Living with a chronic illness can make it difficult to maintain steady work, and many people turn to Total and Permanent Disablement (TPD) insurance through their super for financial support. This article outlines how we secured a significant TPD payout for our client after years of pain, delays and two trustee rejections, and highlights how strong medical evidence, persistence and experienced legal guidance can shift an insurer’s position.
History or illness that led to stopping work
Our client, Sarah (name changed for privacy), is a 44-year-old former childhood educator who has spent most of her adult life working with young children. In 2019, her life changed dramatically when she was diagnosed with endometriosis and chronic pelvic pain syndrome; conditions that progressively worsened and ultimately made meaningful work impossible.
Despite living with severe and unpredictable symptoms, Sarah did everything she could to remain productive and financially independent. When her physical job became too demanding, she didn’t stop work immediately but rather changed careers and began running her own small e-commerce business from home. For several years, she managed her chronic pain, adjusting her workload and lifestyle around her symptoms.
By 2023, however, even the flexibility of self-employment became unmanageable. Her pain was constant, debilitating and incompatible with any form of sustained work. She made the difficult decision to cease work entirely.
Lodging the TPD claim
In March 2024, Sarah instructed us to assist her to lodge a Total and Permanent Disablement (TPD) claim under her superannuation fund. Her long-term GP and specialist provided strong supportive medical evidence outlining the severity of her conditions, her extensive treatment history and the realistic expectations of her long-term capacity for work.
Despite this, her claim stalled.
As months passed without meaningful progress from the insurer or the trustee, Sarah’s financial situation became increasingly stressful. To ensure she had support while waiting for a determination of her TPD claim, we assisted her with a Disability Support Pension (DSP) application using our DSP Toolkit, and she was approved while the TPD claim remained in limbo.
Procedural fairness letter issued by the insurer
After a prolonged assessment process, the insurer finally issued a procedural fairness letter, raising concerns that contradicted the views of her treating doctors and noting that they intended to reject the claim. You can read more about procedural fairness letters here.
We responded, but Sarah’s claim was rejected, not once but twice.
We responded in detail to each issue raised in complaint letters, providing further medical evidence, clarifying her work history and correcting inaccurate assumptions made during the assessment. In summary, many of the issues on the claim related to the nature of our client’s medical condition and doubts about the extent of her pain and associated work incapacity.
Despite our efforts, the claim was still heading toward a dispute, and we began preparing for litigation, including gathering expert evidence. But then…
Insurer finally accepts the claim
On 3 November 2025, after more than 19 months of delays, procedural fairness rounds, and two trustee rejections, the insurer formally accepted Sarah’s TPD claim.
She received a TPD benefit of $481,110.00, giving her long-awaited financial security after years of pain, income loss and uncertainty.
Interest claim underway due to the significant delays assessing the TPD claim
We have now commenced the process of lodging an interest claim, arguing that the insurer’s delays were unreasonable and resulted in Sarah being paid much later than she should have been.
If successful, she stands to receive an additional up to $46,318.37 in interest.
You can read more about interest claims in our earlier blog, “When am I owed interest on my TPD or income protection benefit?”
A hard-fought and well-deserved outcome
Sarah’s story is unfortunately common among people with chronic and invisible illnesses, particularly women with reproductive pain. Despite strong medical evidence and a genuine inability to work, claimants can experience unnecessary delays, repeated requests for information, and incorrect decisions by trustees and insurers.
Her perseverance and the strength of her medical evidence ultimately led to the right outcome, even if it came much later than it should have.
We are proud to have supported her at every step, including:
- lodging the claim;
- responding to procedural fairness;
- overturning two trustee declines;
- preparing for litigation;
- securing DSP approval along the way (pro bono);
- successfully securing her TPD payout;
- now pursuing an interest payment claim for the excessive delay.
Sarah can now focus entirely on her health, without the financial stress that dominated the last several years of her life.
Get help from a TPD lawyer
If you or someone you know is struggling with a delayed, rejected or complex TPD claim, we’re here to help. A second opinion can make all the difference. We provide free initial advice, no upfront fees and run cases on a “no win, no fee” basis, so there is no risk to finding out where you stand.
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