Total & Permanent Disability
Guide to TPD Claims & Compensation
If you have suffered an injury or illness that has left you unable to work, you could be eligible to make a Total and Permanent Disability (TPD) claim. At LHD, our specialist team of TPD lawyers can help you lodge a claim and provide expert knowledge to guide you through the process to ensure you get the financial compensation you deserve.
In this guide, we’ll provide answers to the following:
- What is a TPD claim?
- What is TPD insurance?
- What does TPD cover?
- Who is eligible to make a TPD claim?
- When can I make a TPD claim?
- What injuries and illnesses qualify for a TPD claim?
- What is the TPD claims process?
- How can you ensure your TPD claim is approved?
- How do you make a successful TPD claim?
- Are there any time limits with TPD claims?
- How long does a TPD claim take to process?
- What happens if my TPD claim is rejected?
- Can I make a TPD claim if I am still working?
- Can I make a TPD claim if I have a pre-existing medical condition?
- TPD payouts
What is a TPD claim?
A TPD claim is a claim on the benefits from a Total and Permanent Disability (TPD) insurance policy.
TPD is defined as the inability to continue working due to an illness or injury. It is not necessary for the illness or injury to be sustained at the workplace, it can result from an injury or illness sustained anywhere including:
- At home
- Playing sports
- At the gym
- Driving a car
The location of the incident also does not affect your eligibility to make a TPD claim.
Your superannuation fund will have its own definition of the term, but essentially TPD refers to any sort of permanent incapacity that directly affects your ability to remain employed in your field of expertise.
What is TPD insurance?
Total and Permanent Disability insurance is a type of insurance provided by your super fund or available as a separate policy from your preferred life insurer. It provides claimants with a lump sum payment if they become totally or permanently disabled and are unable to return to work.
What does TPD cover?
Your superannuation provider or insurance fund will have their own definition of what it means to be permanently disabled. Essentially, TPD coverage falls into two broad categories:
- Your own occupation: This category covers you if you’re unable to work again in the job you were in before you became disabled.
- Any occupation: This category covers you if you’re unable to work in any job that’s suited to your experience, education or training.
If in doubt, always refer to the terms and conditions of your policy, or contact the team at LHD Lawyers for expert advice.
Who is eligible to make a TPD claim?
To be eligible to make a TPD claim, you generally must have a disability that has rendered you unable to work in your chosen occupation or any other occupation for which you are reasonably qualified by education, training, or experience.
The specific eligibility requirements for a TPD claim will depend on the terms and conditions of your insurance policy.
When can I make a TPD Claim?
After you become totally or permanently disabled, you must wait a certain amount of time before filing a TPD claim with your insurer. The reason for the wait period is so that you can prove that you have been out of work and won’t be able to return to your occupation (or any occupation).
The amount of time you must wait varies from insurer to insurer and policy to policy, so you should always double check yours. But, in general, you should be able to make a TPD claim three to six months following the date of your injury or illness.
What injuries and illnesses qualify for a TPD claim?
Some common injuries and illnesses that may qualify for a TPD claim include:
- Serious spinal cord injuries
- Loss of limbs or amputations
- Total and permanent blindness or deafness
- Severe burns or disfigurement
- Traumatic brain injuries or other neurological conditions
- Chronic illnesses such as cancer, heart disease, or autoimmune disorders
However, simply having one of these conditions does not automatically qualify for a TPD claim. You must also meet the definition of “total and permanent disability” as stated in your policy and possibly provide evidence to support your claim.
More information about what kind of injuries or illnesses could qualify for a TPD claim can be found in our most common TPD claims article.
Can you claim TPD for depression?
Yes, in some circumstances you can claim TPD for depression. When depression becomes severe to the extent that it impedes your ability to perform basics such as dressing yourself or bathing, it can qualify as a TPD.
Check your insurance policy to see if it is covered within the stated definition of TPD.
Can you claim TPD for cancer?
It is possible to make a TPD claim for cancer as it is considered a serious illness and can prevent an individual from being able to work in their usual occupation or any other occupation that they are reasonably suited for, based on their education, training, and experience.
You may be asked to provide evidence to support your claim, such as medical reports, and demonstrate that your condition prevents you from engaging in work-related activities.
Check your insurance policy to see if it is covered within the stated definition of TPD.
What is the TPD claims process?
The TPD claims process is straightforward, although it can be lengthy. Here are the steps you should follow to start a successful claim:
- Contact your insurer or superannuation and ask them which forms/applications you need to fill out.
- Gather all the documentation they request: This may include medical records, details about your former occupation, workers compensation forms, and more. They may also require you to be assessed by a private medical examiner. Be as compliant and thorough as possible, so that they will have more than enough evidence to approve your claim.
- Submit all the forms and documentation your insurer requires and wait for a verdict.
If your claim is denied, LHD Lawyers may be able to help you file a dispute.
What percentage of TPD claims are successful?
A report was published by ASIC in April 2022 which indicated that the acceptance rate for TPD claims has increased from 81.5% in 2020 to 82.5% in 2022, which is a 1% improvement year on year.
Percentage of Payouts by Insurance Provider:
|Insurance Company||TPD Insurance Claims Accepted %|
At the time of this article Resolution life/AMP has the highest rate of rejecting claims sitting at 67.7%, indicating that 3 out of 10 claims are rejected.
On the other hand, Resolution life had the highest rate of approving claims at 89.2%, indicating that 1 out of 10 claims are rejected.
It is worth noting that the overall approval or rejection rate does not determine the quality of a superannuation company.
How can you ensure your TPD claim is approved?
In this section, we’ll look at three key steps behind making a successful TPD claim to help ensure it gets approved.
1) Have a thorough understanding of your policy
The definitions of TPD and the allowances made by policies can vary greatly, so it’s important to ensure that you understand your policy’s intricacies.
Those who lodge successful TPD claims have a good grasp on the following variations in TPD policies:
- The wait time length for your policy (i.e. how long you must wait before making a claim)
- Whether your policy requires you to be receiving ongoing treatment from a specialist, or attending rehabilitation
- Whether your policy covers pre-existing conditions (for circumstances where you had the condition before you signed the policy)
2) Be aware of eligibility requirements
Being knowledgeable about your eligibility requirements and the stipulations of your policy will increase your chances of lodging a successful TPD claim.
Having an expert TPD lawyer to assist you in the process and ensure you satisfy the conditions set out in your superannuation policy can lead you to win a TPD claim you may well have lost otherwise.
3) Prove your total permanent disability status
The five things you will need to prove in order to win a TPD claim include:
- Your level of disability
- The cover provided by your superannuation
- Your minimum work history
- Your inability to perform tasks
- Ongoing medical attention
Are there any time limits with TPD claims?
There are time limits associated with making a TPD claim. These time limits can vary depending on the terms and conditions of your insurance policy, but in general, you will need to submit your claim within a certain period after you have become permanently disabled and unable to work.
Most insurance policies require that you make a claim within a specific time frame after the onset of your disability, which is typically between 6 and 24 months. Some policies may also require that you have been continuously disabled for a specific period before you can make a claim.
Review your insurance policy to understand the specific time limits and conditions associated with making a TPD claim.
How long does a TPD claim take to process?
Since each TPD claim is unique, there’s no set time frame for processing TPD claims. Your insurance provider may request that an independent medical examiner assesses you to provide additional information to support your claim from your employer, GP, Centrelink, or the ATO. This could lengthen the processing time of your claim.
What happens if my TPD claim is rejected?
If your TPD claim is rejected, it could be because of one or a combination of the following factors:
- You don’t meet the TPD requirements
- Your policy is no longer active
- Your age (a lot of policies require you to be under 65 years of age to qualify)
- You don’t meet the work history requirements
- Your claim was lodged too late
- Your claim was disputed
Understanding the reason for having your TPD claim rejected is the first step to remedying the situation. Remember that even if you have had your TPD claim rejected, there is still hope. At LHD Lawyers, we understand the difference a successful TPD claim can make to your life, and will strive to help you every step of the way.
Can I make a TPD claim if I am still working?
If you are deemed unable to work in your own occupation, there’s still a possibility that you might still be able to work in a different occupation and therefore make a TPD claim while actively working.
Certain individuals can do this due to one or a combination of the following factors:
- Medical advances: There might have been medical developments in the time since your claim was lodged, which could make it possible for you to work again.
- The performance of Activities of Daily Living (ADL): You might be able to rejoin the workforce after a TPD claim if you are still unable to complete at least two tasks of daily living.
- The inability to use your limbs or see: In this instance, you may still be able to work after a TPD claim has been made, depending on your situation.
- Retraining in a new field: You may be able to find work in a different industry to the one you were working in when you lodged your TPD claim.
Can I make a TPD claim if I have a pre-existing medical condition?
Yes, it is possible to make a TPD claim even if you have a pre-existing medical condition. However, the success of your claim will depend on a variety of factors:
- The severity of your pre-existing medical condition
- How it affects your ability to work
- The terms of your insurance policy
If your pre-existing medical condition is deemed to be a significant factor in your disability, it may impact the amount of compensation you receive.
Insurance policies vary, so reviewing your policy to determine what is covered and what is excluded is crucial. Speaking to one of our experienced TPD lawyers may help ensure your claim is properly documented and presented to the insurance company.
Can you claim TPD more than once?
It might be possible to claim TPD more than once if you have multiple superannuation (or insurance) policies. Sometimes people can have multiple superannuation accounts if they have had several different jobs. If you have more than one super fund, and each of these funds has TPD benefits, it might be possible for you to claim each benefit separately.
Can you claim TPD and death benefit compensation?
You cannot claim both TPD and death benefit compensation from the same insurance policy. These are two different types of claims, and most insurance policies only provide coverage for either one or the other, but not both.
However, some insurance policies may offer both TPD and death benefit coverage as separate benefits. In such cases, you can claim either TPD or death benefit compensation depending on your circumstances.
Read your policy’s terms and conditions to determine what coverage is available and what benefits you are eligible for.
Your TPD payout amount will vary depending on the specifics of your case and the conditions of your super policy. As a general rule, lump sum payouts can range anywhere from $30,000 to $1,500,000.
The length of time it takes to receive a payout can vary. First of all, you’ll need to prove to your insurer that you are unable to work: this time of inactivity usually ranges between three and six months. Once your TPD claim has been filed, the process can take around six to twelve months (although this may vary depending on your case).
If your TPD claim is successful, the payment is usually deposited directly into your super fund. Visit our Guide to TPD payouts for more information.
What is the average payout for a TPD claim?
The average payout for a TPD claim in Australia is between $60,000 and $300,000. However, payouts can also go as high as $2 million, depending on the severity of the case.
Example of a successful TPD payout
Our client was employed as a courier in NSW and suffered a workplace accident in 2013 where they injured their right groin. They also suffered ongoing hip pain as a result of the groin injury. They subsequently found alternative work as a merchandiser but were unable to continue with the role as a result of the ongoing hip and groin pain. LHD Lawyers proceeded with a successful TPD and Income Protection claim where the client was approved to access their super account balance prior to retirement age including their TPD lump sum benefit. The client was also approved to receive ongoing income protection benefits separate to their TPD lump sum benefit up to the age of 65.
More case studies like this can be found at our TPD payout hub.
Do I need a lawyer for a TPD claim?
To maximise your chances of a successful TPD claim, our experienced TPD lawyers at LHD can help you find information about the entitlements that are embedded in your superannuation policy, and guide you through the process of lodging a claim. If you think you have a TPD claim, call us on 1800 455 725 for a no-obligation consultation.
Author: James Bodel