Your TPD claim was denied. Here is what happens next.

The most common reason, and it turns entirely on which test your policy uses.

If your policy applies an any occupation test, the insurer only has to identify some occupation you could reasonably perform given your education, training and experience. Insurers frequently point to a theoretical role rather than a realistic one.

What answers it: evidence about your actual capacity in the real labour market. Vocational assessment, your work history, the physical or cognitive demands of the roles suggested, and medical opinion directed specifically at whether those roles are open to you. A job that exists in theory is not the same as a job you could get and hold.

This usually does not mean your doctors said you were fine. It means the reports did not answer the question the policy asks.

Treating doctors describe conditions, symptoms and treatment. Policy definitions ask something narrower: whether you are unlikely ever to return to work of a particular kind. A report can be entirely accurate and still not address that.

What answers it: reports commissioned to speak to the definition in your policy, in its wording, supported by treatment records covering the relevant period.

The insurer says cover had lapsed, never commenced, or had been cancelled, often because contributions stopped or the account balance fell.

Fund records are not always right, and cover rules have changed over the years. Legislation has also altered when default insurance can be cancelled for inactive or low-balance accounts.

What answers it: the fund’s own records, contribution history, member statements and the policy terms as they stood at the relevant time. This is a documentary argument, and documentary arguments are winnable.

The insurer relies on an exclusion, arguing your condition existed before cover started.

Whether the exclusion genuinely applies depends on its precise wording, when cover commenced, what you knew at the time, and whether the current incapacity actually arises from the earlier condition. These are often arguable, particularly where a condition worsened materially later.

A quieter reason, and an important one. The date you are taken to have become disabled determines which policy applied, which definition governs, and sometimes whether you were covered at all.

Insurers commonly choose the date you last worked. That is not always the correct date, and establishing the right one can change the outcome entirely.

Insurers sometimes close claims administratively where forms were not returned or requests were missed. If you were unwell, this is unsurprising and it is not fatal.

A closed claim can generally be reopened or relodged. It is worth acting rather than assuming the opportunity has gone.