Total and Permanent Disability Claims
If an injury or illness prevents you from returning to work, you may have Total and Permanent Disability insurance through your superannuation.
Making a TPD claim can involve extensive forms, medical evidence and communication with both your superannuation fund and its insurer. David Healey Solicitors can assist at every stage, from preparing an initial application through to challenging a delayed or rejected claim and making a complaint to the Australian Financial Complaints Authority.
What is a TPD claim?
Total and Permanent Disability insurance, commonly called TPD insurance, may provide a financial benefit if an injury or illness leaves you unable to work again in circumstances covered by your policy.
TPD cover is commonly held through superannuation, although the definition of total and permanent disability varies between policies. The assessment may consider factors such as your health, employment history, education, training and capacity to return to work.
The insurer and superannuation trustee will assess whether your circumstances meet the particular requirements of your cover. Being unable to continue in your previous role does not automatically mean that a TPD claim will be accepted.
Where are you in the TPD claims process?
David Healey Solicitors assists with TPD matters at all stages.
Preparing an initial application
We can help identify the relevant superannuation and insurance information, explain the claims process and assist with preparing your application.
Obtaining advice before lodging your claim can help you understand the applicable policy definition and the supporting evidence that may be required.
Dealing with a delayed or rejected claim
If your claim is taking an unreasonable amount of time or has been rejected, we can review the available documents, correspondence and reasons provided.
This may include communicating with the fund or insurer, identifying whether further information is needed and assisting with the internal complaints process.
Making a complaint to AFCA
If your TPD claim has been delayed or rejected, or another dispute arises with the fund or insurer, you may be able to make a complaint to AFCA.
We can advise you about the complaint process and assist in preparing and presenting your matter.
How can a TPD lawyer help?
TPD claims can involve the interaction of insurance policies, superannuation trust documents, medical evidence and information about your employment history and capacity for work.
David Healey Solicitors can assist by:
- Identifying and reviewing relevant TPD cover
- Explaining the applicable policy definition and claims process
- Preparing claim forms and supporting documentation
- Reviewing medical, employment and other evidence
- Communicating with superannuation funds and insurers
- Assisting with delayed or rejected claims
- Preparing internal complaints and complaints to AFCA
- Taking over TPD claims that are already underway
The assistance required will depend on the stage of your claim and the terms of the relevant insurance policy.
What information may be needed for a TPD claim?
The information required will vary between policies and individual claims. You do not need to have every document before contacting a solicitor, but any information you can provide may assist with the initial assessment.
Your insurance and superannuation details
Relevant information may include your superannuation account details, insurance summaries and the policy that applied when you stopped working.
You may also have held TPD cover through a previous superannuation account.
Medical evidence
Medical records and reports may be required to explain your injury or illness, the treatment you have received and its effect on your capacity for work.
The evidence should address the requirements of the particular policy under which the claim is being made.
Your work, education and training
Information about your previous employment, work duties, education, qualifications and training may be relevant when assessing whether you satisfy the applicable TPD definition.
We can explain what documentation may be required for your particular claim.
SPECIALIST LEGAL SUPPORT
Delayed and rejected TPD claims
A delayed or rejected TPD claim can be particularly stressful when an injury or illness has already affected your ability to work and your financial security.
A rejection does not necessarily mean that no further options are available. The appropriate response will depend on the policy definition, the reasons given for the decision, the available evidence and the steps already taken.
Options may include providing further supporting information, making a complaint through the fund or insurer’s internal dispute-resolution process, or lodging a complaint with AFCA.
David Healey Solicitors can review the decision and supporting material, explain the available options and assist with the next stage of the matter. Time limits may apply, so it is important to seek advice promptly.
Frequently asked questions
How do I know whether I have TPD insurance?
TPD cover is commonly provided through superannuation. You can check your superannuation account, annual statement, insurance summary or policy documents, or contact your superannuation fund.
You may also have held cover through a previous superannuation account.
Does a TPD claim have to relate to a workplace injury?
Not necessarily. Depending on the policy, a TPD claim may relate to an injury or illness regardless of whether it was caused by work.
Eligibility will depend on the terms of your cover and your individual circumstances.
Do I have to be unable to perform any type of work?
Not every policy uses the same definition of total and permanent disability.
Some definitions consider whether you are unlikely to return to work for which you are reasonably suited by education, training or experience, while others use different criteria. The wording of your particular policy must be reviewed before your eligibility can be assessed.
What is AFCA?
The Australian Financial Complaints Authority is an independent external dispute-resolution body that considers eligible complaints about financial firms, including superannuation funds and insurers.
You can make a complaint directly to AFCA. Depending on what has already occurred, the fund or insurer may first be given an opportunity to review and respond to the complaint.
How long does a TPD claim take?
The time required varies according to the complexity of the claim, the information available, the responsiveness of the parties and whether a dispute arises.
If you are concerned about an unreasonable delay, we can review the progress of your claim and advise you about your options.
Related resources
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