New APRA data for 2025 shows TPD claims accounted for 88% of all life insurance claim disputes. Aussie Injury Lawyers reveals the cover-up and calls for change.
BRISBANE, QLD, AUSTRALIA, October 16, 2026 /EINPresswire.com/ — Advocacy call for reform by Aussie Injury Lawyers
New APRA data covering 2025 shows disability income and total and permanent disability claims accounted for 88% of all disputes made on life insurance claims, despite making up 64% of claims lodged. The disputes are not evenly spread. They cluster around the claims that are hardest to substantiate — and the evidence suggests the assessment process, not the claimants, is where the problem sits.
1 · The denials concentrate in one narrow test
An ASIC review of more than 26,000 TPD claims found that just 4% were assessed under the activities-of-daily-living definition. Of those, 60% were declined. Claims involving mental health or musculoskeletal conditions were roughly five times more likely to be rejected than others.
That is the pattern advocacy groups have described for years, now confirmed in the regulator’s own sample: the further a condition sits from a single verifiable event, the more likely the claim fails — not because the person can work, but because permanence is hard to prove on paper.
2 · The three mechanisms that make denial look routine
Definition drift. TPD Policies commonly require that you be unlikely ever to work again in any occupation for which you are suited by education, training or experience — not the job you actually held. The gap between “can’t do my job” and “can’t do any job” is where most claims die.
Evidence asymmetry. The insurer has legal teams, in-house medical reviewers and a financial interest in the outcome. The claimant has a treating doctor with a waiting list, a form, and no legal training.
Friction by design. Disputes are time-limited, paper-heavy and procedurally unforgiving — and APRA’s data shows that in most resolved disputes, the insurer keeps its original decision anyway. A person navigating a serious diagnosis while facing loss of income is not well placed to build a case file.
3 · What the dispute volume tells us
When 88% of claim disputes arise from two benefit types, the problem is not individual claimants misunderstanding their policies. A claims model generating that concentration of escalated complaints is producing denials faster than it is resolving them — and the people absorbing the cost are, by definition, those most vulnerable.
4 · What Aussie Injury Lawyers is calling for
• Plain-language definitions. Standardised disclosure of TPD definitions in clear English, and notification to members whenever the definition changes.
• Mandatory publication of appeal outcomes. Insurers and superannuation trustees to report denial and overturn rates annually.
• A statutory right to reasons. Claimants entitled to a written, itemised explanation of the evidence relied on in a denial.
• Independent review before escalation. A funded, no-cost internal review by a reviewer with no involvement in the original decision.
• Extended appeal windows. Timeframes that account for illness, hospitalisation and incapacity.
5 · The point
A dispute concentration this extreme is not a natural rate. It is a policy outcome. Reform the definitions, publish the numbers, and fund the reviews, and the volume will move. Leave it alone, and it will not change.
6 · Sources
• APRA Life Insurance Claims and Disputes Statistics, calendar year 2025 (published April 2026).
• ASIC review of TPD claims, 2025.
• KPMG Life Insurance Industry Insights, 2023.
About Aussie Injury Lawyers
Aussie Injury Lawyers is an Australian accident and injury compensation law firm specialising in advice for Total and Permanent Disability claims. Their insurance claim experts work with the guidance of Kerry Splatt – an Accredited Specialist personal injury lawyer. They help people claim an insurance payout for any injury or illness that stops them working, including car accident injuries and work injuries and mental health issues. If you have a denied TPD claim, they can champion your case and help you achieve a reversal.
Quotes available from Nigel Munt, Principal, Aussie Injury Lawyers. Media enquiries: michael@splattlawyers.com.au
Michael Ford
Aussie Injury Lawyers
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