TPD insurance can pay a lump sum if an illness or injury leaves you unable to return to work and you meet the definition in your policy. Many Australians hold this cover through their superannuation, so you may have a TPD insurance claim even if you never took out a separate insurance policy.
Our team at Hall Payne Lawyers can check what cover you had when you stopped working and explain your policy’s requirements. We can help gather the medical and employment evidence needed to support your claim, as well as prepare and manage your claim with the insurer and super fund.
Usually pays a lump sum if illness or injury means you meet your policy’s definition of total and permanent disability.
Is often held through superannuation, including accounts you may no longer contribute to.
Depends on the wording of your policy, your work history, your medical evidence and when your cover was in place.
Can take several months. For insurers that subscribe to the Life Insurance Code of Practice, lump sum claims should generally be decided within six months of the claim being received or the end of the policy waiting period, unless circumstances beyond the insurer’s control apply.
Total and Permanent Disability, or TPD, insurance pays a lump sum when an illness or injury leaves you permanently unable to work, and you meet the definition set out in your policy.
TPD cover is commonly included with superannuation. Premiums are paid from your super account, which means you may have had cover without arranging the policy yourself. It’s worth checking current and previous super accounts, especially if you’ve changed jobs or funds over the years.
Different policies use different words and thus different definitions of TPD. An “any occupation” definition generally asks whether you’re unlikely to work again in a job suited to your education, training, or experience. An “own occupation” definition focuses on whether you can return to the occupation you were working in before your disability, although this cover is more commonly held outside super. Some policies use other tests, including activities of daily living.
Being unable to return to your old job does not automatically mean a claim will be accepted. The policy that applied when you stopped work sets the test you need to meet.
You may be eligible to make a TPD claim if you had TPD insurance in place when an illness or injury caused you to stop working, and your circumstances meet the definition in that policy. The diagnosis itself is only one part of the claim, as your insurer will also look at what your condition means for your ability to work.
Your policy may consider your age, work history, education, training, experience, treatment and whether there is another type of work you could reasonably do. Medical evidence is important, but so is evidence about what your job involved and why your condition prevents you from returning to suitable employment.
A TPD claim process may be worth investigating if:
You do not necessarily need to hold the same super account right now. Our team at Hall Payne has previously assisted clients with claims based on cover that was in place when they stopped work, even where they no longer held that cover by the time the claim was pursued.
A TPD payout is based on the amount of insurance cover attached to your policy, and is not a standard figure for a particular injury or illness. Two people with similar conditions can receive different amounts because their policies and level of cover are different.
Your super statement or insurer records may show the insured benefit, but there can be other factors to check. Where the policy sits inside super, the insurer may first pay the benefit into your super account, and from there, the fund trustee then considers whether it can be released to you. Tax may also affect the amount you receive, depending on your age and circumstances.
Some people have TPD cover through more than one super fund. Multiple claims can be made in some cases, but the order in which claims are lodged or decided can affect the outcome. Hall Payne has dealt with a case involving three separate TPD policies where the order of the claims mattered because of a clause in one policy.
Your insurer and super fund need enough information to decide whether you meet the policy definition, so preparing the claim properly can help avoid gaps in the evidence.
Check your TPD cover
Identify the policy that was in place when you stopped work because of your condition, including cover through previous super funds.
Review the policy definition
Check the TPD definition, waiting period, exclusions, and evidence required.
Gather medical and work evidence
This may include reports from treating doctors, medical records, job duties, payslips, tax records and information about your education, training or experience. Insurers may also ask for further medical information or an independent medical examination.
Lodge the claim
For cover held through super, both the insurer and super fund trustee may have a role in the process.
Respond to further requests
The insurer may seek more records, ask about your work history, or arrange further medical assessment.
Receive the decision
If the claim is accepted, the benefit is paid in line with the policy and super fund rules. If it is declined, you may have options to ask for a review or challenge the decision.
TPD claims often take months. Under the current Life Insurance Code of Practice, subscribing insurers should generally make a decision on a lump sum claim within six months of receiving the claim, or within six months after the end of any waiting period, unless circumstances beyond their control apply. A claim can take longer where medical evidence is still being gathered or further information is required.
A TPD claim can be based on a psychological condition as well as a physical injury or illness. The condition and its effects, however, will need to meet the wording of your TPD policy and will need to be supported by the evidence.
For a PTSD TPD claim, or a claim related to depression, anxiety disorders or bipolar disorder, the insurer may look at your treatment history, symptoms over time, attempts to return to work, medication, specialist opinions and how the condition affects concentration, attendance, interaction with others and day-to-day functioning.
Our team at Hall Payne Lawyers has experience with TPD claims involving mental health conditions, including matters where further medical evidence was needed after an insurer initially declined the claim.
A rejected TPD claim does not always mean the matter is finished. The insurer may have decided that the medical evidence was not enough, that you did not meet the policy definition, or that another policy term applied.
Depending on the circumstances, you may be able to provide further medical evidence, ask for an internal review, make a complaint or pursue another review option.
Being different types of insurance, some people can claim both. TPD usually pays a lump sum if you meet the policy definition, while income protection generally pays a regular benefit for a period of time while illness or injury prevents you from working. If you have both types of cover, check how the policies interact before lodging claims. The wording can differ and one benefit may affect another.
TPD claims often end up hinging on the details. The wording of the policy, the date your cover applied, your work history, and the medical evidence all need to support the claim. Our team of experienced lawyers at Hall Payne Lawyers can help you work through TPD claim requirements before the claim is lodged and deal with the insurer and super fund while it is being assessed.
Hall Payne’s Superannuation and Insurance team includes Senior Associate Amanda Knock in New South Wales and Leanne Taylor in Queensland. Amanda has almost 20 years’ experience working with injured people, while Leanne has led the firm’s TPD and income protection claim work since 2015.
You can speak with us face-to-face, by phone or by videoconference about a superannuation TPD claim. We’ll explain our fees before you decide to proceed and let you know whether a no-win, no-fee arrangement is available for your matter.
A TPD claim can take several months. For insurers that subscribe to the Life Insurance Code of Practice, a lump sum claim should generally be decided within six months of the claim being received or the end of any waiting period, unless circumstances beyond the insurer’s control apply. The timeframe for your claim will depend on the policy, the evidence required, and whether further information is needed.
There is no universal TPD claim time limit that applies to every policy or situation. In many cases, it may still be possible to investigate a claim years after you stopped working if you held the relevant cover at the time. However, delays can make evidence harder to obtain, and time limits can apply to complaints or legal action. It’s worth getting advice from our team at Hall Payne Lawyers as soon as you can. We have previously pursued a TPD matter years after the original claim was declined.
This depends on your unique circumstances and whether you had TPD cover through the fund when illness or injury caused you to stop working, rather than whether the account is still active today. Your previous fund or insurer may be able to confirm the cover that applied at the relevant date.
A TPD claim can be based on a mental health condition if the condition and its effects meet the definition in your policy. Claims may involve conditions such as PTSD, depression, anxiety disorders or bipolar disorder, with medical evidence used to show how the condition affects your capacity for work. Hall Payne has previously acted in successful TPD matters involving mental health conditions.
Facing challenges with superannuation or insurance claims? Our blog offers practical articles and updates from our legal team on TPD claims, superannuation disputes, insurance matters, and related topics.
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