Confused about the TPD claim process?
If you’re unable to work due to an injury or illness, you may be eligible for a Total and Permanent Disability (TPD) Benefit claim. The TPD claim process can be difficult to work through if you’ve never had to do it before, which is why many people seek legal advice to pursue a TPD payout.
TPD claims are designed to support individuals who are unable to return to work due to injury or illness, but there are certain eligibility criteria you need to meet. If you’ve been injured or suffered an illness that prevents you from working, read on to find out more about the TPD claim process.
What is a TPD Claim?
TPD insurance is often included as part of your superannuation fund, however, some people choose to take out their own TPD cover, too. A TPD claim can be made where you can no longer work in the kind of work you have previously performed, ‘your usual occupation’ due to injury or illness. If approved, you will receive a lump-sum benefit as defined by your policy documents. If your insurance is held within your superannuation the TPD benefit payment is made into your superannuation fund.
You may find that different insurance companies and superannuation funds have varying eligibility and TPD entitlement criteria, and they may even have different definitions of what constitutes a total and permanent disability. So, it pays to check your policy carefully, but ultimately, it’s about providing a lump sum benefit when an injury or illness prevents you from working in your usual occupation.
What injuries and illnesses might qualify for a TPD payout?
Any condition which has a significant impact upon your capacity to work may qualify for a TPD payout, but it really depends on a person’s individual circumstances. For example, a wrist injury might prevent a skilled tradesman from doing the work they’ve been trained in. However, a wrist injury for an office worker may only require a set amount of time away from work. TPD policies usually have several different definitions of TPD that fall into two broad categories related to whether you were employed or not employed when you suffered your illness or injury:
- If you were employed, you must be unlikely to ever again work in a role for which you are educated, trained and experience;
- If you were unemployed, you must be wholly unable to perform 2 or 3 of the nominated Activities of Daily Living
The wording of your policy determines whether you’re eligible for a benefit payout or not, so it pays to check the eligibility conditions and TPD definitions carefully and consult an experienced TPD lawyer to ensure you have the best chance possible. While every claim is assessed individually, some of the common injuries/illnesses for a TPD claim include:
- Spinal injuries
- Brain injuries
- Loss of limbs
- Paraplegia
- Cancer
- Multiple Sclerosis
- Parkinson’s disease
- Motor neurone disease
- Depression
- Schizophrenia
- Bipolar disorder
What are the eligibility criteria for TPD claims
As we mentioned, all TPD policies are different, with varying definitions and criteria that must be met. Generally, though, you’ll need to provide certain types of evidence to confirm you are totally and permanently disabled. Here’s what you’ll need:
- Medical evidence: You’ll need comprehensive medical reports from doctors and specialists, confirming the injury, illness or disability. Your medical practitioners will need to make an assessment as to whether you meet the correct TPD definition or not.
- Employment details: Providing clear details of your job and why you are unable to perform the duties of that occupation (or any occupation, depending on your cover), and your entire work and education history.
In addition, and we can’t stress this enough, you must provide the evidence necessary to prove to the insurer’s satisfaction that you meet the policy’s terms and conditions. Each policy is different, if you are unsure, you may want to seek legal advice to pursue your TPD benefit.
Why choose our TPD services?
If you’ve suffered an illness or injury and can no longer work, we understand that it’s an incredibly challenging time for you and your loved ones. Chasing doctors for medical advice, past employers for employment information and filling out forms and managing paperwork is probably the last thing you want to do. However, a superannuation TPD claim can be life-changing if your income has been halted.
Our team of expert TPD lawyers take the stress and hassle out of making a claim. We have a deep understanding of the TPD system, and we understand your specific policy and what is required to improve the likelihood of a successful claim.
Our principal lawyer, James, has years of experience assisting Australians to claim the benefits they’re entitled to following illness and injury, providing a tailored service that aims to deliver the best outcome on each claim.
The TPD claims process
The process for lodging a TPD claim contains multiple steps if you want to give yourself the best chance of success. Here is a step-by-step guide on the TPD claim process.
Step 1: Gather your policy information
The first step is to gather all of your insurance policies together. If you’ve worked multiple jobs, you may have more than one super fund. So, if you intend to make a superannuation TPD claim, keep this in mind and collect policy information for each. You can claim against multiple insurers, but bear in mind you’ll need to submit separate applications to each.
Step 2: Check that policies were valid at the time of injury or illness
When gathering your policy information, double-check that all policies were valid at the time of your injury or illness. If any policies were inactive at that time, you won’t be able to make a claim against them.
Step 3: Review the eligibility criteria
Thoroughly read through the eligibility criteria for each policy you intend to claim against. Remember, every superannuation fund and insurer has different eligibility requirements. For example, some policies will cover you for pre-existing conditions by default, and some will only cover you for pre-existing conditions in certain circumstances. To know which policy you have, you must carefully review the eligibility criteria. Then review the TPD definition to ensure you gather the right evidence to show you meet it.
Step 4: Submit your application
Contact your superannuation fund or insurer to get the appropriate claim forms. Complete and submit these forms, but pay attention to the details. It’s crucial that you provide substantial evidence to support your claim, rather than simply filling out the form. Remember, you are required to provide all necessary evidence to the insurer, they are not required to obtain the bulk of the evidence on your behalf. Incomplete applications may be suspended, or closed, so take the time to prepare a thorough application.
Step 5: Explain why your claim should be approved
When you apply for a job, you don’t just send a resume. You also include a cover letter explaining why you’re the best person for the job. TPD claims are the same, so don’t just fill out the form and provide no context. Include a well-written submission outlining why your claim should be approved, and give specifics on why you meet the eligibility criteria and the TPD definition.
Step 6: Contact the insurer
If you don’t hear anything from the insurer, keep following up with them. They may need further information to progress your claim, but they aren’t always proactive in contacting you to request it or in providing you with updates.
Step 7: Seek legal advice if your claim is denied
If your initial claim is denied, don’t panic. There is always a dispute process you can follow. If you’re not satisfied with the result, contact a TPD lawyer for guidance. They can let you know where your application could be stronger, and even prepare submissions on your behalf, even if your claim has been denied. You must seek help as soon as possible after your claim is denied as a six (6) year statutory limitation period applies. This is usually from the date your claim is first denied by the Insurer, however in some circumstances it can be earlier than that.
Need help with the TPD claims process?
Whether you’re in Chermside, Nundah, Banyo or anywhere else in Australia, Beach2Bush Lawyers is committed to delivering quality outcomes to our clients. If you’ve been injured or suffered an illness that prevents you from working, our legal experts can help guide you through the process of making TPD claims. Our TPD services are comprehensive and tailored to your circumstances. Contact us today and book a consultation to discuss your needs.
