Would highly recommend the team at Claimsplus Lawyers and Athelene in particular. She helped me through my case and was thorough and communicated well at all times. When I thought things were looking bleak, they were able to turn it around with a positive result. Thanks again Athelene for a job well done!
Rejected, Delayed or Reduced
Disputed Super & Insurance Claims
A rejection, delay or reduced payment does not necessarily mean the decision is correct. If your super insurance claim has been declined, delayed or reduced, the issue may be how the policy was applied to the available evidence — not whether you are genuinely affected.
Policy vs evidence
most disputes turn on this single issue
Am I eligible?
This may apply to you if…
Claims through superannuation insurance are not always resolved correctly the first time. If any of the following sounds like your situation, your claim may warrant review.
Your TPD, income protection, terminal illness or death benefit claim has been rejected
Your claim has been delayed for an extended period without a clear decision or explanation
Your payments have been reduced or stopped after previously being approved
You believe the wrong policy definition was applied, or the evidence was not properly considered
Why Claimsplus
Why people choose Claimsplus for disputed super & insurance claims
Policy + evidence
The core issue in most disputes
No win
No fee unless we recover your entitlement
AFCA
Independent dispute resolution
All types
TPD, IP, terminal illness, death benefit
Understanding your claim
What is a disputed claim?
A disputed claim arises where there is disagreement about entitlement or outcome. This includes situations where:
- A claim has been rejected
- Payments have been reduced or terminated
- The claim is delayed without clear progress
- A death benefit decision is contested
- A super fund trustee decision is being challenged
Disputes can occur at any stage — from initial assessment through to payment. Insurance decisions are based on policy definitions and evidence, not general circumstances. In many cases, the outcome turns on a single issue: whether the evidence clearly addresses the definition in the policy — not simply how serious the condition or situation is.
Eligibility
Who qualifies?
Your TPD, income protection, terminal illness or death benefit claim has been rejected
Your payments have been reduced or stopped after previously being approved
Your claim has been delayed for an extended period without a clear decision
A death benefit decision appears inconsistent, unfair or is being contested
You were told you could return to work, but your treating doctors disagree
New or stronger evidence has become available since the original decision
A claim does not need to be formally declined to be in dispute. Delays, repeated information requests and inconsistent communication may also indicate issues in the assessment process that need to be addressed.
The process
How it works
01
Request the full reasons
Obtain a clear explanation of which policy definition was applied, why the claim was declined or reduced, and what evidence was relied on.
02
Identify gaps in the claim
Most disputes arise from medical reports not addressing work capacity, lack of specialist evidence, missing employment or income details, or incorrect assumptions about your circumstances.
03
Obtain targeted evidence
Additional evidence should directly address the policy definition, your functional capacity for work (TPD/IP), whether improvement is expected, or dependency and relationship status (death benefits).
04
Request an internal review
Claims can often be reconsidered by the insurer or the super fund trustee. This may involve submitting new or clarified evidence that directly addresses the reasons for the original decision.
05
Escalate the dispute if required
If the issue is not resolved internally, it may be referred to the Australian Financial Complaints Authority (AFCA). AFCA can review whether the decision was fair and reasonable, the policy terms were applied correctly, and the available evidence supports the outcome.
Common concerns
Questions people ask before they start
Many disputes arise from issues that only become clear once the decision and policy are properly examined.
“The insurer already rejected my claim — isn’t that the end?”
A rejection is the insurer’s initial decision, not necessarily the final outcome. Claims can be reconsidered through internal review, and if necessary, referred to AFCA. In many cases, the issue is not whether the person is genuinely affected — but whether the policy was correctly applied to the available evidence.
“I already resubmitted and it was rejected again”
Resubmitting the same evidence without addressing the specific reasons for the decision is one of the most common mistakes. A disputed claim usually requires a different approach — targeting the policy definition, obtaining specialist evidence that addresses the criteria, and identifying gaps the original claim did not cover.
“I assumed the insurer’s medical assessment was final”
Insurer-appointed medical opinions are one input in the assessment process — they are not determinative. Where there is a genuine disagreement between treating specialists and insurer-appointed assessors, the quality, recency and relevance of the evidence on each side matters.
“I don’t have the energy to deal with this right now”
We handle the process on your behalf — reviewing the decision, identifying gaps, obtaining evidence, and managing all communication with the insurer, fund or AFCA. You only need to provide basic information to get started.
Client stories
What our clients say
I came across Claims Plus on the web after ending my claim with another law firm who charged heaps. Athelene is one of the nicest people I’ve ever met. She kept me updated regularly and would promptly answer any questions or concerns I had. The application was approved quicker than expected and I can’t thank them enough.
My correspondence with Vanessa and the whole team at Claimsplus has been nothing but true diligence, fighting for my claim in which we WON. Communication was excellent 100% all the way, and the outcome was way better than expected. I truly can’t thank them enough.
Common questions
Disputed Super & Insurance Claims — Frequently asked questions
Yes. There are limits on how long you have to request a review or escalate a complaint. Delaying action may affect your ability to rely on certain evidence or access particular dispute resolution pathways. Taking steps early can preserve your options.
The Australian Financial Complaints Authority (AFCA) is a free, independent dispute resolution body. AFCA does not simply re-run your claim — it assesses whether the decision-making process and outcome were appropriate, whether the policy terms were applied correctly, and whether the available evidence supports the decision.
A claim does not need to be formally declined to be in dispute. Delays may suggest issues in the assessment process, particularly where there are repeated requests for similar information, ongoing medical reviews without a decision, or extended timeframes without explanation. Delays can create financial pressure and may need to be actively addressed.
Resubmitting the same evidence without addressing the specific gaps identified in the decision is one of the most common mistakes in disputed claims. A dispute usually requires a different approach — not a repeat of the original claim. The focus should be on whether the evidence properly addresses the policy definition.
No. Insurer-appointed medical opinions are one input in the assessment process. They are not determinative. Where there is a genuine disagreement between treating specialists and insurer-appointed assessors, the quality, recency and relevance of the evidence on each side matters.
Yes. Disputes involving death benefits can arise where multiple people claim to be dependants, there is disagreement about financial dependency, a nomination is invalid, unclear or contested, or the trustee’s distribution decision is challenged. These matters can be both legally complex and sensitive.
Common mistakes include: accepting a rejection without reviewing the reasoning, resubmitting the same evidence without addressing gaps, focusing on diagnosis instead of policy criteria, missing time limits for escalation, assuming insurer medical opinions are final, and not understanding trustee discretion in death benefit matters.