You might have TPD insurance in Super. 

You’ve probably heard those very words or perhaps you’ve spoken them, but most people who have heard the phrase don’t know where to start when the time comes. How do you know whether you’re eligible or not? If you are eligible, what do the next steps look like for making a claim? 

Total Permanent Disability (TPD) Insurance, which is usually held inside super, pays out a lump sum when a claimant is unable or unlikely to work again. Some policies pay out if you are unable to work in your field, and some will only pay out if you can’t find suitable work in any field. In this guide, we’ll cover eligibility, evidence, the claims process, timelines, and the mistakes you should avoid.

At AJB Stevens, we have a long history of supporting our clients through the Total and Permanent Disability (TPD) claims process, whether we’re with them from the start or aiding their appeal.

TPD: What is it under Australian Law? 

The first thing to understand is that the term Total and Permanent Disability is an insurance definition, rather than a term you will come across in workers’ compensation or Centrelink. It’s Permanent Disability Work Cover. However, policies differ so it’s important you get to know yours and consider private cover for extra protection. Some policies cover own occupation, ensuring you a payout only if you are unlikely to return to the occupation you held pre-disability.

While other policies cover any occupation, ensuring a payout if you are unlikely to return to any type of work suited to your training or education. Additionally, certain policies come with cognitive loss tests or have a higher threshold of activities of daily living. 

It’s separate from the National Disability Insurance Scheme; it’s also separate from income protection and workers’ compensation. You could potentially pursue more than one of these, and finding a lawyer who specialises in Total Permanent Disability Insurance claims will help keep you on track. 

Eligibility: When You Qualify

  • Incapacity

You must have medical evidence to show your condition is unlikely to improve to the point where you will return to suitable work. 

  • Waiting Period

Waiting periods are policy-specific. However, most policies require at least three months of continuous absence from work before you can make a claim, while others may expect six months of absence.

  • Employment Status

If you held Total Permanent Disability in super or a private policy at the time of the event, you can qualify for TPD even if you’re a casual, contractor, or between jobs.

  • Psychological

A range of psychological conditions are eligible under TPD policies, including anxiety, depression, and PTSD. Your records matter and can serve as evidence of consistent treatment and add credibility to your claim. 

  • Pre-Existing Conditions/Exclusions

Always check the wording in your policy because there are always exclusions, and often, it’s pre-existing conditions or self-inflicted injuries.

Where TPD Cover Sits

The majority of industry and retail super funds include TPD insurance by default unless you choose to opt out. However, many people hold separate TPD insurance cover with their stand-alone life insurance policy or with a mortgage or credit policy. 

The most effective way to find out what TPD cover you have is to check your super statements and online portals. Many people hold multiple super accounts, so it’s important to track all of them down to claim with your best option for success. Some policies will allow you to make a TPD claim against more than one policy, which is why legal advice is a must before you take any action.

The Claims Process

1. Identify Your Policies 

First, find all your policies and check the fine print to ensure you’re eligible. You can request the policy terms for the date of your disability or diagnosis to get a better idea of what you’re up against. 

2. Confirm Cover 

Always ensure the policy you’re claiming against was active and valid at the time of your disability or when you ceased work.

3. Waiting Period

Check the policy for the waiting period and satisfy this if applicable. 

4. Notify Insurer

You will need to let your insurer know you plan to file a claim and request the relevant forms (member, employer, doctor).

5. Evidence Pack

Compile your evidence into a clear pack, including medical reports from your GP, psychologists, radiologist, or other specialists involved in your case, hospital notes, rehabilitation records, and vocational assessments. 

6. Occupational History

Compile a history of your education, qualifications, past roles, duties, hours, licenses, physical demands of the job, and also the psychological demands.

7. Submit

Once you submit your claim, the insurer will assess it. They may reach out for additional information or request an independent medical examination. Some may want vocational reviews.

8. Decision

If your claim is approved, a lump sum will be paid into your super account. If your claim is rejected, the rejection letter will detail the reasons, and you can address each of these in your appeal. 

9. Challenge

If your claim fails, there are several paths to take, and a lawyer can offer advice on which path is best, whether it’s an external complaint to AFCA, following the insurer’s appeals process, or starting court proceedings.

The timeframe you’re looking at should be thought of in months, rather than days or weeks. If your claim is psychiatric in nature or a more complex case, the process can take even longer. Working with an experienced lawyer by your side could prevent some of the delays. Your lawyer can also help you gather the right evidence, deal with your insurer, and handle any other issues that come up. In the case of an appeal, they coordinate the response. 

Common Pitfalls: 

  • Policy mismatch – arguing over own occupation when the policy states any occupation.
  • Treatment history – if you’ve had inconsistent diagnoses or there are long gaps between GP appointments or specialist reviews, it could go against you. 
  • Playing up, playing down – it’s important that your documents and evidence are consistent, whether they’re searching your social media, reading your employer statements, or reviewing the forms you completed. 
  • Incomplete occupational evidence – accurately describe the critical demands of your job, including tasks and expectations. You also have to address transferable skills and be honest about your education, training, and experience. 
  • Missed deadlines – always respond to queries and follow through with appointments, whether it’s an independent medical examination or a request for additional information.
  • Assuming you won’t succeed – this is a common mindset for people with psychological claims. They are more complex, but they can be successful if your clinician links your symptoms to functional incapacity and prognosis.

Tax, Super Release, Interaction

Your benefit will land in your superannuation account, and once it does, you can apply for a condition of release to release the funds. There is a risk of your lump sum attracting concessional taxes, but this is something to speak to a lawyer or tax professional about. There is a range of components to consider. Another key reason to work with an expert is to ensure you claim the maximum possible amount from the other paths available to you, including income protection, common-law damages claim, Centrelink DSP, or workers’ compensation. Likewise, you may be able to claim against multiple TPD policies if they were active at the time of your disablement. 

How a TPD Lawyer Can Help 

  • A lawyer will review the policy terms before proceeding to ensure they choose the best option and build their evidence strategy around the specific terms of the policy. 
  • A lawyer can help you gather and curate all the relevant evidence to support your claim, whether it’s preparing statements, coordinating specialists, or addressing any inconsistencies across notes.
  • It’s a stressful process, and a lawyer will handle the insurer processes, including surveillance, vocational assessments, independent medical examinations, and build a robust response to dissenting opinions.
  • A lawyer can manage the appeals process or negotiate resolutions on your behalf. 

When should you call a lawyer? If you have been off work for several months already, call a lawyer as soon as possible. If your doctor has told you it’s unlikely you are able to return to suitable work, call a lawyer as soon as possible.

FAQs

Do I have to be completely unable to do anything to qualify? 

That depends on the wording of your policy, but no.

Will a workers’ compensation payout stop my TPD claim from going through? 

Not usually, but you should always check the terms to be sure.

What if my TPD claim is denied? 

You still have several options, including an appeal. 

Call AJB Stevens

Your life can change in a split second, and TPD is there to provide financial stability for people who are unable to realistically return to suitable work. To ensure you receive the payout you deserve and can enjoy financial stability, take advice early to start the ball rolling and avoid denials or delays. 

If you had to give up work due to injury or illness and you’re unsure whether you’re eligible for TPD or whether you have a policy at all, contact AJB Stevens to schedule a confidential review of your TPD policies. We’ll help you plan a clear path forward to ensure you receive the compensation you’re entitled to.