What is a TPD Claim?

What exactly is a TPD Claim?

A TPD Claim is a ‘total and permanent disability’ claim.

If you are unable to work due to an injury or illness and you have total and permanent disability insurance, you can make a claim to your insurance fund for a lump sum payment.

Often people have total and permanent disability insurance cover as part of their superannuation fund. (Though sometimes, it does not form part of a superannuation policy. And there are also situations where people have cover from another insurance policy that is outside of their superannuation fund.)

TPD insurance – if you have it - is a benefit that is additional and separate from the contributions that you made to your superannuation fund during your membership.

Do I have TPD cover?

You are usually able to check whether you have TPD insurance on your annual superannuation statement or if you are not sure, by contacting your superannuation fund directly.

Every super fund has different requirements and considerations for TPD Claims. You need to be sure that you understand the policy terms of your insurance fund.

Can I make a TPD Claim?

Anyone who has an injury and/or illness that prevents them from returning to work and has TPD cover with their insurance can make a claim.

If you are making a CTP or Motor Vehicle Accident, Workers Compensation, Medical Negligence, or Public Liability claim – you may be eligible to make a TPD claim as well.

How do I know if I am ‘Totally and Permanently Disabled’?

Each superannuation fund has their own strict policy terms that set out when a person is totally and permanently disabled.

Usually, you must establish that you are unable to perform your usual occupation or any other work that you are trained or experienced in.

Your superannuation fund will carefully consider medical evidence regarding your illness or injury to determine this.

When should I make a TPD Claim?

If it seems unlikely that you will return to work, you should enquire about lodging a TPD Claim.

Superannuation funds/insurers often have waiting periods ie. You need to have been off work for at least 6 months. However, this differs for each fund and there may be other requirements that need to be met. For example, some superannuation funds may require that your injury or illness has ‘stabilised’ or reached ‘maximum medical improvement’ before they will consider your claim.

What do I need to do to make a TPD Claim?

To make a claim, you will usually need to fill out initial claim paperwork. There are several documents that will need to be filled in. If these documents (and the information they contain) are accepted, then the superannuation fund (or insurance company) will request documents (information) to assist them in determining your claim. They may require documents such as:

• Medical evidence including doctor's reports, clinical notes, and referrals.
• Employment History including reports from your employer and copies of your CV or job history.
• Financial Documents such as tax documents, payslips, and Centrelink documents.

Does it matter how old I am?

Your current age and the age at which you were injured or diagnosed with an illness may impact the amount of TPD benefits you will receive.

Generally, the older you are the less the insurance company is required to pay, so it is very important to make the claim soon rather than later. Starting a claim even a year later than you could have, can impact the amount of insurance money / TPD cover that you will receive.

How long does a claim take?

The TPD Claims process should take roughly six months but it can take much longer than this. This will depend on the complexity of the claim, your policy, and the attitude of the insurer.

Often superannuation funds/insurers attempt to delay claims, particularly if they are considered complex.

How does a pre-existing condition affect my claim?

In certain circumstances, you may be excluded from receiving a TPD payment due to an exclusion. This means you may not be entitled to TPD benefits if you had symptoms of your injury or illness prior to beginning your insurance cover.

Insurance companies refer to this as a pre-existing condition. There are exclusion periods for pre-existing conditions. This means, if you have a pre-existing condition, you can be excluded from claiming for a period of years. (And in some situations, you might be permanently excluded from making a claim.)