One of the big South Australian based super funds, of which all SA government employees must be a member, is SuperSA. Super SA is governed by the Southern State Superannuation Regulations 2009, which set out the terms for insurance offered. This means they do not operate under an insurance policy, as is the case with most other funds/insurers. SuperSA usually provides total and permanent disability (TPD), death and Income Protection (IP) type benefits to its members, primarily through its Triple S scheme. This blog will deal with the TPD benefits only.
When is a TPD benefit payable?
The Super SA Board, who are effectively the same as super fund trustees in non-government super funds, are the administrators for all Super SA schemes.
A TPD benefit will be payable if the Super SA Board is satisfied that the insured:
- “Is suffering from ill health (whether physical or mental) that makes it unlikely that the insured will at any time engage in gainful employment for which the insured is reasonably qualified by education, training or experience or for which the insured could be expected to become reasonably qualified following appropriate training or rehabilitation”; and
- Is receiving treatment from a medical practitioner and is following the advice of the practitioner.
SuperSA typically assess a member as being incapacitated by utilising a percentage rating where:
- 100% incapacity means “unfit for all work”;
- 50% incapacity means being “partially unfit/fit for some work”; and
- 0% means no incapacity.
They require the member to have at least a 60% total incapacity to be eligible for a TPD benefit.
How is my percentage disability assessed?
There is no defined assessment rating system that doctors are expected to use and the ratings are completely at the discretion of the doctor. This can cause some confusion when working with the doctors to get support for the claim. We are experts at navigating this complex system and can help you to ensure you maximise the potential of your claim.
How do I claim TPD benefits with SuperSA?
To make a claim, you must provide all required claim documents. Importantly, these must be in the approved form. Two medical statements must also be completed by a GP and a specialist. The cost for the initial medical statements is paid for by you. Often, if your doctors understand that it is you that will be paying for the medical forms and not an insurance company, they will reduce or waive the cost of completion.
On the odd occasion where they require further information from a doctor, the member is required to obtain this at their expense unless an Independent Medical Examination (IME) is required, which will be paid by the Board.
Some important things to know about SuperSA TPD claims
There are a number of things that operate differently with SuperSA TPD claims compared with other super funds. Some of these can have a significant impact on your claim and many claimants may be caught out. It’s important to be aware of some of the major differences, as outlined below.
- Strict time limits apply. An application for TPD benefits must “give written notice of the claim to the Board no more than 2 years after termination of the member’s employment”.
- If you are seeking to make a claim out of time or you are almost out of time, speak to one of our specialists urgently and we can discuss your options. The time limits are strict, but there may be some circumstance in which we can still assist.
- TPD benefit amounts are not based on the level of cover at date last worked, as is the case with most other super funds/insurance claims. Rather they are based on the amount of cover at date the claim is approved. This can sometimes lead to confusion when you are trying to work out how much the benefit you are claiming is. We can help with this.
- A TPD benefit will usually not be paid if a member ceased work due to voluntary redundancy/voluntary separation package and/or if they are working less than 20 hours per week in the 12 months prior to disablement.
Get help from a TPD lawyer
We help a lot of South Australian workers claim disability benefits; with SuperSA and many other funds.
SuperSA claims can have some extra complexities so it’s important to seek expert legal advice if you’re considering making a claim.
Give us a call for some free advice or you can get in touch directly with today’s blog writer, Matt Charbel. It costs you nothing to find out where you stand.
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