How JustAnswer Works:
  • Ask an Expert
    Experts are full of valuable knowledge and are ready to help with any question. Credentials confirmed by a Fortune 500 verification firm.
  • Get a Professional Answer
    Via email, text message, or notification as you wait on our site.
    Ask follow up questions if you need to.
  • 100% Satisfaction Guarantee
    Rate the answer you receive.
Ask James D. Ford Your Own Question
James D. Ford
James D. Ford, Solicitor
Category: Australia Law
Satisfied Customers: 1601
Experience:  Consulting Principal at Nexus Law Group
Type Your Australia Law Question Here...
James D. Ford is online now
A new question is answered every 9 seconds

If I have TPD insurance as follows: Part D (ii). Where at

Customer Question

If I have TPD insurance as follows:
Part D (ii). Where at the time of disablement, solely because of Illness or Injury and immediately prior to the occurrence of the Illness or Injury, you were not gainfully employed and were at home performing unpaid domestic duties; and you satisfy all of the following:
a. as a result of Illness or Injury, you are under the care of a Medical Practitioner
b. are unable to perform those domestic duties
c. are unable to leave your home unaided
d. from the date of disablement you have not worked in any domestic duties for a period of three consecutive months
e. have not engaged in any gainful employment for a period of three consecutive months after the occurrence of the Injury or Illness, and
f. at the end of the period of three months, in the Insurer’s opinion, after consideration of all relevant evidence, you are disabled to such an extent as to render you unlikely to perform those domestic duties or engage in any gainful occupation for which you are reasonably suited by education, training or experience.
Date of disablement: The later of the following:
 the date you cease to work due to Injury or Illness, or
 the date a Medical Practitioner examines you and certifies in writing that you suffer from the Illness or Injury that is the principal cause of your inability to work.
If i was very sick and spent 5 months in hospital 2 years ago, assuming the date of disablement is when I was admitted to hospital, would my current medical condition be taken into account or would they have to assess my claim by forming an opinion according to my health at 3 months from disablement or would the 'all relevant information' mean they can take into account my current health?
Submitted: 2 years ago.
Category: Australia Law
Expert:  James D. Ford replied 2 years ago.
My view is that if the decision was to be made at the point of 3 months after the date of disablement... your health at that point in time would be all that the insurance company would have in order to make the assessment regarding your TPD (Total and permanent disablement) claim. In the current situation, they would also have what has actually occurred, and what you have and have not been actually able to do since your disablement. If in fact, you have been able to perform domestic duties, and engage in gainful employment... then these would be factors that the insurer would be entitled to take into account in their assessment, using "all relevant evidence". TPD stands for Total and Permanent Disablement... and if there is evidence that your disablement has not been total, or permanent.. this would impact on your insurance claim. If your current health shows you are still disabled, and unable to perform domestic duties/engage in gainful employment for which you are reasonably suited... etc., then your claim should still be successful. Kind regards, James
Expert:  James D. Ford replied 2 years ago.
Also note that an Insurer may defer their decision on your TOD claim.. until a later point in time... Deferred The Insurer may defer your application for a period of time to determine the full extent of your disability and whether it’s permanent. Your application will be reviewed again at the end of this period although it may be deferred again if the Insurer is still unable to reach a decision based on the medical opinion/s provided