If you have had to stop working on a permanent basis because of illness or injury you may be able to make a Total and Permanent Disability (TPD) claim. Insurance for TPD may exist as a stand-alone policy or form part of your superannuation.
The first step is to check your superannuation accounts and personal insurance policies to see if you have TPD insurance. If you’re not sure or cannot find any of your documents your lawyer can assist.
In addition to a lump sum payment under a TPD claim, your illness or injury may qualify for early release of your superannuation entitlements.
Navigating the terms and conditions contained in a TPD policy and the claims process can be very daunting, particularly when you are unwell. This article is aimed at helping you understand what TPD insurance is and the process for making a claim.
What is TPD insurance?
Total and Permanent Disability insurance provides a lump sum payment to individuals who can no longer work in their usual occupation or other type of employment, taking into account their qualifications, experience and training.
Total and Permanent Disability insurance often forms part of a superannuation policy so it is important to check your documents carefully to ascertain your entitlements. People are often unaware that they have an entitlement to claim TPD.
A TPD policy is a contractual arrangement between the insurer and person entitled, with the terms set out in the policy document or product disclosure statement. Important provisions include:
- eligibility conditions including age limits for making a claim;
- waiting periods and excluded claims;
- definitions for TPD, terminal illness, permanent disability; usual occupation;
- the requirements and process for making a claim;
- the amount payable if the claim is paid out.
Making a TPD claim
If any injury or illness prevents you from working and you have TPD insurance in place, then you may have a claim. The cause of your injury or illness does not matter for the purposes of claiming TPD. In other words, you need not establish fault or negligence as would normally be the case in a motor vehicle accident or public liability claim.
If you consult a lawyer to assist in making a TPD claim, he or she will review your policy carefully to determine your eligibility and the procedural requirements.
You will need to provide supporting information specific to your illness or injury such as reports from your general practitioner and treating specialist as well as other material relevant to your work such as employer statements, trade certificates, qualifications and information regarding your training and experience.
The insurer will have specific forms to complete and a list of information required to accompany your claim.
Superannuation funds and insurers have their own governing rules and TPD definitions. Generally, TPD means that you have been unable to work in your usual occupation for at least six months and you are likely never to be able to engage in any gainful work for which you are reasonably qualified given your training, education and experience.
The condition suffered and preventing work must generally be permanent.
After receiving your claim, the insurer will assess your eligibility and conduct its own investigations and will usually request for you to be examined by its own appointed medical expert.
Once all evidence has been submitted, the insurer will make a decision on whether to accept or deny your claim and notify you.
Disputes over TPD claims
A TPD claim may be rejected for technical reasons (such as age limitations or making the claim too late) or because of the insurer’s interpretation of what constitutes a TPD, or other definitions contained in the policy. This can be a very complex area of law and usually requires the assistance of an experienced expert to challenge the insurer’s decision.
If you are not satisfied with the decision reached by your superannuation fund or insurer, you can request a formal internal review. If a satisfactory outcome is still not obtained, your lawyer can discuss whether Court proceeds might be justified.
Disputes concerning decisions relating to TPD claims or claims for misrepresentation about the terms and conditions of a life policy can also be dealt with by the Superannuation Complaints Tribunal. Time limits apply and your lawyer will advise in this regard.
Accessing your TPD entitlements can be time consuming and challenging, particularly when you are battling illness or injury. Sadly, we cannot offer advice on your recovery or treatment but can assist in alleviating some of your financial concerns by helping with your claim and ensuring that you receive your maximum entitlement.
If you are in the fortunate position of not having to claim TPD insurance, we suggest that now is a good time to review your superannuation and life insurance policies to confirm your entitlements should the unforeseen happen.