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What is a TPD claim?

If you have a superannuation fund, odds are you have a total and permanent disability (TPD) insurance policy. This helps protect you in case you become disabled. If you have more than one superannuation fund, you may have more than one TPD policy, all of which could provide you with a payout in the event you become unable to work.

Unfortunately, many people who suffer a disabling incident or illness don’t know that their super carries this cover, or if they do they don’t understand it (or how to access it). Filing a TPD claim isn’t necessarily difficult, but it does require certain steps to be followed.

A TPD lawyer could help you not only discover what TPD cover you have and how many policies could potentially yield a payout, but also walk you through the superannuation disability claim process and ensure you get the compensation you deserve.

What is TPD?

TPD stands for Total and Permanent Disability, and is usually attached to life insurance provided by your superannuation fund. It delivers a lump-sum payout if you have a medical diagnosis indicating that your life has been irrevocably changed and you will most likely never be able to work again.

TPD insurance claims are typically filed to take advantage of the lump sum payout, which can be used as income protection, help cover medical costs and other debts and provide for living expenses to reduce the ongoing burden of disability-related income loss.

For a successful TPD claim, you’ll need medical evidence and the reports from at least two doctors to prove you have a total permanent disability (or, in some cases, a terminal illness). Loss of a hand or foot, blindness, or a severe spinal cord or brain injury are all common causes for TPD claims, as are claims made for mental health reasons.

What kind of TPD insurance should you have?

While the most common source of a TPD policy is through a superannuation fund, you can also purchase TPD policies separately, or they may be bundled with other coverage such as a life insurance policy. There are three different levels of TPD insurance, and you should ask your super administrator or other insurer what type of policy you have.

Own occupation TPD

This type of cover doesn’t kick in unless the claimant is diagnosed with a disability that will prevent them from working in their own occupation ever again.

Any occupation TPD

This cover is even harder to meet conditions for, as it requires not only that the claimant be unable to work in their own occupation, but that they also cannot be retrained or reskilled to work in any other occupation.

Non-occupational TPD

This cover, instead of requiring that disability parameters regarding your ability to work be met, simply entails that you are unable to perform two out of five ordinary daily living tasks. It is typically not available on superannuation cover, and must be purchased privately.

Your TPD insurance policy must be in force for you to make a claim. In most cases, you must be gainfully employed, and have been such for at least the preceding six months before becoming disabled and filing a TPD claim. Your level of impairment should be measured after you have been diagnosed, treated, and reach a plateau that is expected to remain steady in regard to the level of impairment; that is to say, no further improvement is expected.

You’ll also need medical evidence showing that you pursued appropriate treatment and that you have exhausted your reasonable medical options. Your doctors should be in agreement over your level of impairment and likelihood of being able to work again.

Our disability lawyers can help determine if you have a good case for a TPD claim, and what you can do to make your argument stronger. They can also help you explore other avenues of disability compensation, which can be useful as the one-time lump-sum payment from your TPD claim (which, of course, won’t last forever).

What is the process when filing a TPD claim?

Step one when filing for a TPD insurance policy lump sum payout: Hire a lawyer.

Your disability attorney can be critical to getting your TPD claim approved. They will know all the ins and outs of the process and can assist you in filing your claim, gathering all of the medical evidence required to support it, and presenting it in an understandable fashion.

In most cases, you’ll want to file your TPD claim as soon as your pursuit of all available and reasonable treatment has been completed and your condition has stabilised. If you have filed for mental health reasons, make sure you’ve had your medical records collected to show your diagnosis and the practical analysis of your case that led to a recommendation for an official TPD assignment.

Once your claim is submitted, you’ll typically have to wait six months to a year for it to be reviewed. If your TPD insurance claim is accepted, the payout will be made by the trustee in a few month’s time, and those funds will land in your superannuation account. If you have made a successful TPD claim, and TPD benefit funds have been transferred to your superannuation account, you have several choices.

You can leave the money there to accumulate with the rest of your super fund until you reach the age when you’d typically begin withdrawing it. Alternatively, you can withdraw part of it or the whole amount, without having to pay the penalty, if you are below withdrawal age. You may even be able to get the lump-sum payout from your compensation claim designated as a tax-free withdrawal.

If your claim is rejected, you shouldn’t give up hope. Many TPD claims are denied the first time around. You can appeal the decision and look for more evidence to support your claim of total and permanent disability and inability to work. If your disability has worsened since your original filing, you may start over with a new claim and your new documentation.

Payouts on TPD claims from superannuation accounts might be anywhere from $60,000 to $300,000. More hefty sums can be obtained from private TPD cover, depending on your plan. Usually, such claims are capped at between $3 million and $5 million.

Even with some of the largest claims possible, if you are fairly young a one-time lump sum payout for your disability may not be sufficient to meet the needs of your loved ones and yourself. You should see if you qualify for the disability support pension (DSP), as this can deliver ongoing support in the form of fortnightly payments.

You also might be able to file a workers compensation against your employer, if your accident happens at work or on the clock. There is a duty of care employers have to employees, and if that trust is broken and you suffer a serious injury, you had best try to recoup your potential future earnings.

DSP claims, TPD claims, and workers’ compensation claims are all technically under different verticals. You may be able to file all three if you have had the right kind of cover for long enough.

Why you need a TPD lawyer to help with your claim

A TPD lawyer will be particularly helpful if your claim is denied. They understand the inner workings of the system, and can help cut through the confusion and find out exactly why your claim was rejected.

If your TPD claim is incorrectly denied, your disability lawyer can appeal the decision and fight even harder to get you the legal payout to which you are entitled. In some cases, there may be a clear reason for a TPD rejection, such as the cover having been explored with that particular super fund. Your lawyer will be able to appeal the rejection.

Typically, however, TPD claims are denied due to errors in the filing process or an insurance company routinely denying claims in the hopes that claimants will simply give up. A trustee for the fund also has to sign off, and it could take months for them to finish the process.

Because it can take so long for a TPD claim to provide the anticipated lump sum payout, you may need your lawyer to pursue other disability compensation claim actions. That way, whether you have a successful TPD claim or not, you can have some other funds coming in.

If you are unable to work and waiting on your TBD benefit, you may be able to file for a disability support pension. This compensation claim requires meeting some fairly strict medical and non-medical rules, but it can be well worth jumping through the hoops to secure a steady fortnightly payment.

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Gerard Malouf & Partners
 — Personal Injury Compensation Lawyers

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