If you have suffered an injury or illness that causes you to stop work then you may be able to pursue a Total and Permanent Disablement (“TPD”) claim.
What is a TPD claim?
A TPD claim is an insurance claim covered by either your Superannuation fund or through a separate insurance policy.
Most Superannuation Policies by default have TPD cover. This is essentially insurance if you become totally disabled and unable to work. It is insurance that pays out as a lump sum if you satisfy the definition of Total and Permanent Disablement in the Policy.
Each Policy is different. You may be able to make a claim if you’re unable to return to work in your own occupation (work that you were doing at the time of your injury or illness), you’re unable to return to any work you’ve done in the past (including work that you are suited to by education training or experience), or you’re unable to return to any work in any job.
You’ll need to consider your Policy definition to understand whether you are eligible to make a claim.
‘Unable to work in your own occupation’ vs ‘any job’
If your Policy covers you for ‘own occupation’ then you could make a TPD claim if you are unable to return to the work that you were doing at the time of your injury or illness.
If your Policy covers you for ‘any job’ then you could only make a TPD claim if you are unable to return to any work because of your injury or illness. It will depend on the extent of your injury or illness as to whether you would satisfy this definition.
If your Policy definition requires you to be unable to work in ‘any job’, and you are unable to return to work you were doing at the time of your injury or illness but able to return to alternate work, then you may not be successful with a claim.
Is it possible to have more than one TPD claim?
Yes it is. It is not uncommon for people to have more than one Superannuation fund. It may be that you are still insured with an older Superannuation fund in which case you may have TPD cover with that fund as well as a current Superannuation fund which would give you access to multiple TPD policies.
What if I have a workers compensation or personal injury claim? Can I still make a TPD claim?
Yes. TPD claims are separate to any entitlements you may have to compensation from a Workers Compensation claim or other personal injury claim such as motor vehicle accident, public liability or medical negligence claim.
Can I make a TPD claim if I am self-employed?
If you work for yourself, are not taking a regular salary or wage and you do not pay yourself regular superannuation contributions, then you may not have TPD cover.
For individual contractors/self-employed it is up to the individual themselves to make payments for superannuation. If they don’t then they may not have TPD insurance. They can, however, take out a stand-alone TPD policy with an insurer if they do not have superannuation.
How do I make a TPD claim if I have cover?
Contact your TPD insurer or Superannuation fund and advise them that you want to make a TPD claim. If you have cover, they will send you a copy of your Policy and various forms to be completed.
There will be a form for you to complete about your injury or illness and work history, a form for an employer to complete, and medical certificate(s) to be completed by one, and sometimes two, treating medical practitioners.
It’s important that you read the Policy carefully to see what you are and aren’t covered for. You’ll need to be as accurate as you can when completing the form and make sure you answer all the questions.
Gather up any relevant medical evidence and let your treating doctors know that you are making a claim because it’s likely that you and/or the insurer will need to request a report from them about your injuries and capacity for work.
If you make a TPD claim yourself, it’s helpful to keep records of all discussions that you have with the insurer whether that’s through emails and letters or over the phone.
Unfortunately, these claims can take time and insurers will first want to gather up all relevant medical evidence to work out whether you meet the criteria for a TPD claim.
Do I need a lawyer to make a TPD claim?
TPD claims can be complicated. While you can make a claim yourself, the insurance industry is notorious for dragging claims out and making the process difficult, with many people finding that their claims are unsuccessful.
It’s beneficial to have a specialist TPD lawyer help with your claim as they understand the process and can help you achieve the best possible outcome.
If you are confused or in doubt about how the insurer is handling your claim, seek legal advice.
Get in touch
Our team of experienced TPD lawyers can guide and advise you throughout the claim process, so you can focus on your recovery.