Most people assume a claim is either paid or declined. The data published by APRA, ASIC and AFCA shows a third outcome is far more common than most Australians expect: claims that simply stop moving. Here is what the evidence says, with every source listed.
One in eight TPD claims never reached a decision at all
When ASIC reviewed around 35,000 TPD claims across seven insurers, it found that 12.5%, or 4,365 claims, were withdrawn before any decision was made.
These were not declines. They were claims that stopped. The most common reason insurers recorded was that the claimant had not responded to a request for information.
What this means for you. A claim doesn't have to be refused to fail. It can simply run out of momentum, and that tends to happen to the people least able to keep chasing it, at the point when they are most unwell.
The “most claims get paid” figure doesn't count the ones still waiting
You will often see that around nine in ten TPD claims are accepted. That figure is real, but it counts only the claims that reached a decision.
Of TPD claims through group super that were finalised in the year to December 2025, 90.2% were admitted. Counting every claim lodged over the same period, the picture looks different.
What this means for you. The acceptance rate describes the finish line, not the journey. A high approval figure is genuinely good news, but it tells you nothing about how long you might be waiting to get there.
Most delay is not caused by the person claiming
ASIC examined how ten superannuation trustees handled death benefit claims. It found that 78% of the delays were caused by processing problems within the trustee's own control, not by claimants, and not by insurers.
The gap between funds was stark. The best-performing trustee closed 48% of death benefit claims within 90 days. The slowest closed 8%.
What this means for you. How quickly your claim moves can depend more on which fund you happen to be with than on anything about your own circumstances.
The wording in your policy can matter more than your diagnosis
Not all TPD cover is the same. The strictest test, known as an activities of daily living definition, asks whether you can still perform basic physical tasks such as feeding, dressing or washing yourself. That is a far harder test to satisfy than being unable to return to work.
What this means for you. Two people with identical conditions can receive opposite answers because their policies are worded differently. Knowing which definition applies to you before you claim changes which evidence actually matters.
Delay is now one of the most complained-about problems in financial services
Across all of financial services in 2024–25, “delay in claim handling” was the second most-complained-about issue at the Australian Financial Complaints Authority, with 8,172 complaints.
Superannuation complaints then rose 29% to 7,687 across the 2025 calendar year, driven largely, AFCA said, by delays in handling claims and disputes over claim decisions.
The problem is documented, and regulators are acting on it
In November 2025 the Federal Court ordered the trustee of Cbus to pay a $23.5 million penalty for failing to handle death, terminal illness and TPD claims efficiently, honestly and fairly. More than 7,000 members were affected.
ASIC has separate proceedings on foot against AustralianSuper over delays in death benefit claims. Those allegations have not been proven in court.
What this means for you. If your claim has dragged on for months with no clear explanation, you are not imagining it and you are not alone. Delay of this kind is a documented, regulated problem, not a normal part of the process that you simply have to accept.
Your cover may have switched off without anyone telling you
Between June 2018 and June 2025, the number of Australians insured for TPD through their super fell from 12.17 million to 8.22 million.
Much of that was by design. Since 2019, default insurance switches off after 16 months without a contribution. Since 2020, cover does not start automatically for members under 25, or on accounts that have never reached $6,000.
What this means for you. Holding a super account is not the same as holding cover. It is worth checking which one you actually have before assuming either way.
What this all adds up to
None of this means your claim will fail. Acceptance rates for cover held through super are high, and the great majority of claims that reach a decision are paid. That is worth saying plainly.
What the evidence does show is that the process has specific, well-documented friction points: information requests that quietly stall a claim, policy definitions that shape the outcome before the medical evidence is even read, and delays that frequently have nothing to do with the person making the claim.
Knowing where those points are is often the difference between a claim that keeps moving and one that quietly stops.
That is what a free claim check is for
A short, no-obligation conversation to work out what cover you actually hold, which definition applies to it, and whether there is a pathway worth pursuing. You don't need any documents to start, and it costs nothing to find out.
Start a free claim check →This article provides general information only. It does not take into account your personal circumstances and is not financial, legal, medical or tax advice. The statistics above describe industry-wide patterns and say nothing about the likely outcome of any individual claim. Claim eligibility always depends on the relevant policy wording, legislation, medical evidence, employment history and individual circumstances.
Sources and further reading
- ASIC, Report 633: Holes in the safety net, a review of TPD insurance claims (17 October 2019). asic.gov.au
- ASIC, Report 806: Taking ownership of death benefits (31 March 2025).
- ASIC, media release 25-286MR, Cbus trustee penalised $23.5 million (25 November 2025).
- ASIC, media release 25-034MR, proceedings against AustralianSuper over death benefit claims (12 March 2025). Allegations not yet proven.
- APRA and ASIC, Life Insurance Claims and Disputes Statistics, December 2025 edition (published 29 April 2026). apra.gov.au
- APRA, life insurance statistics, June 2018 and June 2025 editions.
- AFCA, Annual Review 2024–25, and complaints data for the 2025 calendar year (February 2026). afca.org.au
A free claim check with ClaimSure
ClaimSure helps people understand the claims they may be able to make through life insurance and superannuation, including TPD, income protection, and death or terminal-illness cover. A free claim check is an obligation-free conversation; it does not guarantee any outcome, and eligibility always depends on the relevant policy wording, legislation, medical evidence and individual circumstances.
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