You could make a TPD claim when you have an illness or injury, and your doctor says you can’t work anymore. A successful TPD claim typically means receiving a lump-sum payout that helps fund your medical expenses, rehabilitation, home mortgage, and other living costs.
Our comprehensive superannuation TPD claim guide helps you understand the claim process, the challenges you might face, and how to win your insurance benefit.
Defining TPD claims is the first step in our TPD claim guide.
Defining TPD Claims
TPD refers to Total and Permanent Disability insurance, a life insurance policy often included through an Australian superannuation provider. When a policyholder has a long-term or permanent medical condition preventing them from working in their regular occupation, they could be eligible to make a TPD claim.
Once an insured person has an approved claim through their super fund, they receive a once-off lump sum TPD payout, helping them pay medical costs and other associated expenses.
Which Injuries Are Eligible for a TPD Insurance Claim?
Generally speaking, you could have a successful TPD insurance payout for any injury, illness, or psychological illness that stops you from working in your regular profession. However, your TPD policy terms will determine the conditions for qualifying as having a permanent disability.
In Australia, the fortunate people receiving a lump sum TPD benefit have conditions like:
- Loss of hearing, vision or speech
- Back and spinal damage
- Partial or complete paralysis
- Head trauma and brain damage
- Loss of limb
- PTSD (Post-Traumatic Stress Disorder)
- Anxiety and depression
- Social anxiety disorder
- Bipolar Disorder
Other Medical Conditions
The above list is a general guide. To understand if you can qualify as having a total and permanent disability, please get in touch with a TPD claim expert. It’s free to find out your eligibility requirements and if you have a valid case.
How Challenging is it to Prove TPD?
To win your TPD benefits, you must prove you have a Total and Permanent Disability, as defined by your policy terms and conditions. This process differs from other methods of demonstrating disability, like the NDIS or Centrelink requirements.
Generally, you only need to show that your medical condition prevents you from doing your usual occupation, which is typically easier than when qualifying for social security benefits, like a Centrelink disability support pension.
How to Make a Successful TPD Claim
In Australia, successfully claiming TPD benefits relies on meeting specific criteria.
Determine the Level of Disability
A critical factor in a winning payout is proving your level of disability. This element considers how much your personal injury or illness stops you from earning a living. However, it is not the same as eligibility for disability Centrelink benefits. In this case, the TPD assessment considers:
- Can you return to your regular job?
- Are you able to do a different type of role in the future?
- Whether your disability is partial or complete
Your Type of TPD Insurance Cover
There are typically three main kinds of coverage for TPD insurance policies. Depending on which one you have, submitting a claim for benefits may be relatively simple or challenging.
- Your own occupation: This means you can’t return to work in the job you were doing previously (which means you could return to work later in a different industry).
- Any occupation: You can’t work again in any role suited to your previous experience, education, or training.
- Non-occupational: This type of policy, which typically isn’t offered by your super provider, means that you can only perform one out of three daily activities.
A specialist TPD lawyer typically helps you understand your eligibility and how to satisfy the terms of your permanent disability insurance policy.
Work History Requirements
Some Australian insurance companies require policyholders to satisfy minimal work history requirements to be eligible for TPD income protection insurance, including:
- Proof of a minimum of 12 months of working history
- The employment basis of that work – full-time or part-time
- How many hours did you work before the injury or illness
Capacity to Complete Daily Tasks
Some TPD superannuation policies that help with additional daily living costs require applicants to prove they cannot manage simple daily tasks like walking, eating, and showering. In this case, a medical assessment or doctor’s report typically satisfies these criteria.
Requirement for Future Medical Treatment
Another requirement for a winning TPD claim is the need for future medical care to support your recovery. In most cases, you provide proof of your treatment history and appointments.
When you hire an insurance claim lawyer to ensure a winning outcome, they will help you meet the terms of your TPD policy to ensure a winning outcome.
TPD Claim Process – Steps to Success
Filing a successful TPD claim can be challenging, but with expert legal support, you will have an increased chance of receiving a TPD lump sum. These are the steps to win your insurance benefits.
Step 1 – Contact the personal injury insurer and superannuation fund.
First, you must confirm your live permanent disability TPD insurance coverage through your superannuation fund or as a stand-alone policy. Some fortunate people have more than one, and they could make multiple TPD claims for the same disability.
Your insurance policies will show the value of your superannuation insurance payout and the terms for meeting your TPD definition.
Step 2 – Ensure you have a ‘live’ policy at the injury date.
Confirm that you had a live super fund policy at your injury date and still have coverage. If you had a progressive condition that escalated over time, the date of injury will not be conclusive and will require legal advice.
Step 3 – Know Your Policy Terms
Understanding your policy terms is crucial for a successful claim, particularly the definition of TPD and occupation conditions. Some policies pay if you can’t work in your own job, and others pay if you can’t work in any position. Meeting this requirement will determine your outcome.
Step 4 – Lodge a TPD Insurance Claim
A winning insurance claim needs a compelling case that meets or exceeds the insurance company’s expectations. This requirement means including your injury details, medical reports, treatment records, and more for TPD claims. If you fail to do this, the insurance company will likely send you multiple requests for more information, which could substantially delay your payout.
Step 5 – Attach A Supporting Letter
You have a greatly increased chance of winning when you attach a letter explaining why you should have an approved payout, including how you meet each criterion. Remember that insurance providers receive many phoney claims each year, so this step helps prove yours is legitimate.
Step 6 – Pursue Your Payout
Pursue your payout by contacting the insurance company to confirm they have everything they need to decide.
Step 7 – Dispute a Rejected Claim
In Australia, over 10% of people have a rejected TPD insurance claim each, but they don’t give up. Your best chance of reversing a negative outcome is to work with a professional TPD lawyer.
What is the Time Limit for a TPD Claim?
There is generally no TPD claim time limit, so you could claim insurance benefits years after you cease working if you still have a current policy. There are some qualifying conditions:
- It would help if you filed before your pension age.
- Some policies have a time restriction clause.
- There may be a time constraint for lodging a claim if you have had a previous denial.
How Long Does It Take to Get a TPD Payout?
Getting a TPD payout takes about six months if you meet all the requirements when lodging. However, taking swift action can be the difference between being approved or denied.
Remember, insurers don’t enjoy paying benefits, and they will be suspicious when there is a significant delay between your injury date and seeking insurance benefits.
Why Do Super Fund Insurers Deny TPD Claims?
These are the common reasons why insurers deny TPD claims.
- Failure to lodge within your age limit
- Claiming before your injuries are stable.
- Dodgy evidence that doesn’t relate to your medical condition.
- Missing or incomplete documentation
- Not including the attachment letter
How Much Is a Typical TPD Payout?
The value of your super insurance policy determines how much you get in a TPD payout. However, in Australia, the average payout is between $ 50,000 and $ 500,000, with some receiving more or having multiple claims.
What Does a Lawyer Charge for a TPD Claim?
Many TPD law firms work on a No Win, No Fee basis but differ. Some will cover all your expenses until you win, including medical assessments and expert reports (disbursement fees), while others ask you to pay disbursement costs.
Furthermore, some will charge based on the value of your payout, while others charge a fixed or capped fee.
Aussie Injury Lawyers is a leading Australian TPD claim law firm that works on a 100% no win, no fee basis. Choosing Aussie means you pay nothing until you win and zero if you lose. Furthermore, they offer fixed or capped pricing for your case. For a free claim investigation, contact them now at 1300 873 252
How to Get the Most from Your TPD Claim
When you claim TPD, here are some tips for maximising your lump sum payment.
1. Supply as much supporting information as possible, including your medical files and other related paperwork.
2. Be honest and accurate during the claims process. TPD payouts generally succeed when well-prepared and consistent.
3. Get expert help from a TPD claims specialist or solicitor. They have the knowledge and expertise to guide and support you to the best possible outcome.
4. The TPD claim process can take time, so please be patient. However, you can accelerate your insurance payout by lodging your best case in the first instance.
Avoid These Four Common Errors When Claiming TPD Benefits
1. Not Understanding the TPD Definition
People often fail to successfully claim TPD because they don’t know the TPD definition. Generally, a Total and Permanent Disability (TPD) prevents you from working in any role for which you have education, experience, or training. Hence, you could make a TPD claim and later work in a different industry.
2. Taking Too Long to Lodge a TPD Claim
Don’t wait too long to file a TPD claim. Delaying your lodgement can increase your chance of denial. Remember that insurance companies receive many fraudulent cases each year. When there is a lengthy gap between the injury or illness date and the claim submission, they are more likely to question your eligibility.
Please submit your super fund claim immediately to ensure you get all your owed TPD benefits.
3. Not Supplying Enough Medical Evidence
Having a successful insurance TPD payout relies on expert medical records and assessments, including how much your illness or injury impacts your work capacity. Sadly, another frequent error is that claimants fail to disclose their medical history, including pre-existing medical conditions, thinking it will harm their results. Hiding information increases your chance of a rejected case, so please be honest.
4. Not Selecting the Best TPD Insurance Lawyers
How Successful are TPD Claims? The Winning Factors
Making a successful Total and Permanent Disability (TPD) claim can be challenging, but with careful preparation, it is possible to achieve a positive outcome. Please remember that winning a disability insurance claim relies on several factors, including:
- The severity of your illness, injury or mental health condition
- Whether your disorder meets your insurance policy’s TPD definition
- The quality of your supporting documentation
- Your level of insurance cover
Understanding how lawyers help with the TPD claims process is the next section in our guide.
Why Hire a TPD Lawyer?
If you have TPD coverage and believe you have an eligible claim, you will likely want to understand the reasons for hiring TPD lawyers. The answer is simple: it is complex to successfully claim TPD, requiring careful preparation and experienced litigation legal advice. Remember, large super funds and insurance companies have legal teams whose role is to reduce their liability for TPD Payouts.
Experienced TPD lawyers regularly negotiate with all the major insurers and:
- Investigate your TPD policies for free.
- Know their expectations.
- How to win a TPD claim payout
- Understands what they do to deny claims.
Aussie Injury Lawyers has a team of experienced insurance litigation lawyers ready to help you on a 100% no win, no fee basis. Knowing if you have a valid case and your payout value is free. Call Now – 1300 873 252