POWERED BY MOMENTUM MEDIA
Insurer stumbles on TPD definition
An insurer's use of an old total and permanent disability (TPD) policy definition has seen it directed by the Superannuation Complaints Tribunal (SCT) to review its decision to reject a member claim.
The SCT ordered both the insurer and the superannuation fund to review their rejection of a member's TPD claim on the basis of the insurer having used an old definition deemed to be less beneficial to the member.
The key difference was that the old definition of TPD was that the complainant needed to be deemed "unable ever again to work for reward in any business, occupation or regular duties for which she is reasonably qualified by education, training and experience", while the more appropriate new definition was that she was "unlikely ever again to work for reward in any business, occupation or regular duties for which he or she is reasonably qualified by education, training or experience".
The SCT pointed out that all of the insurer's assessments (including its submissions to the tribunal), had referred to the old definition and that while the superannuation fund had utilised the new definition, it had not sought to correct the insurer.
"While the tribunal notes that the trustee has assessed the complainant's claim using the ‘unlikely' definition, it has not drawn the insurer's attention to or shown that it has turned its mind to the fact that the insurer has assessed the complainant's claim on the incorrect definition," the SCT determination said.
It said that in the circumstances, "the tribunal considers it appropriate that the insurer and the trustee reconsider the merits of the complainant's claim using the correct ‘unlikely' definition".
Recommended for you
The insurance company has joined this year’s awards as a principal partner.
The $135 billion fund has transitioned away from TAL Life Insurance following an “extensive tender process”.
The $80 billion fund is facing legal action over allegedly signing up new members to income protection insurance by default without active member consent.
In a Senate submission, the Financial Services Council has once again called for further clarification that the government will assess the consumer outcomes of group insurance against the enshrined objective of superannuation.
TOP PERFORMING FUNDS
ACS FIXED INT - AUSTRALIA/GLOBAL BOND
Fund name
3y(%)pa
1
DomaCom DFS Mortgage
93.34 3 y p.a(%)
2
Global X GlobalX FANG+ ETF
37.15 3 y p.a(%)
3
GAM LSA Private Shares AU I
33.96 3 y p.a(%)
4
Fidante Credit Suisse Global Private Equity
29.68 3 y p.a(%)
5
Plato Global Alpha A
28.73 3 y p.a(%)
