Written by Umrah Syed
If you are unable to work due to a critical injury or illness, a total and permanent disability (TPD) claim might be just the financial lifeline you need.
For many people, however, handling a TPD claim without legal advice brings extra stress at a time when it’s least needed. That’s why we’ve put together this guide with everything you need to know about TPD claims and securing a successful compensation payout.
TL;DR: TPD Claims Eligibility
To be eligible to lodge a TPD claim, you need to satisfy 4 requirements:
- At the time of your injury/illness, you hold TPD insurance cover in your superannuation fund;
- As a worker, we all have at least one superannuation fund where our employer pays our superannuation. Most superannuation funds will offer TPD, death and income protection. You are currently suffering from an injury or terminal illness;
- Due to your injury or terminal illness, you have remained off work for a consecutive period of at least 3 months; and
- You are under the regular care of a treating provider.
What is a Total and Permanent Disability (TPD) claim?
TPD means “total and permanent disability”. A TPD claim is an insurance benefit entitling you to a lump sum payment if you suffer a critical injury or sickness that prevents you from working.
If you’re like many Australians, you might automatically hold TPD insurance cover through your superannuation fund – perhaps without even realising.
How do I know if I have a TPD claim?
If you’re unable to work or are unlikely to work for at least 6 – 12 months due to illness or injury and cannot return to work in the same capacity as before the accident, you may be eligible to make a TPD claim for a lump sum under your policy. The illness or injury doesn’t need to be work-related or caused by your employer in order to make a claim.
Most importantly, if you have not worked or are unlikely to work for at least 6 – 12 months due to illness or injury and cannot return to work in the same capacity as before the accident, you may be eligible to make a TPD claim for a lump sum under your policy.
TPD insurance can be purchased from insurers as an independent product, however, you could already be receiving total or partial coverage under another policy (such as superannuation).
If you’re unsure whether you currently hold valid TPD insurance cover, check with your insurer or superannuation fund. You can also check your most recent superannuation or insurance statement to see if you had cover as of your last date of work.
If you’re in any doubt as to whether you have the grounds for a TPD claim, speak to a professional TPD lawyer about the specifics of your case as soon as possible.
Do permanent disability TPD Claims have to be work-related?
TPD claims don’t have to be work-related or caused by someone else’s negligence. No matter the cause, If you’ve suffered from an illness or injury that prevents you from working, you may be eligible to make a claim.
What if my TPD claim is related to an old injury or sickness?
Most policies don’t place a time limit on when a TPD claim can be filed.
Certain government or employer-sponsored super funds may specify that you have to make your claim before or soon after ceasing employment, but these are the exception rather than the rule. Contact Schreuders to find out your eligibility.
What Type Of Physical and Mental illnesses qualify for TPD Claims and can you claim for depression?
TPD can be claimed for a variety of mental and psychological illnesses. If a mental or psychological illness has prevented you from working, you may be eligible to make a claim. It can be slightly more difficult to prove your level of disability when suffering from a psychological condition, but regular treatment from your GP, psychologist and/or psychiatrist can make it much easier to substantiate.
Here is a list of injuries and illnesses that can prevent people from working:
Mental Health Conditions
- Depression
- Schizophrenia
- Bipolar disorder
- PTSD
- Obsessive-compulsive disorder.
When can I make a TPD Claim?
You can make a TPD claim after you have spent an extended amount of time (usually three to six months) off work due to a medical condition. This ‘waiting period’ will vary from policy to policy, but once it has been seen through, you are free to claim at any time – even years after ceasing your employment.
Making a successful TPD Claim
How do you successfully claim TPD?
To make a successful claim for TPD benefits, you must first be eligible for the policy under your superannuation insurance scheme.
Every insurance policy will have slightly different criteria for what qualifies as total and permanent disability.
This can involve being assessed by doctors and other medical professionals to see if you meet the requirements required by your policy for totally and permanently disabled.
A professional TPD lawyer can help you make sense of your policy’s criteria and source the evidence needed to make a successful claim. Contact the team at Schreuders for legal advice.
Can you claim for partial disability?
TPD generally refers to ‘total’ disability, but you may be able to claim for partial disability depending on the policy of your super fund.
In this case, you will receive compensation for your reduced capacity to earn. These benefits might be based on duties you can no longer perform or the need for reduced hours due to your condition.
What’s the difference between “any” and “own” occupation?
TPD policies can cover you for either “any” occupation or “your own” occupation. Here’s the difference:
- Any occupation covers you if you can no longer perform any job that fits your education, experience, or training. This is a cheaper level of cover, but one that is less likely to payout.
- Your own occupation covers you if you can no longer perform the same job you did before you were disabled. This level of cover generally comes at a higher premium.
Can I claim TPD and Income protection at the same time?
TPD and Income protection can usually be claimed at the same time without impacting on each other.
Interferences only tend to occur when TPD is claimed while you are receiving ‘temporary’ benefits (such as temporary salary continuance).
Why would a TPD claim be rejected?
Making a total and permanent disability claim isn’t easy. It’s surprisingly complicated to prove that an injury or illness is preventing you from being able to work as you once did, under their specific policy.
TPD claims can be rejected on a number of grounds, including:
- Submission of documents that are not in accordance with policy requirements
- An insurer finding that you are able to work
- Inadequate provision of medical evidence
- Failure to meet all policy criteria for total disablement
- Having an out of date or invalid policy.
- Failure to meet work history requirements
Remember that your claim is treated at the insurer’s discretion under the policy, and they may not always make the right decision. This means you may still dispute the decision if your claim is dismissed. Seeking legal advice from the beginning, however, is the best way to minimise your risk of rejection.
The TPD claim process
How long does it take to get a TPD payout
Before you can make a TPD claim, you need to spend an extended period of time off work to evidence your inability to earn an income. This waiting time varies between policies but is usually between three and six months.
Once the waiting period has concluded and your claim has been submitted to your super fund or insurance company, the process is usually resolved in 6 to 12 months. Again, this varies depending on individual circumstances and the amount of time it takes to gather all required evidence.
Can you claim on multiple TPD policies?
If you have TPD insurance with more than one super fund, you might be able to claim multiple benefits, if all the TPD policies were held at the date of disablement, or the date you last worked. However, certain legislative and policy restrictions can apply so it’s best to contact a TPD lawyer if you’re planning to claim on multiple policies to gain expert legal advice.
What are the steps of the TPD claims process?
The exact claims process varies between law firms and insurance companies and different super funds.
Here is a step by step breakdown of the process we ordinarily use to handle TPD claims at Schreuders Law Firm. You can also expect to follow similar steps if you decide to handle your claim independently.
- Contact your insurer or super fund. Obtain the entire TPD policy from the insurer or superannuation company.
- Obtain all of the documentation necessary for the policyholder to meet the eligibility criteria for total and permanent disability. This includes payslips, medical documents, employer correspondence etc.
- Compare the policy requirements with the evidence provided to determine the amount of compensation.
- Check each piece of evidence against the TPD policy, to give it the best chance of approval
- To make a claim you will need to complete the claim forms which the insurance company requires to be completed. Submit your claim once all the documentation is complete
- Your claim is assessed. Your super fund and insurer will review your documentation. They may request additional information/evidence.
- Your insurers make a decision on the claim
In some cases, you may also be required to meet with a medical specialist organised by the insurer and may need to attend further medicals from your end also.
Our expert team of TPD lawyers will liaise with the insurance company or superannuation provider to secure the maximum possible compensation you are entitled to.
Do I need a lawyer to make a TPD claim?
Having a lawyer is not a requirement of the TPD claims process; however, handling a claim on your own can be a stressful and difficult experience when you’re already dealing with an injury or illness.
Insurers’ fine print may be filled with complex processes and requirements that may minimise your chance of a satisfactory payout. In some cases, they can even send you to multiple specialists and insurance doctors in search of a single diagnosis that could undermine your claim, depending on the doctor’s opinion.. An experienced TPD lawyer can fight for your legal rights against these practices, saving you time, money, and health. As a law firm Schreuders works on a No Win No Fee guarantee.
Call your local Schreuders team today for a no-obligation discussion of your case.
How much do you charge for a TPD claim?
Our accomplished team at Schreuders has a No Win No Fee guarantee, which means that while we manage your claim and finalise your compensation payments, there are no out of pocket costs for you. You’ll only be required to pay legal fees at the end of your settlement, and if you don’t win, then you won’t be charged anything.
TPD Payouts
How much is a typical TPD payout amount?
The amount that you are entitled to claim will depend on the insurance arrangements in your specific super fund(s). TPD payouts vary depending on the specifics of each individual case and policy; however, lump-sum payments usually range between $30,000 and $450,000.
How is TPD paid out?
If your TPD insurance claim is approved, the lump sum is usually paid into your superannuation fund. From here, you can opt to transfer all or part of the balance to your regular bank account or leave it with the rest of your super fund.
Is a TPD payout considered taxable income?
There are some instances in which you can be taxed upon a TPD payout. For example, if you have not met the preservation age (60+), you may have to pay tax on a certain portion of the TPD payout. Tax is rarely paid on the entire amount.
Taxation requirements can be complex and vary from policy to policy. Speaking to TPD lawyers can help you gain an estimate of the figure prior to payout.
Does a TPD payout affect Centrelink payments?
This can entirely depend on the type of Centrelink payment you are receiving, while we do not often see it affecting a Centrelink payment – if you elect to transfer your TPD benefit from your super fund and into your everyday accounts, it may be classed as income that affects your Centrelink entitlements – particularly if you are of pension age.
Report your situation to Centrelink if in doubt or speak to a TPD claims professional for advice.
Can you work after a TPD payout?
After the TPD benefit has been made, you are no longer bound to the superannuation insurance scheme or the TPD insurance provider. Should you wish to work or follow other pursuits in life, you may do so under the guidance of your medical practitioners.
Why trust Schreuders with my disability insurance and super claim?
Schreuder’s TPD lawyers are experts in Australia. We understand the importance of having someone in your corner when taking on a well-resourced insurer.
We know the impact that an unexpected illness or injury can have on your life. Our team can help you navigate the complicated claim process giving you a lot more certainty about the future.