TPD Guide: How to Claim Through Your Super Fund

If you have suffered an injury, or an illness, which stops you from working, you may have an entitlement to lump sum compensation for total and permanent disablement (TPD). TGB partner Barney Gask has written this guide which takes you through the claim process, what happens when a claim is made and the Superannuation Complaints Tribunal.

Starting the Superannuation Claim Process

Defining Total and Permanent Disablement

The lump sum is offered through your policy of superannuation.  Many people are unaware of the entitlement and in most cases it can be a significant sum of money.

However, just because you can’t work doesn’t mean that you are automatically entitled to the lump sum. You will need to satisfy the definition of TPD in your policy. That definition can differ from policy to policy. If you have been advised by your doctor/s that you will not be able to return to the work for which you are experienced because of your injury then you have a good prospect of succeeding with your claim.

How do you begin the process? 

If you have considered the policy definition and you think you might qualify, you then need to begin the process.

Firstly, you need to check that your policy includes TPD. You should have received statements from your fund and those statements will confirm if you have a TPD entitlement, and the amount.

Once you have checked your statement you need to notify the fund that you want to claim your TPD lump sum. The fund will then send you forms to complete, this will include a form that requires you to include your personal information and details of your injury/illness, medical statements to be completed by your doctor and an employer form. Once the forms are returned to the fund they may request further information.

They will then make a decision to either accept or reject your claim. That decision can take some time. With the assistance of a lawyer you will be able to ensure the accuracy of your claim and consequently aid the process.

“What happens once I have made my Super claim?”

Once you have completed the required Claim forms and lodged them with your fund it will often take some time for a decision to be made. Your lawyer will be able to provide you with an estimated time frame, however, this can sometimes be a slow process.

The claim is usually referred to another body or an insurer to assist in the decision making process. This is one of the causes of delay.

Accepted claims 

If the claim is accepted the fund will confirm it in writing and will usually provide you with a number of options in relation to the TPD or insured component. Once you are deemed TPD the fund will also pay the accumulated superannuation contributions to you.

At that point it is very important that you seek advice from a financial adviser or accountant as there are tax implications depending on how the payment is made and where.

Rejected claims 

If the fund rejects the claim it is important to obtain legal advice at that point, if you have not already done so. A lawyer can advice you of any further medical evidence that needs to be obtained to support your claim and then assist you to dispute the decision. In most cases the dispute initially needs to be referred to a dispute resolution representative within the fund.

If the rejection is maintained the decision then needs to be referred to the Superannuation Complaints Tribunal (SCT). They will consider the claim and determine whether the decision was valid.

The Superannuation Complaints Tribunal

The Superannuation Complaints Tribunal (SCT) should be able to deal with your complaint about the decision made by the trustee of your superannuation fund to reject your claim. They won’t deal with all complaints and there are conditions that apply to decisions that are referred to them. Whether they can consider the complaint will depend on whether the condition that gives rise to the claim for TPD caused you to stop working and also the date the decision was made to deny the claim.

There are conditions that apply to decisions made before 1 July 2013, but if the decision was made after 1 July 2013 the SCT will deal with your complaint if the decision has firstly been referred to the internal dispute resolution service of the fund, but also if your complaint is referred to the SCT within 2 years of stopping work as a result of the condition, and within 4 years of the decision to deny your claim.

To lodge a complaint a Registration of Complaint form needs to be completed. The forms are lengthy and it is especially important that the grounds of the complaint are completed properly.

The SCT will attempt to resolve the dispute through conciliation but if a resolution cannot be reached the SCT will then make a determination of the claim. If the SCT finds that the decision made by the fund was wrong, and that you should be paid your benefit, then the fund is bound by that decision unless there has been an error of law. If the SCT finds the decision was valid you can challenge the decision further in Court.

A lawyer experienced in TPD claims can assist you in preparing the forms to be lodged with the SCT and if necessary challenging the decision of the SCT in Court. Given that there are time limits that apply to referring your complaint to the SCT advice should be sought as soon as possible after the claim is rejected by the fund.

For a free initial interview about your potential TPD claim, contact your nearest TGB office.