TPD Claims – Total and Permanent Disability Claims

Broadly speaking, Total and Permanent Disability refers to a permanent condition (i.e., an injury, an illness, etc.) that leaves you totally unable to work. However, the precise definition varies by each super insurer. The challenge lies in establishing that you meet the specific requirements for Total and Permanent Disability used by the insurance company.

Many different health issues could give rise to a viable TPD claim—if it can be shown that you satisfy the terms of the superannuation policy. An experienced TPD lawyer can evaluate your situation and determine whether you have a claim.

Serious injuries are a common cause of Total and Permanent Disability. You may have a TPD claim if you suffer any of the following:

• Spinal Injury
• Brain Injury
• Eye Injury Resulting in Vision Loss or Blindness
• Permanent Hearing Loss
• Disc Injuries in the Neck & Back
• Loss of the Use of a Limb
• Amputation Injury
• Paralysis
• Repetitive Stress & Motion Injuries (e.g., carpal tunnel syndrome, torn rotator cuff, etc.)
• Severe Burns

Unlike other compensation schemes, the injury does not have to occur in a particular situation for you to lodge a TPD claim. Life-altering injuries sustained in a motor vehicle accident, at work, at home, or under any other circumstances may entitle you to a TPD benefit.

Severe illness is a leading cause of Total and Permanent Disability. You may be entitled to TPD compensation if you have any of the following conditions:

• Cancer
• Heart Attack & Stroke
• Arthritis & Other Musculoskeletal Disorders
• Heart Disease
• Progressive Vision Loss
• Hearing Loss & Deafness
• Respiratory Illnesses
• Alzheimer’s Disease & Dementia
• Multiple Sclerosis
• Amyotrophic Lateral Sclerosis (ALS)
• HIV/AIDS
• Epilepsy
• Parkinson’s Disease
• Autoimmune Disorders

Experien Insurance Services reports that mental health conditions are the most common reason for TPD claims, accounting for 24% of claims made by men and 27% of claims made by women. Mental disorders for which you may be able to claim the Total and Permanent Disability benefit include:

• Depression
• Schizophrenia & Schizoaffective Disorder
• Bipolar Disorder
• Anxiety Disorders
• Personality Disorders
• Impulse-Control Disorders
• Post-Traumatic Stress Disorder (PTSD)

These are not comprehensive lists. TPD Compensation Lawyers will evaluate your medical records. We may also refer you to qualified medical practitioners who can assess your condition. All of this evidence can help our lawyers complete your TPD application. It also improves the likelihood of your claim being accepted.

No. Although work-related injuries and illnesses can give rise to conditions that may qualify for Total and Permanent Disability, your disability does not need to be work-related for you to lodge a claim.

Employers in Australia are required to carry workers’ compensation insurance. Workers’ comp provides coverage if an employee gets injured or becomes sick as a result of their job.

Total and Permanent Disability cover is a separate type of insurance policy. There is no requirement for a disabling injury or illness to be related to your employment—even if you are claiming a TPD benefit on super insurance held by your employer.

Eligibility for TPD hinges on the claimant’s ability to work. Super insurers use one of two definitions for determining Total and Permanent Disability based on an individual’s employment:

1. Any occupation coverage: The most common form of TPD cover is ‘any occupation’ insurance. If you are unable to work in any capacity for which you are suited based on your education, skills, and training, you may be entitled to a Total and Permanent Disability benefit.
2. Own occupation: ‘Own occupation’ insurance, meanwhile, provides cover if a Total and Permanent Disability prevents you from working in your current occupation. Under ‘own occupation’ coverage, you may be entitled to a TPD benefit even if you are able to find work in another field.

Generally, TPD claims under ‘any occupation’ cover are more difficult to get approved. Insurers set a high threshold for Total and Permanent Disability when an individual is claiming that they are unable to work at all. However, if this describes your situation and you are covered by super insurance, you deserve the maximum benefit.

TPD Compensation Lawyers will review the superannuation insurance policy and advise you what is required to qualify for TPD. We know the types of medical records and other evidence insurers look for when evaluating TPD claims, and we will thoroughly prepare the application on your behalf.

Multiple documents are typically required when lodging a TPD claim. In addition to your application, the following may be requested:

• Medical records
• Signed medical authorities (i.e., statements that authorise a medical practitioner to discuss services provided to you with the insurance company)
  • NOTE: Most super insurers require the submission of a minimum of 2 medical authorities from different practitioners
• A resume, CV, or other document showing your employment history
• Tax documents
• Workers’ compensation records (if applicable)

You may be required to undergo one or more appointments with specialised medical practitioners (often known as Independent Medical Examinations, or IMEs). Undergoing an IME can further support your claim for Total and Permanent Disability; specialist doctors will evaluate your capacity for work based on a disabling condition.

Ultimately, it can be difficult to know what, exactly, the insurance company is looking for when reviewing a TPD claim. It is in your best interest to contact a TPD specialist lawyer before you try to lodge a claim on your own.

Generally, yes, you can receive both income protection payments and a TPD benefit. Income protection is a separate insurance policy from TPD insurance. Your employer may provide income protection, or you may purchase coverage on your own.

Income protection pays a percentage of your monthly income if you are unable to work due to disability. Payments continue until one of the following happens:

• You return to work
• The maximum benefit period elapses (varies by policy; usually 2–5 years)
• You reach retirement age
• Death

You can lodge a TPD claim while you are receiving income protection benefits. Once the TPD benefit is paid, you can typically still get income protection payments until one of the events above occurs. However, some super funds will require that income protection benefits cease upon the payment of a lump sum TPD entitlement. TPD Compensation Lawyers will review all insurance policies to determine what effect claiming one benefit may have on your eligibility for other forms of coverage.

There is no way to answer this without knowing (a) the terms of your TPD cover and (b) how much money is currently in your super fund. Our lawyers get started on your claim by reviewing the insurance policy and contacting the insurer to determine what funds are available.

A TPD payout is made in a one-time lump sum. The amount of the payment could range from $30,000 to more than $1 million, but these numbers may vary. TPD Compensation Lawyers can provide a more accurate assessment at your FREE consultation.

Lodging a TPD compensation claim may involve several challenges. Common issues claimants face include:

• Multiple requests for more information: Sometimes an application may be incomplete, in which case the insurer will reach out for additional information, paperwork, etc. Depending on what’s missing, the insurance company could contact you multiple times.
• Delays: The average time for the super insurer to complete its assessment of a TPD claim is approximately 6 months to 1 year. More complicated claims could take longer. If you have been waiting for months with no communication, the insurer could be intentionally dragging out the process.
• Requests for Independent Medical Examinations: Most requests for an IME are considered reasonable if they can provide the super insurer with needed information on a Total and Permanent Disability. However, repeated requests for multiple IMEs could be a delaying tactic.

Many of these difficulties can be overcome by hiring an experienced TPD compensation lawyer. A knowledgeable specialist in TPD claims can help you file a complete application the first time and handle any additional communications with the insurance company. If your claim is rejected, we can promptly appeal the decision.

The majority of TPD claims are rejected by super insurers—at first. Some of the most common reasons for the rejection of a claim include:

• Your application is incomplete.
• The insurer believes that you don’t meet the criteria for Total and Permanent Disability.
• Insufficient medical evidence is provided.
• The waiting period has not been satisfied; TPD cover only becomes available after you have been unable to work for a defined period of time (usually 3–6 months).
• You have not satisfied the requirements concerning work history.
• The policy has become inactive due to lack of contributions to the super fund.
• Your age exceeds the term set forth in the policy (eligibility for TPD usually ends at retirement age).

If your TPD claim is rejected, TPD Compensation Lawyers can help. A TPD benefit can make an enormous difference in your ability to pay for daily necessities, medical care, and more. There are multiple options for appealing the rejection of your claim, and we will fight to obtain the entitlement you deserve.