Written by: Angelica Adhar For many Australians facing the life-altering effects of a total and permanent disability, the TPD claims process can feel daunting. Whether your disability stems from a workplace accident, a severe illness, or a traumatic event, securing TPD compensation is critical for ensuring financial stability.
What is a TPD claim and how does it work?
For many Australians facing the life-altering effects of a total and permanent disability, the TPD claims process can feel daunting. Whether your disability stems from a workplace accident, a severe illness, or a traumatic event, securing TPD compensation is critical for ensuring financial stability.
Understanding TPD claims: 4 things you should know
Coverage source
While most Australians hold TPD insurance through their superannuation, you may have multiple policies if you’ve switched jobs or opened new super accounts. In some cases, clients have discovered additional policies, increasing the amount of income protection they’re entitled to.
Payment type
TPD benefits are typically paid out as a lump sum, providing immediate financial relief. This lump sum can help cover urgent expenses, such as modifying your home or purchasing medical equipment, while also allowing you to establish a sustainable financial future.
Purpose of TPD insurance
The lump sum from a TPD claim can be used for several critical needs, including:
- Covering ongoing medical treatments and rehabilitation costs
- Adapting your home or vehicle to accommodate your disability
- Replacing lost income and supporting your family’s financial future
- Paying off debts or other financial obligations.
Multiple claims
Many people don’t realise that you can have multiple claims running simultaneously. For instance, if you’re eligible for a
Am I eligible for a TPD claim?
- Inability to work due to illness or injury: You must be unable to work for a significant period, typically between 3 to 6 months, due to your condition.
- Inability to return to your occupation or any suitable work: You need to have a condition that prevents you from returning to your original job or any other job you’re reasonably qualified for.
- Meeting your policy’s definition of TPD: Each policy has a specific definition of “total and permanent disability.” This definition must be met for your claim to be valid.
- Valid coverage at the time of your injury or illness: You must have had valid TPD insurance coverage in place when your condition developed.
Examples of TPD eligibility:
- Michael’s Case: Michael, a construction worker, developed chronic back pain over two years. He initially thought he couldn’t claim because there was no single injury date. However, with the help of a TPD lawyer, he was able to demonstrate that his condition had progressively worsened over time, eventually preventing him from working.
- Sarah’s Case: Sarah, a 45-year-old registered nurse, developed severe rheumatoid arthritis that made it impossible for her to continue working in her role. While Sarah initially doubted her eligibility, her TPD claim was successful once her lawyer demonstrated that her condition left her permanently unfit for her occupation.
What conditions qualify for TPD claims?
- Spinal injuries and paralysis
- Loss of limbs or limited mobility
- Severe burns
- Loss of hearing or speech
- Chronic pain conditions
- Severe arthritis
- Complex regional pain syndrome
- Fibromyalgia.
Mental health conditions
- Severe depression
- Post-traumatic stress disorder (PTSD)
- Schizophrenia
- Severe anxiety disorders
- Bipolar disorder
- Obsessive-compulsive disorder
- Treatment-resistant depression.
Chronic illnesses
- Cancer
- Multiple sclerosis
- Parkinson’s disease
- Chronic lung disease
- Alzheimer’s disease
- Chronic fatigue disease
- Autoimmune conditions
- Heart disease.
Can you make a TPD claim for depression?
What is the average TPD payout?
- Your occupation and qualifications
- Your age and earning capacity
- The severity of your disability
- The terms of your specific insurance policy
- The level of coverage you’ve maintained.
Book an appointment with our expert team
How does the level of personal injury affect TPD payouts?
| Your ability to return to your previous occupation | If your condition prevents you from performing your regular job duties, it may significantly impact the size of your payout. |
| Your ability to work in any other capacity | Assessors will determine if you’re able to perform other types of work for which you’re reasonably qualified. If you’re unable to work in any role, the payout may be higher to reflect the long-term loss of income. |
| The nature of the disability | Disabilities resulting from the loss of a limb, eyesight, hearing, or other critical senses can result in higher payouts, as they have a more profound impact on your ability to work and live independently. |
How does the level of personal injury affect TPD payouts?
Own Occupation TPD Insurance
- Better protection as it focuses on your ability to work in your exact role
- More expensive due to the higher level of coverage
- Example: A surgeon with hand tremors may qualify for a TPD claim even if they could still perform other medical roles.
Any Occupation TPD Insurance
- More common in superannuation policies
- Harder to claim successfully as it requires proving you are unable to work in any suitable occupation
- Example: An office worker with severe back pain would need to show they can’t work in any desk job, such as administrative or customer service roles.
Non-Occupational TPD Insurance
- Not typically included in superannuation policies
- Requires evidence of significant functional impairment, such as needing help with basic tasks
- Example: A person who requires assistance with self-care tasks like dressing, bathing, or eating may be eligible.
Get a Free Claim Check
How do I make a TPD claim? A step-by-step guide
Step 1: Initial assessment (2-4 weeks)
Confirm your coverage details
Start by contacting your superannuation fund or insurer to confirm your TPD insurance coverage. Many clients are surprised to discover they have multiple TPD policies across different super funds, particularly if they’ve changed employers over the years. You might also be eligible for coverage under different policies that you weren’t initially aware of.
Review your policy and claims forms
Request and carefully review your policy documents and claims forms. It’s crucial to focus on how your policy defines “total and permanent disability,” as this definition will form the foundation of your claim. Different policies may have slightly different criteria, so understanding the specific requirements is vital to formulating an effective strategy.
Verify the validity of your insurance
Check that your TPD insurance was valid at the time of the injury or illness and that it remains valid now. Policies have specific coverage periods, and they typically don’t provide retroactive coverage. In cases of long-term or progressive conditions, such as chronic pain or illness that has worsened over time, determining the start of your disability can be complex. This is why it’s crucial to consult with a TPD lawyer to clarify any uncertainties about when your condition legally began.
Step 2: Documentation gathering (4-8 weeks)
Medical evidence
- Detailed reports from at least two medical practitioners, including your treating specialists
- A complete treatment history, including all medications, therapies and interventions attempted
- Future treatment plans and prognosis reports
- All relevant medical imaging and test results
- Hospital admission records and discharge summaries
- Mental health assessments, if applicable.
Employment documentation
- A comprehensive employment history covering the past decade
- Detailed job descriptions and duty statements
- Recent payslips and tax returns
- Documentation of any attempted return-to-work programs
- Performance reviews from before and after your condition developed
- Workplace incident reports if your condition is work-related.
Additional supporting evidence
- Centrelink documentation showing any benefits you’ve received
- Workers’ compensation records if applicable
- A detailed diary documenting how your condition affects your daily activities
- Witness statements from family members, colleagues, or carers who can attest to the impact of your condition
- Financial records showing the economic impact of your disability.
Step 3: Claim submission (1-2 weeks)
Complete all required forms
Ensure that all forms are filled out carefully and consistently. Double-check that the information you provide is accurate and matches across all documents. We’ve seen many claims delayed or rejected due to seemingly minor inconsistencies in how conditions are described or dates are recorded.
Craft a comprehensive cover letter
A well-crafted cover letter is a critical component of your submission. This letter should clearly outline the key points of your claim and highlight the most compelling evidence. It serves as a roadmap for the claims assessor, helping them to understand how each piece of evidence supports your claim. In particular, the cover letter should reference your life insurance policy, explaining why you meet the specific criteria for Total Permanent Disability (TPD) based on your condition and the policy terms.
Step 4: Claim assessment (6-8 months)
Respond promptly to requests for additional information
If your insurer requests further documentation or clarification, provide it as soon as possible. Delays in responding can lengthen the assessment timeline and potentially weaken your claim.
Attend independent medical examinations
The insurer may require you to attend an independent medical examination to assess your disability. It’s vital to attend all scheduled exams and be honest and consistent in describing your condition, as discrepancies can harm your claim.
Get a Free Claim Check
Understanding TPD claims rejections and appeals
| Rejection reason | Solution |
|---|---|
| Insufficient medical evidence | Obtain comprehensive reports from specialists |
| Not meeting policy definitions | Carefully align evidence with policy requirements |
| Pre-existing condition exclusions | Prove the current disability is unrelated or significantly different |
| Incomplete documentation | Use a comprehensive checklist and regular reviews |
Can you return to work after a TPD payout? > Read More
How GMP Law can help
- Thorough policy review to ensure you understand your coverage and entitlements
- Identification of all potential claims to maximise your compensation opportunities, including additional policies or related personal injury claims
- Assistance with gathering medical evidence to strengthen your claim, including coordinating with specialists and obtaining necessary documentation
- Comprehensive employment history compilation to highlight the impact of your condition on your work capacity
- Form completion and review to ensure accuracy and avoid common mistakes that can delay your claim
- Statement preparation to present a compelling narrative that supports your claim
- Timeline management to ensure timely submissions and follow-ups, keeping your claim on track
- Expert appeals handling if your claim is denied or requires further negotiation
With our support, you can focus on your recovery while we handle the complexities of your TPD claim.
John's Journey: Overcoming adversity to secure a $500k TPD Claim
This image does not depict our actual client.
