Falling ill or experiencing an injury can lead to serious financial strain, which can result in mental health challenges, especially if that illness or injury results in total and permanent disability. That doesn’t mean you are out of options, however, as you may be able to claim for total and permanent disability through your superannuation fund. It’s far more than a simple retirement fund, and many people don’t realise the potential cover they have. Additionally, you can still claim for TPD if you receive WorkCover, trauma insurance, or other types of benefits.
Common Causes of Total and Permanent Disability (TPD) Claims
There is no strict list, and what is classed as a total and permanent disability in your situation will depend on your insurance policy.
However, some of the most common causes of TPD claims include mental health issues, car accidents, cancer, autoimmune disorders, and workplace accidents. The latter is particularly common as almost half a million Australians are injured on the job each year. They don’t necessarily all rise to the seriousness of a TPD claim, but they are more common than one might believe. Around 7% of those people were out of work, lost their job or left as a result of their injury, while a further 8% changed jobs.
Generally, if you are unable to continue working in your usual occupation as a result of injury or illness, TPD insurance will cover you. While the word permanent may seem big, if you have been absent from work for a continuous period of three to six months, you generally qualify to make a claim.
Often, people will find they have Permanent Disability Work Cover tied to their superannuation. This is generally the most basic Total Permanent Disability (TPD) Insurance available. It typically covers you if you are unable to continue working in any field or position. Private TPD Insurance is more expansive, if you are unable to continue in your specific field or what you trained for, then you are bound to receive a payout. For example, if you have private cover and injure your back on a construction site, you will likely receive your claim because you cannot continue in your position. Whereas, someone who is only covered through their super may not receive the claim because they can find work elsewhere that doesn’t require manual labour.
There are certain factors that come into play when making a TPD insurance claim, including age, ability to work, multiple policies, active employment, and whether you have pre-existing conditions.
The Legal Options
Every policy sets its own requirements and you have to meet these to secure a payout. It will likely require an independent medical examination so your level of fitness for work can be accurately assessed. If you are denied, the insurer will outline what potential next steps you have, whether it’s a complaint directly to the insurance team or to the Financial Ombudsman. This is why it’s so vital that you seek legal advice as early in the process as possible. An expert can help guide the process to ensure you don’t get refused, and if you do, the wording of the follow-up complaint is crucial to overturning the decision.
You must disclose all of the relevant information to your claim and the insurer can refuse your claim if they uncover the information you withheld, whether it was intentional or not. There are certain disabilities a policy may exclude, these are generally tied to medical conditions, especially pre-diagnosed. Likewise, insurers will generally refuse to cover conditions or disabilities that are a result of intentional self-harm.
If you work in a high-risk job, there may be additional exclusions based on your employment. There are also often exclusions based on dangerous hobbies, such as base jumping.
How AJB Stevens Can Help
In addition to TPD Insurance or TPD Insurance in Super, you can go down the route of filing a personal injury lawsuit. You may also be able to file a workers’ compensation claim if your accident was work-related. Ultimately, seeking advice from expert lawyers will help you determine what route will serve you best.
A lawyer can help you track down the various Total Permanent Disability in Super cover you have, and ascertain whether you can make an application on all of them, or which one is most likely to pay out a larger sum.
Alternatively, they can advise you on pursuing a different legal option if your TPD payout is lower. If you pay for Total Permanent Disability Insurance privately, you are more likely to receive a larger payout and it will provide broader coverage. In the past, there was nothing to prevent you from filing claims if you hold multiple policies. However, many insurers are including clauses to prevent this. Still, it’s worth discussing this option with your lawyer if you hold several super accounts and a private policy.
You may still be able to file a claim if your illness or injury was pre-existing, it’s important to seek legal advice to be sure you are taking the correct course of action. Additionally, just because you make your super contributions, does not necessarily mean the TPD insurance will cover your specific circumstances. The criteria tend to be quite specific. By paying for a private TPD policy you extend your chances of a successful TPD claim. If you, or a loved one, has experienced a total and permanent disability as the result of an illness or injury, reach out to AJB Stevens to discuss your case. Our team can help you receive the compensation you deserve.