Your TPD claim was denied. What happens next.

A declined claim is a decision, and decisions get reviewed. There are three steps from here and the first two cost you nothing: get the reasons and the evidence in writing, make a formal complaint through your fund's internal dispute resolution process, which must respond within 45 calendar days, and then take it to AFCA, which is free and whose superannuation determinations are binding on the fund. Legal help comes after that, if it is still unresolved. You do not have to decide anything today.

Last reviewed: 14 August 2026

First, understand what has actually been decided

A refusal is not a judgment about how sick or injured you are. It is a decision that the evidence, as the insurer read it, did not satisfy the particular words of your particular policy. Those are very different things, and people take the first meaning when only the second was decided.

This matters practically, because the specific reason determines what would change the outcome. Common reasons include:

• The definition was not met. Most often on the harder tests: "any occupation", where a job you have never done but could be retrained into counts against you, or "activities of daily living", the highest threshold of the three.
• The medical evidence was considered insufficient, which is frequently a gap in documentation rather than a dispute about your condition.
• An exclusion was applied, such as one relating to a pre-existing condition.
• A dispute about the date you stopped work, or about which version of the policy applies.
• Cover had ended before the claim, for example because an account became inactive.

ASIC's 2019 review REP 633 Holes in the safety net found industry wide problems in this area, including poor consumer outcomes from the activities of daily living test and insurers with higher than predicted rates of declined claims. A refusal is not proof the system worked correctly.

Step 1: Get the reasons and the evidence, in writing

Before deciding anything, ask your fund in writing for:

• The full written reasons for the decision.
• The policy wording and definition that was applied, and confirmation of which version was in force when you stopped work.
• The evidence and reports the decision relied on, including any independent medical examination report and any file notes about your claim.

Read what the insurer actually concluded and compare it against what your treating doctors said. Very often the gap is specific and identifiable: a question the medical form never asked, a specialist report nobody requested, a description of your job that does not match what you did. That gap is the thing a review can address, and you cannot see it until you have the documents.

Costs nothing, and it is the single most useful hour you can spend at this stage.

Step 2: Complain to the fund, free, with a 45 day deadline

This is the internal dispute resolution stage, and it is not merely a formality: it is a regulated process with an enforceable time limit.

Contact your super fund and say plainly: "I want to make a complaint." Those words matter, because they start a formal process rather than another general enquiry. Ask them to confirm in writing the date they received the complaint, because that is when the clock starts.

Under ASIC Regulatory Guide 271, issued 2 September 2021 and in force since 5 October 2021, a superannuation trustee must give you an internal dispute resolution response no later than 45 calendar days after receiving the complaint. ASIC has also been explicit that third parties involved in handling the complaint, including the insurer, must be able to meet that timeframe, so "we are waiting on the insurer" does not stop the clock.

In the complaint, be specific about what you say is wrong. Useful things to include: which part of the decision you dispute and why, any evidence the insurer did not consider, any new medical evidence, and a correction of any factual error about your work or your condition. Keep it factual and calm, and keep a copy.

Step 3: AFCA, free, independent, and binding

If the fund's response does not resolve it, or the 45 days passes without one, take it to the Australian Financial Complaints Authority on 1800 931 678.

What makes AFCA genuinely worth using rather than a box to tick:

• It is free for consumers. No fee to lodge, and no fee to run the complaint.
• Decisions on disability claims are squarely within its remit, including where the cover is held through your super fund. AFCA lists exactly this among the issues it can consider.
• There are no monetary limits on superannuation complaints, unlike other parts of its jurisdiction.
• For superannuation, a determination is binding on the financial firm. This is not mediation that a fund can walk away from.
• You do not need a lawyer to lodge, and lodging does not prevent you engaging one later.
• Insured members can complain, not only account holders. AFCA specifically lists a person insured under a policy held through superannuation as someone who can bring a complaint.

Interpreters are available on 131 450, and the National Relay Service covers people who are d/Deaf or have a speech or communication difficulty.

The time limits, including the one that catches people

Strict time limits apply to superannuation complaints, and they are set out in AFCA's own Rules. Rule B.4.1.1, in the Approved Rules released 12 March 2026, covers a decision about a total and permanent disability benefit:

• If you permanently stopped work because of the condition you are claiming for: you must have made the claim to the fund within two years of permanently ceasing employment, and you must submit the complaint to AFCA within four years of the fund's decision.
• If you stopped work for reasons unrelated to that condition: you must submit the complaint to AFCA within six years of the fund's decision.

Two details in AFCA's Operational Guidelines decide real cases, and neither is obvious.

The two years runs from formal termination, not from the last day you worked. AFCA states that the two-year limit "runs from when the date the fund member's employment is formally terminated, not the date the fund member was last able to work". Employers often keep someone on the books while they wait to see whether they recover, so if that happened to you, you may have more time than you assume.

Asking the fund to reconsider does not restart the clock. This is the trap. Under Rule B.4.1.2 the decision that counts is the original decision, and a later decision that confirms, varies or replaces it "is taken to have been made at the time when the original decision was made". So the four and six year clocks keep running from the first refusal, even while an internal review is going on. Complaining to the fund is still the right first step, but it does not buy you time at AFCA.

Being outside the limits is not automatically the end. AFCA's guidelines say that where a member does not meet the time limits for a superannuation complaint, it "may be able to accept a complaint against the insurer under our general jurisdiction". Separately, Rule B.4.4.2 lets AFCA extend a time limit where there are special circumstances, assessed case by case, though AFCA says plainly that simply not knowing AFCA existed is not enough on its own.

Do not work out your own deadline from this page. Which limit applies depends on why you stopped work and when the original decision was made, and getting that wrong in either direction is costly. Phone AFCA on 1800 931 678 and ask them to confirm your position. It is free, and theirs is the only answer that counts.

Step 4: Legal help, if it is still unresolved

A declined claim with contested medical evidence is one of the genuine cases for paid legal help, and we are not going to pretend otherwise. Before you engage anyone, two things are worth knowing:

A law practice cannot lawfully take a percentage of your payout. That is a contingency fee and it is prohibited. What can be charged is professional fees plus disbursements, with an uplift on a no win no fee arrangement capped at 25 per cent of the legal costs, not of your money.

Free legal advice may be available first. Legal Aid in your state or territory, and community legal centres, provide free advice where you qualify. That is worth checking before signing anything.

We have set out the fee rules, the questions to ask before signing, and the specific situations where a lawyer earns the cost, in what lawyers charge for TPD claims and when one is worth it.

Things worth doing now, and one to avoid

• Keep every document, and keep a dated log of calls: who you spoke to, when, and what was said. This becomes your evidence.
• Check your other super accounts. A refusal by one fund does not bind another. Each policy is assessed separately, and cover may exist elsewhere.
• Ask your doctors whether anything was missed. Sometimes a single additional specialist report addresses the exact point the insurer raised.
• Do not close or roll over super accounts while any of this is live, without checking what insurance is attached to them first.

The short version

A denial is a decision about policy wording, not a verdict on how unwell you are, and it can be reviewed. Get the written reasons, the policy definition applied, and the evidence relied on. Make a formal complaint to your fund using the words "I want to make a complaint": under ASIC RG 271 a super trustee must respond within 45 calendar days. If that does not resolve it, go to AFCA on 1800 931 678, which is free, has no monetary limit on super complaints, and whose superannuation determinations bind the fund. Only then consider paying a lawyer, and know that a percentage of your payout is not a fee a law practice may lawfully charge. Check your other super accounts, and do not close any of them meanwhile.

Common questions

My TPD claim was denied, is that the end?

No. A declined claim is a decision that can be reviewed, and the first two review steps cost nothing. Ask the fund for the reasons in writing and the evidence the decision relied on, make a formal complaint through the fund's internal dispute resolution process, which must respond within 45 calendar days, then take it to AFCA, which is free and whose superannuation determinations are binding on the fund.

How do I appeal a declined TPD claim?

Start by making a formal complaint to your super fund and using the words I want to make a complaint. Under ASIC Regulatory Guide 271 a superannuation trustee must give you an internal dispute resolution response no later than 45 calendar days after receiving the complaint. If you are not satisfied with the outcome, or no response arrives in time, you can take the complaint to AFCA at no cost.

Does complaining to AFCA cost anything?

No. AFCA is free for consumers. There are no monetary limits on superannuation complaints, and for superannuation matters an AFCA determination is binding on the financial firm. You do not need a lawyer to lodge a complaint with AFCA, and doing so does not prevent you engaging one later.

Why do TPD claims get declined?

Common reasons include the insurer deciding you do not meet the specific policy definition, particularly the harder any occupation or activities of daily living tests, medical evidence the insurer considers insufficient, an exclusion such as a pre-existing condition, a dispute about the date you stopped work, or cover having ended before the claim. The decision letter should state the actual reason, which is why getting it in writing matters.

Should I get a lawyer after a TPD claim is denied?

A declined claim is one of the situations where legal help can genuinely be worth the cost, especially where the medical evidence is contested or a restrictive definition is being applied. It is still usually worth using the free internal review and AFCA first, because they cost nothing and an outcome there leaves you with the whole benefit.

Free help, all of it

• AFCA, 1800 931 678, weekdays 9am to 5pm AEST/AEDT. Free and independent, binding determinations in superannuation. Interpreters on 131 450.
• Legal Aid in your state or territory, and community legal centres, for free legal advice where you qualify.
• National Debt Helpline, 1800 007 007, weekdays. Free, independent financial counsellors who do not sell anything.
• Lifeline, 13 11 14, and Beyond Blue, 1300 22 4636, for support at any hour. If life is in danger, call 000.

Where this comes from

• ASIC Regulatory Guide 271, Internal dispute resolution, issued 2 September 2021, in force from 5 October 2021. Source for the 45 calendar day maximum for superannuation trustee complaints.
• AFCA, Superannuation complaints, for disability claim decisions being within remit, the absence of monetary limits, and who may complain.
• AFCA Rules and Operational Guidelines. The time limits above are Rule B.4.1.1 and Rule B.4.1.2 of the Approved Rules released 12 March 2026, with the formal-termination point, the insurer fallback and the Rule B.4.4.2 extension taken from the Operational Guidelines effective the same date.
• ASIC REP 633, Holes in the safety net, released 17 October 2019, for declined claim rates and the activities of daily living test.
• Victorian Legal Services Board and Commissioner, No win no fee cost agreements, for the 25 per cent uplift cap being on legal fees rather than on your payout.

About this guide

This is general information, not legal advice and not financial advice. It cannot tell you why your claim was refused or whether a review would succeed, because that depends on your policy, your evidence and your circumstances. Biz in a Box is an independent Australian small business site. We are not affiliated with Cbus Super, or with any superannuation fund, insurer or law firm. We do not act on TPD claims, we do not refer you to anyone, and we do not take referral fees or commissions. Speak to your super fund, then AFCA on 1800 931 678, and get legal advice if the situation calls for it.