If you are no longer able to work due to injury or illness, you may be considering a Total and Permanent Disability (TPD) claim. This financial support is designed to provide you with a lump sum payment in circumstances where injury prevents you from working, and that is likely to be permanent. It’s a type of insurance payout that comes from your superannuation fund and has very specific requirements for claim submission, so you need to be on top of the process. Below we break down how to claim TPD and other important information.
What does TPD insurance cover?
The extent of your insurance cover will depend on decisions you made at the time you commenced the superannuation policy and your employer commenced making contributions into the fund. Elections you made at that time will determine the insured benefit you could be entitled to under a total and permanent disability application through your superannuation policy. Each insurer has a specific TPD definition and satisfaction with the requirements of the definition will determine whether you are entitled to obtain the TPD insurance payout. We explain the different types in our article about TPD requirements.
What is the TPD claim process
Before we break down the TPD claim process, let’s look at some key considerations for a successful claim. It’s important to note that with a TPD claim, you either qualify or you don’t. To give yourself the best chance of success:
- make sure all forms are properly completed, paying very precise attention to the definition of TPD in the policy
- ensure that the medical statement to be submitted specifically addresses the definition of TPD and confirms that you meet that definition requirements
- respond promptly to insurer requests.
To properly navigate the process, we’d recommend discussing your circumstances with a Gouldson lawyer experienced in TPD claims. Below is an overview of what your process may look like.
1. Confirm your insurance and eligibility criteria
The first step is to determine what TPD insurance you have (and that you actually have insurance), that the insurance was in place at the date you ceased work and became disabled, and the specific eligibility requirements outlined. You can learn more about “own occupation” TPD and “any occupation” TPD definitions in our article about the requirements of these types of insurance.
2. Gather required documents
For a TPD claim to be successful, you’ll need to provide detailed documentation that proves you are not able to return to work, and that you otherwise meet the TPD definition relevant for your policy at the date you became disabled. This will include 1 or 2 medical reports, a Member Statement or application form, proof of identity, and documentation from your employer confirming details of your employment. Your insurer will assess your claim against the definition of “total and permanent disability”, and will often request further information and documents, or ask you to submit for an independent medical examination, so these documents help prove you are eligible.
3. Lodge your TPD claim
While you can lodge your TPD claim directly with your insurer, having a lawyer makes sure no detail is missed, and ensures that the information submitted addresses all of the requirements and is tailored specifically to meet the required definition. Even otherwise valid applications can be unsuccessful if a detail is missing or incorrect, or specific requirements of the TPD definition are not addressed on the evidence provided to support the application. Once your claim is lodged with the insurer, they will commence assessment of it against the TPD definition outlined in your policy.
4. Investigation process
Once the insurer has considered your application, and supporting medical reports, member statement, and employer documents, they will generally require further information to support the claim:
- Further medical records from treating doctors or other historical records.
- Records relating to your employment and earnings around the date of disablement or afterwards.
- Require you to submit for an independent medical examination.
5. Claim outcome is determined
Once your claim outcome is determined, you will receive a written notice. This will be sent from your superannuation fund or insurer via email or post and if we are engaged on your behalf it will come to us directly. In this communication the details of the planned payment will be set out. These details should be checked carefully against your Superannuation statement and the policy terms. If you have lodged your claim through a lawyer and are unsure of anything in your notice, they can talk through it with you.
6. Lump sum payment
Having your TPD claim accepted brings you the financial stability you deserve and the relief that comes with it. Successful TPD claim payments are usually a lump sum paid into your superannuation account, or released as a cash payment, either way you’ll be asked at the time of payment determination to make an election on how you want the benefit paid. Depending on your insurer, you may be given regular annual payments instead of a lump sum. The next step is to make sure you understand your payout and to plan your finances for current and future stability.
It is also incredibly important to seek financial advice before you make any decision on how to accept the TPD payment, to maximise your outcome.
Navigating the TPD claim process can be complicated, but the main thing is to focus on your recovery. Put your mental and physical health first by speaking with friends and family, as well as to the relevant medical specialists for your circumstances and needs.
If you have any questions about your claim eligibility or the process, please reach out to our TPD lawyers.