Content updated September 2022
TPD means “total and permanent disability”. It is a definition or a test, contained in insurance policies that must be satisfied to receive a lump sum insurance benefit. TPD benefits can often be claimed through your superannuation fund. You are a candidate for a TPD claim if you cannot work because of injury or illness.
Like anything involving insurance, there are things you should do when you make a TPD claim and things you should not do. There are tricks to use and traps to avoid and you can read more about those here.
Furthermore, the claim process can be exhausting and frustrating. It goes without saying that having expertise in the TPD claim’s process or seeking professional advice and assistance will improve your chances of the TPD claim being a success.
Do I have TPD cover?
You will almost certainly have TPD cover in your superannuation fund. Pretty much everyone who has worked has at least one superannuation fund, and most super funds offer insurance cover. This insurance cover means you can:
- make a TPD claim if you have an injury or illness which prevents you from returning to work; or
- you or a family member or someone close to you (a beneficiary) can claim for a death benefit lump sum (either through your Will or a binding death benefit nomination).
The insurance attached to your superannuation fund might also have income protection insurance.
Income protection insurance is a monthly benefit to replace your wages while you are off work. These monthly benefits can be paid for a short period, usually after a waiting period. Some income protection policies provide benefits for two years, five years or up to age 65.
There are hundreds of superannuation funds in Australia (there used to be many more) and almost all of them have different types of insurance arrangements and entitlements. It can be a tiresome exercise working out and understanding what benefits your superannuation fund has.
When it comes to looking into making a TPD claim, one of the most important things to know is that you could still have a claim even if you stopped working many years ago. So many people don’t know this and have claims they could make but aren’t aware of their rights.
So, no matter how long ago you stopped working, Berrill & Watson can investigate if you claim a claim or claims, for free!
What level of impairment do I need to make a TPD claim?
The level of impairment (in superannuation claims, it is called disability), for physical injuries, chronic illness or mental health, is different to that needed for other types of compensation (like worker’s compensation or motor vehicle accident compensation). The term ‘impairment’ is often a term associated with worker’s compensation or motor vehicle accident compensation.
So, it’s important to understand that if a worker’s compensation or other injury claim is rejected because you don’t meet an impairment threshold, it doesn’t automatically mean a TPD claim will be rejected.
Likewise, if you are not entitled to a Disability Support Pension (DSP), it does not necessarily follow that a TPD claim will fail.
And you must also understand that just because you may have received a benefit from your worker’s compensation claim, your motor vehicle accident claim or have been approved for the DSP, does not automatically qualify you for a TPD claim. Every claim is different.
There are a number of factors to take into account when bringing a TPD claim. For example, an injured person’s “work capacity” is one of the main considerations when claiming TPD benefits. Your GP can help to answer questions about work capacity, even if you stopped working many years ago, but consideration must also be given to your education, your age and your work history.
A TPD claim is not straightforward. The circumstances of your employment can also impact on your right to claim.
We have the knowledge and experience to assess your prospects of success and to maximise your prospects of success. There are various factors that must be considered), but running and winning superannuation TPD claims is more or less all we do and we’re good at it.
You can learn more about this in our blog, “What’s the deal with TPD claims and your capacity to work?”
What TPD definition needs to be met to win a claim?
To win a TPD claim, you must satisfy the definition of being ‘totally and permanently disabled’.
The definition of TPD is contained in the insurance policy. Most definitions are similar, but there are also different and subtle changes in the definitions that can change the approach of an insurer when assessing the TPD claim.
The standard TPD definition is usually like this:
- you ceased work due to illness or injury;
- you do not return to work for a period of months (called a waiting period) after ceasing work; and
- at the conclusion of the waiting period, you are unlikely (or unable) to ever return to work in any occupation that you are reasonably suited to by education, training or experience
Sometimes the TPD definition will contain a “retraining clause”, which means that you must also show that even after undergoing reasonable retraining (if that is possible taking into account your disability), you can still not return to work.
The above TPD definition is referred to as an “any occupation” TPD definition.
There is a TPD definition called an “own occupation” TPD definition, which is for stand-alone insurance policies or policies that are not attached to your superannuation fund.
A policy with an “own occupation” definition is considered to have a TPD definition which is easier to satisfy than an “any occupation” TPD definition. As its name suggests, meeting an “own occupation” TPD definition requires that you:
- ceased work due to illness or injury;
- you do not return to work for the waiting period after ceasing work; and
- at the conclusion of the waiting period, you are unlikely (or sometimes unable) ever return to work in your own occupation – that is usually the job you were doing immediately before you stopped working
It is obviously important to know the details of the TPD definition contained in your insurance policy before lodging a TPD claim. You can learn more about the impact of specific definitions in our blog, “Differences in TPD definitions effect how insurers pay out claims.”
What is the TPD claim process?
In our experience, it’s rare that two TPD insurance claims are ever the same. However, the following is a broad overview of how we approach TPD claims:
- We check with your superannuation fund to see if you had insurance cover when you last worked. It doesn’t matter if the super account is now closed or your insurance cover has stopped for some reason. If you had insurance cover when you last worked, it is possible to make a claim. It is vitally important that someone checks your insurance cover on the date you last worked, not some other date.
- We get the insurance claim forms from the super fund/insurer and help you, your doctors and your old employer to complete them. If you have concerns about information being taken from the employer because your relationship with them soured before you stopped work, you don’t need to be worried because usually the only information which is obtained relates to your hours, duties and income that you were earning before you ceased work. (Remember, this is not a claim against your employer. Nor does it matter if your injury or illness arose from your job or not).
- Once the claim forms have been accurately and fully completed, they are submitted with the fund/insurer for assessment. The decision can then go in a number of different directions in the assessment of the claim. This might include requests for information from your doctors, requests for reports from medicolegal doctors, requests for tax documents, requests for Centrelink documents, requests for Medicare documents and request for copies of your medical records
- The insurer will then complete its assessment and make a decision on your claim, based on the materials which have been provided to it or it has obtained from elsewhere. You have the onus of proving that you satisfy the TPD definition, so it’s very important that you provide all supportive materials to the fund/insurer.
- If the fund/insurer decides to:
- accept the claim, the money will be paid either to you or into your super fund (after which you can make a separate application to withdraw the money).
- reject the claim, you can obtain further materials and/or request a review of the decision via the fund/insurer’s internal dispute (IDR) resolution processes or at the Australian Financial Complaints Authority (AFCA) or you can issue court proceedings. You can learn more about this in our blog, “What to do if your superannuation TPD claim is rejected”.
We can help with all of the above steps, as part of our agreement to act for you on a no win, no fee basis.
It’s important to understand that the above is only a very general overview of the TPD claim’s process. In every claim, there are considerations to be made about the best way to approach a claim. An awareness of these considerations comes from knowledge of working in this area of law. So, in the same way a mechanic can explain to you how to fix a car, or a dentist can explain to you how to work with teeth, it’s highly unlikely you will achieve the same result if you did it yourself. There is only so much information that can be gleaned from a general overview of the blog you are reading. The knowledge we have gained and a craft we have refined by running these claims for thousands of hours is what delivers optimal results for our clients.
How much will I get paid for my TPD claim?
The amount you will get paid if your TPD claim is successful will depend on the insurance arrangements in your specific super fund(s).
TPD insurance is usually sold in units of cover. So, for example, you might have received two units of TPD cover when you first joined your superannuation fund with each unit of cover being worth $50,000 each. So the amount you would receive if your TPD claim is successful is $100,000. But the benefits you hold vary from superannuation fund to superannuation fund.
The amount of the TPD benefit can often be based on the age you were when you stopped working, with the general rule of thumb being the younger you are, the greater the insurance benefit.
Furthermore, if you have more than one super fund, you might be able to make more than one TPD claim.
Helping people understand their entitlements and what they might be able to claim is a very important part of what we do.
What physical injuries can I make a TPD claim for?
Any physical injury that has stopped you working can be a reason to lodge a TPD claim. The cause of the illness or injury or illness doesn’t usually matter and your illness or injury doesn’t have to be work-related. A TPD benefit can be payable for any illness or injury that prevents you from working.
We have assisted people to claim for all manner of injuries; the key is that the injury impacts your capacity for work. Some examples of physical injuries for which we have brought successful TPD claims are:
- back injuries;
- shoulder injuries;
- knee injuries;
- acquired or traumatic brain injuries; and
- hand injuries.
But, setting out a small list of injuries like this does not help when explaining what is required to make a TPD claim. Basically, any injury that impacts on your work capacity can be the reason to make a claim.
Indeed, what is important is the impact the injury has on your work capacity and how that injury has made you totally and permanently disabled when looking at the definition in the insurance policy.
What chronic illnesses can I make a TPD claim for?
We’ve assisted people claiming for many chronic illnesses including:
- Multiple Sclerosis (MS);
- Parkinson’s Disease;
- Kidney/Renal failure;
- Mental Health issues;
- Chronic Fatigue Syndrome;
- Fibromyalgia; and many other illnesses.
You can learn more about claims for illness in our blog, “TPD and income protection insurance for people with a chronic illness”. Again, lists like this aren’t helpful. Any illness or injury that leads to you stopping work can be a reason to lodge a TPD claim.
What mental illnesses can I make a TPD claim for?
There are a number of mental illnesses that may prevent you from returning to work, including:
- bi-polar disorder;
- schizoaffective disorder;
- borderline personality disorder;
- obsessive-compulsive disorder;
- and more.
Any mental illness that stops you from working is a reason to seriously consider making a TPD claim.
For more detail on these types of claims, you can read our blog, “Super TPD claims and mental illness”.
Are there time limits for making a TPD claim?
In most circumstances, there is no time limit to make a claim for a TPD benefit. Therefore, even if you ceased work a long time ago, you should still consider investigating and lodging a claim.
Having said that, there are always exceptions and also, delaying lodging a claim can impact on your ability to lodge a complaint to the Australian Financial Complaints Authority (“AFCA”) if your claim is rejected. Therefore, we recommend that you seek advice as soon as possible about lodging a TPD claim, rather than delaying the claim.
There are time limits for appealing decisions to reject TPD claims. These time limits vary between AFCA and Court claims. We are happy to give free advice regarding what time limits may apply to your rejected claim, along with advice about prospects of success in lodging an appeal.
Can I make more than one TPD claim?
Yes. If you have multiple super funds holding TPD insurance, you can usually make multiple claims. However, there are exceptions depending on the specific policies you hold.
Learn more about this in our blog, “Can I make a claim for a TPD benefit on more than one policy or superannuation account?”
Can I make a TPD claim if I’m self-employed?
Yes, whether you are self-employed or working for someone else, if you have TPD insurance at the time of your injury or illness you can make a claim.
We have helped many self-employed people successfully claim TPD benefits.
You can learn more about this in our blog, “TPD and other disability insurance claims when you’re self-employed”.
Can I have a worker's compensation claim or motor vehicle accident claim at the same time as a TPD claim?
Yes. If you have a worker’s compensation claim or a compensation claim from a motor vehicle accident, you can also make a claim for a TPD benefit. A super TPD claim is a separate claim to any right you have to make a worker’s compensation or motor vehicle accident claim.
Unlike, for example, a worker’s compensation claim, the time limits regarding TPD claims are very different. You are probably still able to make a TPD claim even if you stopped work over a decade ago. We have acted for people who stopped working in the 90’s and who were still able to claim.
Often people are told incorrect information when it comes to the time limits for making a TPD claim. The rule of thumb is – if someone says you cannot claim, contact us and check if that’s right. It’s free to do this so, it costs you nothing to know where you stand.
Can I make a TPD claim if I’m on Centrelink?
Yes. People receiving the Centrelink Disability Support Pension (DSP) or Newstart can make a TPD claim.
Whatever decision Centrelink might make about your right to receive DSP benefits or other Centrelink benefits, does not mean you can’t lodge a TPD claim.
We have acted for many people who have been told they have no right to receive a DSP, but we have been successful with a superannuation TPD claim. We can provide guidance if you have a rejected DSP claim too.
Need help from a TPD lawyer?
We can help you find your old superannuation funds and check if you had TPD insurance, even if your fund was closed years ago.
We can also help you if your TPD claim has been rejected. We’ll discuss your rights of appeal internally with the super fund, or externally through the Australian Financial Complaints Authority or through the Courts.
We run these types of claims every day. Remember, your interests and the insurance company’s interests are not aligned. It’s important to seek advice from a lawyer experienced in superannuation and insurance law.
If you would like to have a chat, free of charge, about your possible entitlements, give the Super Lawyers a call. We will investigate your superannuation and insurance rights for free and act in all TPD claims on a “no win, no fee basis”.
Contacting Berrill & Watson
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📞 Anywhere else in Australia: 03 9448 8048
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