TPD claims for injury and illness

Total and permanent disability (TPD) benefits are available to people who are unable to work due to injury or illness. Each potential benefit is different and is based upon the individual policy or trust deed you entered into when taking out the insurance, as well as your age and the date of your injury.

What types of injury or illness are covered?

It does not matter what your injury or illness is. You simply have to be unable to return to work either doing your own job or a job you are trained for, experienced in or educated for.

Further, your injury or illness does not have to be related to your work. That’s what workers compensation benefits are for. Even if you claim WorkCover, if you are unable to return to work, you can also claim on your TPD insurance.

If you are in receipt of TAC (motor vehicle accident) benefits, medical negligence compensation or public liability compensation, you can usually also claim on your TPD insurance.

There are a number of illnesses for which you may be able to claim your TPD benefits for. Some of these include:

• Multiple sclerosis;
• Parkinsons;
• Cancer;
• Mental health;
• Chronic fatigue syndrome; and other chronic illnesses.

Can I claim TPD benefits for mental illness?

Yes.

Generally, so long as your illness or condition is preventing you from returning to work, either doing your own job or a job you are trained for, experienced in or educated for, you can claim TPD for mental illness. Each insurance policy is different and there will be different criteria for claiming.

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If you suffer a mental illness and you are unable to return to work, it’s critical you seek legal advice to determine if your TPD policy covers you.

How is the TPD lump sum payment calculated?

It is important that you are aware that TPD claims are brought for the benefit (the insured amount) you held as at the date you stopped working.

We often meet with clients whose super statements do not show a TPD benefit. This is because they ceased work some time ago and their employer stopped making contributions. This resulted in the TPD cover ceasing.

At Guardian Injury Law, we are happy to investigate your entitlements to make sure you can access the benefit you are entitled to as at the date you ceased working.

Are there time limits for TPD claims?

There is generally no time frame in which to lodge a TPD claim. At Guardian Injury Law, we have successfully lodged TPD claims for clients whose injuries or illness prevented them from working many years ago.

Can I make a TPD claim on multiple policies?

Many Australian workers have more than one super fund and often, those funds will provide for TPD insurance. If you have more than one policy, you may be able to make multiple claims concurrently. However, dependent on the specific wording of each policy, the order in which you claim is crucial. It’s important to seek legal advice before lodging any claim.

How do I know if I meet the threshold of total and permanent disablement?

To be successful with a TPD claim, you will need to meet the definition of total and permanent disablement contained in the insurance policy or super fund’s trust deed.

These definitions sometimes vary between funds and should be looked at carefully. In some instances, the definition will require you to be totally and permanently disabled for your “own occupation”. Other definitions require that you are totally and permanently disabled for “any occupation”.

To prove that you meet the relevant definition, it is essential that your treating medical practitioners complete the forms provided by the super fund. These are known as Medical Attendance Statements (MAS). It may also be necessary to obtain additional medical evidence to support that you are unable to return to work including clinical notes, insurer reports and expert medical opinion to show that you meet the fund’s definition.

At Guardian Injury Law we are able to assist you with obtaining all of the relevant and required information as well as preparing detailed submissions on your behalf. We will ensure you meet the fund’s definition as well as address any potential issues in your claim, to give your claim every chance of success.

What if my claim is taking too long?

It is important that you are aware that super funds do not have a set timeframe in which to determine your claim. Some will respond relatively quickly and some will leave you hanging.

They can request additional information or assessments as required. Once they have all of the relevant information, they are generally afforded 6 months in which to determine the claim. If they do not determine a claim within this timeframe, then we are able to seek that they pay penalty interest for unnecessary or unreasonable delays when your claim is approved.

What if my TPD claim is rejected or declined?

We are experienced in challenging decisions made by super funds to decline claims.

This can be done in a variety of ways including obtaining additional evidence and submitting this to the fund for reconsideration, issuing proceedings in the relevant Court or alternatively, lodging a complaint with the Australian Financial Complaints Authority (AFCA).

We will always take the time to get to know you to determine which dispute resolution avenue will work best for you and give your claim every chance of success.

There are strict timelines in which to appeal decisions to decline TPD claims. It is essential that you speak with Guardian Injury Law to ensure your rights and entitlements are protected.