Total and Permanent Disability (TPD) insurance policies come with definitions that the insurer uses to determine if your TPD claim will be successful. Although there are similarities in definitions across funds, there are also differences that can impact whether your insurance benefits will be paid. One common definition is called an ‘own occupation’ TPD definition. As the name suggests, such TPD insurance policies enable you to claim if you cease work and are permanently unable to return to your own occupation.
Jeremy’s story
Jeremy (a pseudonym) was referred to Berrill & Watson by his financial planner in February 2024. A carpenter by trade, Jeremy ran his own property development business and had been working for many years through severe back pain.
He originally injured his back in 2017 and went on leave before returning to work on lighter duties. At the time, he approached his broker about making an income protection claim but was told he wouldn’t be able to.
Then, in 2019, Jeremy suffered a second injury that exacerbated his pain. He continued to run his business, albeit with much less time spent ‘on the tools’.
By the time Jeremy was referred to us, his back pain had become so debilitating that he needed to stop work and consider claiming income protection and/or TPD benefits through his superannuation.
"Own occupation" TPD definition
Jeremy’s TPD policy had an ‘own occupation’ definition. Therefore, to be successful in his TPD claim, he was only required to show that he couldn’t do his usual job as a self-employed carpenter. He did NOT have to prove that he was unable to work in any occupation he was suited to because of his education, training, and experience. You can read more detail about TPD definitions in our earlier blog, “Differences in TPD definitions effect how insurers pay out claims”.
In Jeremy’s case, it was difficult to satisfy the ‘own occupation’ definition. Although his medical records clearly showed that he suffered significant injuries in 2017 and 2019, the fact that he continued to run his own business meant that it was hard to prove his original injury prevented him from working in his usual occupation.
Further complicating his claim, Jeremy had received nearly all of his treatment from a physiotherapist and only saw a specialist and a GP on a few rare occasions. Having the support of your doctors and specialists is very important. Learn more about the benefits of a supportive medical team in our earlier blog, “The importance of your doctors for a successful TPD claim”.
Our approach to the TPD claim
During our first appointment with Jeremy, we advised him to reengage his GP and specialist and get their opinion on his capacity for on-the-tools work. We then obtained clinical files from his physio and specialist. Before lodging Jeremy’s claim, we also briefed an orthopaedic surgeon to complete a supportive medical report that commented on his ability to perform his usual carpentry work.
After reviewing Jeremy’s initial claim documents, the insurer followed this up with further requests for information from his GP and specialist, as well as financial information regarding Jeremy’s business structures. These revealed an increase in wages paid to other employees and subcontractors who took on the carpentry work Jeremy was no longer able to do.
Successful TPD claims pays out over $2,000,000
In January 2025, Jeremy’s TPD claim was accepted, and the insurer paid him more than $2 million dollars. Berrill & Watson continue to assist Jeremy with an income protection claim supported by evidence from his successful TPD claim.
Get help from a TPD lawyer
For a self-employed person who has an illness or injury affecting their capacity to work, it is common for the business to continue running if it is established and there are other employees or subcontractors to pick up the slack. This does not mean a business owner cannot claim a TPD benefit with an ‘own occupation’ definition.
If you run a business but can no longer perform your duties because of an injury or illness, we recommend that you get in touch with us for some free advice.
Contacting Berrill & Watson
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