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TPD CLAIMS LAWYERS - AUSTRALIA

Our specialist TPD Insurance Claims Lawyers can help you make a claim on your TPD (Total and Permanent Disability) cover, and advise you of your legal rights if your claim has been denied or delayed by an insurance company. If you would like free legal assistance regarding your total and permanent disability insurance claim, complete the contact form or call our free 24/7 helpline on 1800 352 100.

Total and Permanent Disability Insurance Claims

In Australia, your employer must pay you superannuation. If you check the super fund you are with, chances are that your super fund has automatically provided you with default cover. This default cover, depending on the fund you are with, may include basic income protection and/or disability insurance when you can’t work. Some super funds provide basic death cover too.

The cover that comes with your super fund is basic, and some Australians choose to purchase a separate policy (or stand-alone policy) outside of their superannuation. The premiums for stand-alone policies tend to be higher than the policies that are in your super, and they tend to have higher payouts.

TPD insurance can be claimed even if you are on workers compensation, receiving the government disability pension, or receiving other forms of personal injury compensation due to negligence or an accident.

To find out how to claim, it is best to seek the advice of a TPD claims lawyer who specialises in the area of superannuation claims and disability insurance. Contact our service for free legal advice on TPD claims.

Frequently asked questions:

What is TPD?

TPD stands for Total and Permanent Disability. TPD insurance pays a lump sum if you suffer an illness or injury that affects your capacity to work. Common reasons for TPD claims include musculoskeletal disorders, degenerative disease, amputations, loss of eyesight, cancer, heart disease, chronic fatigue syndrome, multiple sclerosis, fibromyalgia, rheumatoid arthritis, depression, and mental illness.

Who offers TPD cover?

There are many insurance companies which offer TPD cover. The main companies (including super funds) which offer Australians TPD cover are listed below:

  • AIA Australia
  • AMP Life
  • Allianz
  • Asteron Life
  • Australian Super
  • AXA
  • Catholic Super TPD
  • Cbus Death and Total and Permanent Disability Cover
  • Clearview Life Assurance
  • Colonial Mutual Life Assurance Society Limited
  • Comminsure
  • First State Super
  • Hannover Life Re of Australasia Ltd
  • HESTA
  • ING Life
  • Macquarie Life
  • MetLife
  • MLC
  • OnePath Life Limited
  • QSuper
  • REST Industry Super
  • St Andrew's Life Insurance Pty Ltd
  • Suncorp
  • Sunsuper
  • TAL
  • Unisuper
  • WESTPAC Life
  • Zurich

Can I make a TPD claim?

To make a TPD claim you must meet the definition of TPD in your superannuation policy and/or the Trust Deed clause. The 2 main elements in most TPD definitions are: that you are unlikely to ever engage in future work for which you are reasonably qualified by education, training or experience; and that you have no realistic prospect of obtaining suitable employment having regard to your disabilities and situation.

There are a number of definitions for TPD that depend on your working status at the time you become disabled. For example, in some policies, being totally and permanently disabled may mean you must be suffering from an ongoing and serious injury or illness for over 6 months.

Some definitions state that you must not be able to work in your “own occupation”. Other tougher definitions require that you must not be able to work in “any occupation” by which you are suited by training, education or experience because of sickness or injury.

The common requirements of a TPD claim relate to your level of disability (including your ability to return to work and the effect of the injury on your activities of daily living), and waiting periods for injuries to ensure that your injury has “stabilised” before you can make a claim. Some policies also consider how long you were employed for (and how many hours) before you can make a claim.

How do I make a TPD claim?

You should contact your super fund and ask them if you have default cover for TPD or Income Protection. If you wish to make a claim on your cover, you will need to complete the necessary forms provided by your super fund. Similarly, if you have a stand-alone policy, you should contact your insurance company for a TPD claim form.

You will need to provide enough information about your condition in order for the insurer to assess whether you fit the criteria for TPD. Our expert TPD claims lawyers can assist you with the claims process from the beginning and can request medical records and reports required for your claim.

What medical evidence is needed for a TPD claim?

You will usually be required to submit a doctor’s statement/report about your condition, together with copies of any relevant medical records. The insurer may also ask you to attend an independent medical examination (IME), where you will be examined by a medical specialist chosen by the insurer. This specialist will then prepare a report outlining their findings on examination and their opinion of your medical condition.

The insurer will assess your claim based on all the evidence that they have access to. A decision will be made as to whether you qualify for TPD benefit (and/or income protection).

In a TPD claim, you may not fit the definition of disablement if the medical evidence suggests that you require further medical testing or treatment, or if your injuries are not yet stable, or your condition may improve or deteriorate.

Both physical and psychiatric conditions should be taken into consideration when determining capacity for employment. A temporary incapacity is insufficient; and a disability must amount at least to a substantial permanent incapacity.

This is a complex and evolving area of law. Our TPD insurance claims lawyers can provide advice and take care of the paperwork for you. We recommend that you seek specialist legal advice early on.

Can I make a TPD claim if I am also receiving worker’s compensation or other disability benefits?

TPD claims are separate from other claims such as worker’s comp. You can be on worker’s compensation and still be able to receive a TPD payout.

It does not matter how your disability or illness came about. Your disability does not need to have been as a result of an injury at work. You do not need to prove fault or negligence in TPD claims.

How long does a TPD claim take?

Depending on how complex your matter is and the nature of your illness, a relatively straight forward claim can be resolved in a matter of months. More complicated cases will take longer. Unlike personal injury compensation claims (workers compensation, motor accidents, medical negligence, public liability) which can take many years to resolve, TPD claims tend to be finalised much quicker.

How much TPD payout will I get?

The amount you will receive will usually be a lump sum benefit and it depends on the level of cover you have. This information can be found in your policy or statements, and when acting for you in your case, we can advise you of the amount.

What if my TPD claim is denied?

The onus is on the member to prove they are totally and permanently disabled, and therefore entitled to TPD benefit. The trustee or insurance company must make the determination of whether you are entitled to TPD benefit, based on good faith, and a real and genuine consideration of the material before them. If you have any problems in dealing with the insurance company, especially if they are delaying your claim or have denied your claim, you should seek legal advice.

A solicitor can advise you of your options. You may be able to seek an internal review of the insurer’s decision. There are also legal avenues which you could pursue such as lodging a complaint with the Superannuation Complaints Tribunal and/or appealing the decision to the Federal Court of Australia.

Do not delay in seeking legal advice. Strict time limits apply from the date your claim is rejected. It is often worth appealing against the insurer’s decision, however it is important to get urgent advice from a lawyer experienced in superannuation appeals. Our TPD claim insurance lawyers operate on a No Win No Fee basis.

For free legal help complete the contact form or call our 24/7 helpline 1800 352 100.