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TPD Claims Guide: Making a Successful Claim

If you’ve been injured in an accident, and your doctor deems you unable to return to work, you may be eligible for TPD compensation. To claim the payout you need to cover your expenses like medical payments, ongoing physical therapy, mortgage, food and other costs you’ll no longer have the income to cover, you’ll have to work with insurers which may come with its challenges. This guide will explain what a TPD claim is, the steps within the claims process, compensation expectations and everything in between

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What is a TPD claim?

Total permanent disability (TPD) insurance is a type of coverage, usually attached to a life insurance policy provided by a superannuation fund. If an individual becomes totally and permanently disabled as a result of an injury, or illness, they may be eligible to make a TPD claim.

A TPD insurance claim can provide financial stability by delivering a lump sum payment which can be used as income protection, to help cover medical costs, and provide for living expenses. This reduces the ongoing burden of disability-related loss of income. 

For a successful TPD claim, you’ll need medical evidence and reports from at least two doctors to prove you have a total and permanent disability (or, in some cases, a terminal illness). 

What injuries would qualify for a TPD insurance claim?

Generally, any debilitating illness or injury that prevents you from working would qualify you for insurance payouts. However, your insurance policy will dictate how much compensation you’ll receive based on your injury or illness, as well as what injuries and illnesses that are included. Common conditions that may qualify for a claim include: 

Physical injuries:

  • Loss of hearing or speech.
  • Spinal fusions or paralysis.
  • Loss of a limb. 
  • Paraplegia.

Mental health conditions:

  • Anxiety.
  • Schizophrenia.
  • Post-traumatic stress disorder (PTSD).
  • Depression.

Disease and Illnesses:

  • Alzheimer’s disease.
  • Parkinson’s disease.
  • Multiple Sclerosis.
  • Chronic Lung Disease.
  • Cancer.
Can you make a TPD claim for depression?

Learn more about filing TPD claims for depression and mental health.

Criteria to make a successful TPD claim

When filing a TPD benefit claim, you’ll need to meet certain requirements.

1. Level of disability

The level of personal injury suffered due to illness, mental illness or after an accident is a major determining factor for a payout. The TPD claims assessor will consider if:

  • You can return to your prior occupation.
  • You are capable of performing any other form of employment in the future.
  • Your disability stems from losing a whole or part of your limbs, eyesight or other senses.
2. Type of TPD insurance

Major injuries that lead to permanent disability are often covered by your superannuation fund, but you can purchase individual life insurance as well.

There are three types of TPD insurance you can choose from:

  • Own occupation: This insurance kicks in when the injured person cannot return to their place of work and complete the work at the same level of ability.
  • Any occupation: The victim of an accident cannot return to their place of work and cannot be retrained or reskilled for another occupation. These claims can be more difficult to prove.
  • Non-occupational: Not typically covered by your super, this type of TPD coverage simply entails that you are unable to perform two out of five ordinary daily living tasks.

Our specialist superannuation lawyers can help you understand the specifics of your insurance policy and to help you navigate your claim. 

3. Minimum work history

Certain insurers require injured individuals to meet minimum work history requirements to qualify for TPD income protection insurance. These include:

  • A minimum of 12 months of working history, which the claimant must be able to demonstrate with evidence such as contracts.
  • Whether the work performed was on a full-time or part-time basis.
  • The total number of hours worked at the time of injury.
4. Ability to perform daily tasks

Some TPD compensation claim policies that assist with increased day-to-day living expenses require individuals to demonstrate that they cannot perform basic living activities. These include — but aren’t limited to — walking, bathing and eating. Your doctor will help you with medical evidence so you can get your insurance claim completed more quickly.

5. Need for ongoing medical care

Other factors in TPD compensation claims require proof that you need ongoing medical care due to the injury. You can meet this criterion by showing evidence of medical and rehabilitation appointments. Compensation law professionals will deal with the insurance company and the overall claims process so you’re not alone when you need TPD coverage.

Book an appointment with our expert team

The TPD claim process: Step-by-step

It’s essential to consider the different steps you’ll need to follow to file a successful TPD claim, so you can get the coverage you need without delays.
Step 1: Reach out to your superannuation and personal injury insurance provider

The first step to lodging a TPD benefit claim is identifying your insurance coverage entities. Whether that’s through your super fund or independently-purchased insurance, you’ll need to find these connections right away.
Here, you’ll find coverage details and how much compensation you can expect from insurance. Keep in mind that you may have multiple TPD claims and insurance avenues to explore if you changed your job or opened additional lines of coverage. This is common and could qualify you for more coverage. The outcome of one super claim does not affect others — you can file a claim for each policy.

Step 2: Ensure that your policies were valid at the time of the injury

Check to make sure your insurance was valid at the time of the injury and is still valid now. Insurance can only cover you for a specific duration, and not retroactively. In situations of a long-term illness or chronic pain that has worsened over time, this could be a grey area. If you have questions about when your condition legally began, it’s important to work with a total permanent disability lawyer throughout the process.

Step 3: Understand what it is your insurance covers

If you have valid insurance, you should consider exactly what your insurance covers. Some protect you if you’re unable to return to your job before the accident, and others apply if you are unable to perform any line of work. This is an important distinction if you’re filing for work protection that has resulted in a severe condition like paralysis.

Step 4: Apply for coverage

A TPD insurance claim requires that you submit an application to the necessary office and include all medical bills, recommendations, details of the injury and all other relevant documentation. You’ll need to substantiate the claim with evidence such as workers’ compensation and medical records to qualify — the application alone will not help you earn a TPD payout.
If you’re working alone, this process may drag on with a back and forth from your insurer asking for more information. In this step especially, you should ask for advice and work with a personal injury lawyer to help you file the necessary documentation. It’s not uncommon for an applicant to give up on filing because the process can be frustrating; this doesn’t have to be you with the help of an informed TPD lawyer.

Step 5: Write up and include a letter on why you need coverage

For your claim to be approved as quickly as possible, you need to write a well-written application that includes a thorough, thoughtful and detailed description of your medical condition, mental illness, disability and income protection needs. 

You’ll need to write a formal letter explaining your condition to insurers and why you need TPD insurance coverage. After looking over your life insurance policy, this letter should outline why you meet each criterion. A well-written application signifies that you’ve reached out to medical professionals and TPD lawyers to formulate a legitimate claim. Insurance company personnel receive thousands of phoney applications every year, indicated by a poorly written application that does not meet the requirements.

Step 6: Be proactive about your claim

Being proactive about your claim means following up with your insurer to check that you included everything they needed for their evaluation. Because insurance organisations have to sift through many applications every year, don’t assume they will tell you if you’ve missed anything before denying your claim.

Step 7: Don’t stop trying if your claim gets rejected

There is a rejection process you can follow if your claim gets denied. Just because your claim gets rejected the first time doesn’t mean that’s the end of the line for your coverage. Reach out to a lawyer to dispute the rejection and help you prepare for the next application.

Is there a time limit to claim TPD?

Typically there is no time limit to filing a TPD claim, which means it could be years after you stop working before you file for a TPD insurance payout. However, there are exceptions:

  • You need to file before you reach pension age.
  • Some policies require a time limit — this will depend on your life insurer.
  • You may have a time limit after which your original request was declined to make another.

How long does a TPD claim take?

It can take up to six months for an insurer to look over your claim and approve you for coverage. Once the insurer has reached a conclusion, superannuation professionals must look over the TPD cover insurance recommendations and make their own determination. This could take between one and two additional months.

Because there are many steps and procedures involved with making a claim, a compensation lawyer at Gerard Malouf & Partners is here to help. They can help you put together the paperwork and pull the evidence necessary for coverage to ensure the process is expedited. 

Can you return to work after a TPD payout? > Read More

Why would a TPD claim be rejected?

There are many reasons why your TPD payment may be rejected. Some reasons are very much within your power to correct in order to get coverage. Here are a few common reasons for a claim being rejected:
  • Filing outside of the age recommendations.
  • Applying before your injuries are fully realised (a minimum waiting period).
  • Turning in evidence that is questionable or not relevant to your current condition.
  • Missing criteria for compensation.
If you filed your claim before reaching the waiting period, talk with your doctor about when you will fully realise your injuries so you can resubmit your claim then.

What is the average TPD payout?

On average, your TPD compensation is two-thirds of your total lost wages. TPD payouts often range between $60,000 and $500,000 depending on your level of injury, how long you will likely need payout and how big your expenses are.

How much do lawyers charge for TPD claims?

GMP Law works on a no-win, no-fee basis. If we don’t win you the benefits you need, you don’t pay. Additionally, it is illegal in Australia to charge a percentage of the compensation you are awarded. Therefore, we work off of a fixed rate so you know exactly the dollar amount of legal fees you’ll pay after you will payout. This fee is taken out of your compensation benefit so you don’t have to worry about paying in instalments or later. 

How to make a successful TPD claim

With this information as your guide, you’re sure to make a successful TPD claim. The law professionals at GMP Law have years of experience and a 98% success rate so you’re sure to get the benefit you need to cover your TPD. For more information or to sign up today, enquire now.

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About Us
Gerard Malouf & Partners have provided friendly, experienced legal advice to communities across Australia for over 35 years. Our Personal Injury Lawyers have taken on ten’s of thousands of cases and we are proud to have won billions of dollars for our clients.
Meet the diverse and dynamic team of compensation lawyers and supporting staff that have made this all happen below. Our multi-lingual team can discuss your claims in Arabic, Assyrian, Turkish, Greek, Italian, French, Serbian, Croatian, Armenian, Mandarin, Hindi, Punjabi or Malayalam.
Meet the diverse and dynamic team of compensation lawyers and supporting staff that have made this all happen below. Our multi-lingual team can discuss your claims in Arabic, Assyrian, Turkish, Greek, Italian, French, Serbian, Croatian, Armenian, Mandarin, Hindi, Punjabi or Malayalam.

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