When you are no longer able to work due to an illness or injury, you may be eligible for an insurance payout from your superannuation fund. This is called a Total and Permanent Disability (TPD) claim. The benefits you could be entitled to receive will depend on the extent of your insurance cover, the TPD definition and, in certain circumstances, the specific injuries your super fund covers. If you’re not sure, you’re not alone. Many people don’t understand their TPD insurance options or whether they are covered. Let’s break down the different TPD claim requirements and what it might mean for you.
The first thing to note is that each insurer defines total and permanent disability in a different way. It can require that you are unable to work in your “own occupation” or from “any occupation” which we’ll unpack below. Some may also have specific injury or illness event definitions such as losing eyesight, terminal illness, or losing a limb which means qualifying for the TPD benefit is dependent on the type of injury.
In contrast to other types of injury claims, TPD is a purely contractual claim that is not influenced by who caused it. If the injury or illness is preventing you from working and you meet your TPD claim definition requirements, you can lodge a claim with detailed medical evidence to receive the TPD insurance payment.
What is an “own occupation” TPD definition?
An “own occupation” TPD insurance definition generally means that your benefit payment is only paid if you are unable to work in your current job or field of work due to a permanent injury or illness. For example, certain types of physical injuries could prevent a tradesperson from doing their work, but an office worker may still be able to perform their role. Each case is considered based on the individual circumstances, and determinations are based upon the insurer’s interpretation of medical evidence concerning the specific individual.
What is an “any occupation” TPD definition?
To meet the requirements of the “any occupation” TPD insurance definition you will need to be unable to work in your current job or any other job you are trained or experienced in, or could be trained in. This means in some cases it can be more difficult to qualify for the TPD payment. However, with the right knowledge, advice, and selection of evidence you can access the compensation you’re entitled to.
An example of where this definition can become complex is if you can’t do your current job, but you are trained to do another type of work. Your insurance company could decide that because you are trained in another occupation and that is not impacted by your injury or illness, then your TPD claim may not be successful. In some cases where it is not a fair decision, our lawyers have been able to help clients navigate the process successfully. If you have any questions or would like a free case review, please don’t hesitate to get in touch.
Can I go back to work if I seek treatment or rehabilitation after I’ve made a TPD claim?
Yes. When you receive a TPD insurance payout, you won’t lose your payment if you are subsequently rehabilitated and able to return to some kind of work. You receive the payment and won’t need to prove you are still unable to work if you’ve made improvements functionally or psychologically allowing you to return to some form of work. The exception is that some policies don’t pay a lump sum and will instead pay you over a period of time, which could be years. In this case, you’ll need to resubmit medical proof to receive your next payment.
What if I have multiple superannuation funds?
As you change jobs and go through life, many people end up with multiple superannuation funds. This is also something that might be set up by choice if it works better from a financial perspective. If you do have multiple funds, it is possible to make a separate TPD claim for each policy. To qualify, the particular fund must have a balance in it that supports the ongoing insurance premium payments.
Your lawyer can help navigate this process as meeting the TPD claim requirements of different policies can quickly become a complicated process. Loosely, the considerations set out above will apply to each and every separate superannuation fund policy.
How do I submit a successful TPD claim?
When you’re pursuing a TPD claim, it’s important to read paperwork carefully and act in a timely manner. If you receive communication from your super fund about next steps and don’t complete the required actions on time, you can end up being unsuccessful with your claim.
When it comes to a TPD claim, it’s not about how much you’re going to receive—you either qualify, or you don’t. This all or nothing situation means it’s critical to navigate the process properly. We’d recommend seeking advice from a lawyer as soon as you know that you’re unable to work or if you think your employment is going to end due to your illness or injury. Doing this will help you meet all the TPD claim requirements of your fund for a better chance of success. For example, one key step where claims can come undone is making sure your doctor words your medical documents properly to meet the criteria outlined in your insurance.
Over the years, we’ve had people come to us for help because their insurer has rejected their claim simply due to information being supplied in a way that didn’t meet the specific TPD requirements. While it’s better to get legal advice before starting your claim, if you’re already on the journey and need help, we are always here to assess the best course of action.
If you need further advice about making a TPD claim, please get in touch with our experienced lawyers today.