What if my super fund asks for more evidence after I lodge a TPD claim?

Why further evidence requests happen

TPD claims are document-heavy because the decision-maker usually has to compare your policy wording with medical reports, employment records, super fund information, and practical evidence about whether you are unlikely to return to suitable work. A request for more evidence can be frustrating, especially after you feel you have already told the story. The request may still be legitimate if a key issue remains unanswered.

Common reasons include missing treating-doctor reports, unclear work duties, old medical material, uncertainty about when symptoms became disabling, questions about whether the insurance was active, incomplete employer records, inconsistent certificates, or a need to understand a failed return-to-work attempt. In superannuation claims, the trustee and insurer may both be involved, so a request can come through the fund even though the insurer is assessing the insurance benefit.

What official sources support this approach?

The first source is always the actual superannuation or insurance policy. ASIC Moneysmart explains that insurers can define TPD differently, including own occupation, any occupation, and activities of daily living style definitions, and that the PDS should be read to understand the policy. That is why a further evidence response should not use one universal TPD rule.

ASIC Moneysmart's life insurance claim guidance says insurers may ask for medical reports, medical test results, work-duty details, payslips, tax returns, permission to contact a doctor, or attendance at an independent medical examination. It also notes that claim decisions and complaint steps can be affected by the claim type and process. The Life Insurance Code of Practice is now overseen by CALI, with the Life Code Compliance Committee administered by AFCA, but the safe consumer-facing point remains simple: ask what is needed, respond to the actual issue, and complain if the process becomes unfair or unreasonably delayed.

Medical evidence the fund or insurer may be looking for

Medical evidence should do more than name a diagnosis. A useful TPD report usually explains symptoms, treatment tried, response to treatment, medication side effects, functional limits, reliability, expected duration, and the practical reason work is no longer sustainable. For mental health claims, that may include concentration, attendance, social functioning, relapse risk, and treatment history. For physical injury or chronic pain claims, it may include sitting, standing, lifting, driving, fatigue, flare-ups, and safety.

If the request says the current evidence is too old or too general, a fresh treating-doctor report may help. The doctor should be given the relevant policy definition, a summary of the actual job duties, and key earlier records so their opinion is not isolated from the history. A short letter that simply says “the patient is TPD” is usually less useful than a report explaining why the person cannot reliably sustain work suited to the relevant policy wording.

Employment and work-capacity evidence

Many further evidence requests are really about work, not medicine alone. The assessor may want to know what your job actually involved, whether modified duties were available, whether you tried to return, and why the attempt did not last. Employer position descriptions can help, but they are often too tidy. A practical duty statement may be needed to explain hours, pace, travel, physical demands, cognitive load, supervision, customer contact, lifting, deadlines, or safety-critical tasks.

If you had a graduated return-to-work plan, light duties, a rehabilitation program, casual work, family-business duties, or unpaid trial duties, do not ignore it. Explain whether the work was short, supported, irregular, below normal productivity, medically unsafe, or ended because symptoms could not be managed. Related guides include failed return-to-work attempts, short reduced-duty returns, and workers compensation, CTP, and TPD.

Policy, super fund, and cover questions

Sometimes the fund is not questioning your disability evidence yet. It may be checking whether cover existed, which policy applied, whether premiums were paid, whether the claim date is correctly identified, whether an exclusion might apply, or whether the claim should be assessed under an any occupation, own occupation, activities of daily living, or other definition. Those questions need policy documents, membership records, account statements, or correspondence, not just more medical reports.

Ask for the policy definition being applied and the date on which the fund or insurer says the claim is being assessed. If the request refers to pre-existing symptoms, waiting periods, active employment, or cover cancellation, get advice before assuming the answer is obvious. These issues can turn on documents rather than general fairness.

How to respond without weakening the claim

Keep the response disciplined. Start with the request, then create a table with three columns: question asked, evidence provided, and outstanding evidence. This helps avoid duplicate records, missing attachments, and contradictions. If you correct an error, do it openly. For example, if a certificate has the wrong work-stop date, explain the correct date and attach the record that supports it.

Avoid overstating medical conclusions. If a doctor has not addressed prognosis, do not write that they have. If a report supports incapacity from your usual job but not every suitable occupation, say that clearly and identify what further opinion is being sought. Accuracy is safer than trying to make every document sound stronger than it is.

What if the request is too broad or repetitive?

Some requests ask for very wide medical authorities, many years of records, or documents that seem only loosely connected to the claim. A broad request is not automatically improper, but it should still have a purpose. You can ask what issue the material relates to, whether the date range can be narrowed, whether existing records already answer the question, and whether the insurer will accept targeted records first.

If the claim has been delayed by repeated requests, keep a timeline of each request, your response date, and any unanswered follow-up. That timeline can help if you need to make an internal complaint to the insurer or super fund, or later consider AFCA. Do not wait until the file is chaotic before recording the delay history.

Practical next steps

1. Save the further evidence request and highlight every separate question.
2. Match each question to the policy definition, medical issue, employment issue, or cover issue it appears to raise.
3. Ask doctors, specialists, employers, accountants, or the fund for the targeted records needed.
4. Prepare a short chronology covering treatment, work changes, work cessation, and any attempted return to work.
5. Send a cover note that lists enclosed documents and explains what is still outstanding.
6. Ask for confirmation that the response has been received and whether anything else is required before assessment continues.

If the request affects a deadline, complaint pathway, medical authority, or possible rejection, seek advice before sending a rushed response. A careful answer now can prevent a wider dispute later.

Further evidence request FAQ

Does a request for more evidence mean my TPD claim will be rejected?

No. It often means the trustee or insurer says it cannot yet decide a specific issue. The safest response is targeted evidence and a clear explanation.

Should I send every medical record I have?

Not automatically. Relevant, organised records are usually more useful than a large unstructured bundle. Use a chronology and index.

What if my doctor is slow to provide a report?

Tell the fund or insurer what has been requested, when it was requested, and when it is expected. Ask for more time if needed and keep proof of follow-up.

Can I challenge an unreasonable request?

You can ask why the material is needed and whether the request can be narrowed. If delay or unfairness continues, complaint options may be available.