Many people in Queensland, particularly current or past Queensland Government employees, are members of QSuper. TPD insurance in QSuper can vary significantly depending on your age, when you joined the fund, whether you are employed by the Queensland Government and whether you work in an emergency services role; for example a police officer, ambulance officer, fireman, nurse in the public system etc.
Members of QSuper who are in employment and receiving contributions from their employer receive a default level of insurance cover when they join the fund. The insurance provided is, for most people:
- Death insurance
- Total and permanent disability (TPD) insurance; and
- Income protection (IP) insurance.
QSuper insurance policies have changed a lot over the last decade
QSuper has changed its insurance arrangements in a number of different ways over the last decade. So, if you’ve had to stop work it is important that you get advice and understand your rights before making a claim.
In addition, if you’re yet to stop work, but are struggling due to an injury or a sickness you should get advice about your entitlements before making a decision to stop work or reduce your working hours.
Under the QSuper insurance arrangements (at 1 July 2018), for the purposes of a TPD claim, you need to satisfy QSuper that (amongst other things):
‘You’re unlikely ever to be able to work again in a job for which you’re reasonably qualified by education, training or experience that you’ve acquired or could reasonably be expected to be able to acquire in the future within a suitable rehabilitation/ retraining program’
Which TPD definition applies to your claim?
The definition of TPD with QSuper has changed over the last decade, and so the definition you need to meet if you stopped work prior to the current insurance arrangements might be an easier definition of TPD.
If you lodge a TPD claim, the definition of ‘TPD’ used, will be the one in place at the time you stopped working.
It is not uncommon in a TPD claim to have disputes about the timing of the assessment of TPD and which definition applies.
Be aware of rejected claims due to ‘pre-existing medical conditions’
In addition, we’ve seen many people in the past who’ve had disputes with QSuper because their claim was declined due to a ‘pre-existing medical condition’. Such disputes can be complex.
We’ve seen some instances where someone may previously have had a minor episode of depression a long time ago and is now lodging a TPD claim for a mental health condition. QSuper has declined their current claim because they say that the previous minor episode of depression is related to the new (current) mental health condition such as anxiety, bi-polar disorder or Post Traumatic Stress Disorder (PTSD).
If a TPD claim is rejected, you have rights to appeal that decision both internally with the super fund or otherwise through the Australian Financial Complaints Authority or a court.
If you’re currently going through a TPD claim and need to speak to someone, please call us for a free, no-obligation chat about your situation. You can speak directly with today’s blog writer, Paul Watson.