What TPD insurance is
Total and permanent disability (TPD) insurance pays a lump sum if illness or injury leaves you totally and permanently disabled, as your policy defines it. Many people hold this cover through their superannuation. The fund holds the policy, you pay for it through your super account, and an insurer assesses and pays the claims.
Each policy has its own definition of total and permanent disability, and the insurer assesses your claim against that wording. TPD cover held through super generally uses an “any occupation” test: broadly, whether you are unable ever to work again in any job suited to your education, training or experience. “Own occupation” cover, which asks whether you can go back to the job you did before, is usually only available outside super. Some policies also look at whether you can manage everyday tasks, such as washing and dressing, without help.
You do not need to work out whether you meet the definition before you call us. That is what the medical evidence, and the insurer’s assessment of it, are for.
Who may be covered
Most super funds give their members life and TPD cover automatically, usually without medical checks, though there are exceptions for younger members and low balances. If you have worked for several employers, you may have more than one super account, and TPD cover in more than one fund.
Cover can end. By law, a fund generally has to stop the insurance on an account that has had no contributions or other money paid in for 16 months in a row, unless you have asked in writing to keep it. Some funds have their own rules as well. What usually matters, though, is whether you were covered when you stopped work because of your condition, so an old or closed account can still be worth checking. We help you work out which funds you were with and what cover each one held.
How a TPD claim works
Every fund and insurer has its own forms, but most claims follow the same path.
- Check your cover. We confirm your funds and the TPD cover in each, using your super statements.
- Get the claim pack. We ask the fund for its claim forms and sort out which are for you and which are for your doctors.
- Medical evidence. Your treating doctors complete the fund’s medical forms. We send the forms to them and follow them up.
- Lodge the claim. We complete your forms from the information and documents we already hold, you check and sign them, and the full claim goes to the fund.
- The decision. The insurer assesses the claim and may ask for more information. We answer its requests and keep the claim moving.
If the claim is accepted, the insurer pays the benefit to your super fund. The fund then releases it, usually as a lump sum, once it is satisfied that your condition is likely to stop you ever working again in a job you are qualified for by education, training or experience. Tax may apply depending on your age and circumstances, so it is worth getting tax advice before you decide how to take the money.
If your claim is declined
A refusal is not always the end of the claim. You can complain to the fund or insurer and ask for the decision to be reviewed, and it is best to do this as soon as you can. A claim that is taking too long can be the subject of a complaint too. We look at the reasons for the refusal, gather further evidence that answers them, and set out your case in writing.
If the fund does not resolve your complaint, you can take it to the Australian Financial Complaints Authority (AFCA), which provides free, independent dispute resolution. Strict time limits apply to complaints to AFCA about a TPD decision on cover held through super. If you permanently stopped work because of your condition, the claim must have been made to the fund within two years of stopping work, and the complaint must reach AFCA within four years of the decision. If you did not permanently stop work because of your condition, the limit is six years from the decision. AFCA cannot extend these limits, so do not wait to get advice once you receive a refusal.
TPD alongside workers compensation or CTP
A TPD claim can run alongside a workers compensation claim or a car accident (CTP) claim. They are separate claims against different insurers, and a TPD claim can usually be made while the other claim continues.
The claims still affect each other in practical ways. The same medical records are used in each, and what you tell each insurer about your health and your ability to work needs to be accurate and consistent across every claim. Because we act in workers compensation and CTP claims as well, we look at the whole picture, including whether a TPD claim is worth making when your doctors say you cannot return to work.
What a TPD claim costs
We explain our fees and set them out in a written cost agreement before we prepare and lodge your claim, so you know how you will be charged. For TPD claims our fees are usually deferred rather than paid up front, and the fee basis we agree with you is written into that cost agreement.
We act for clients across NSW from our Sydney and Blacktown offices. Book a free first consultation and we can check whether you hold TPD cover before you commit to anything.
How we help
- We help find your super funds and check your TPD cover
- Claim forms completed for you — you check and sign
- Medical forms sent to your doctors and followed up
- We deal with the fund and the insurer for you
- Refusals reviewed and taken to AFCA where needed
- Fees set out in a written cost agreement before your claim is prepared