law degree from the University of Melbourne 1978, with thirty years of practice experience.
Verified
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Peter G., Solicitor
Category: Australia Law
Satisfied Customers: 767
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Experience: Law degree from the University of Melbourne 1978, with thirty years of practice experience.

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