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Total and Permanent Disablement claims (TPD Claims) are a form of personal injury claims that can be made when you can show that you are permanently unfit and unable to return to your usual employment. TPD claims can also be made in conjunction with any other type of personal injury claims. If you have a worker’s compensation claim, a motor vehicle accident claim or any other claim resulting from an injury that prevents you from working; you will be entitled to make a TPD claim.
Total and permanent disablement does not have to be a result of an injury to make a TPD claim. Disability can arise from a medical condition, illness or disease such as heart attacks, cancer, mental illness etc.
What do I have to do?
Many Australian Superannuation Funds provide TPD insurance benefit which is also known as disability insurance. Please note that TPD is different to income protection insurance and death benefit insurance which are discussed below.
Every insurer and TPD policy has its own definition and criteria which are required to be met in order to successfully make a claim. Generally, total and permanent disablement means :
- the person must be unable because of an injury or illness to work in the field for which they are qualified by education, training or experience
- the person must have stopped working as a result of the injury or illness
- the person must be absent from work for at least 6 months. Please note that the waiting period varies between each superfund.
The person making a TPD claim must be able to show that he is incapable of returning to his usual occupation. Often, alternative employment may be available to a person if further education or training is undertaken. This person can still make a TPD claim because the alternate employment is outside the education, training and the experience he has.
The Superannuation TPD Claim Process
Do you have TPD Cover?
In order to make a TPD Claim, we need to contact your superannuation fund to find out whether you have TPD insurance cover. If you do not know who your superannuation fund, do not worry as with your authority, we will be able to conduct a search for all your super accounts. Many people find out that they have more than one superannuation fund and more that one TPD insurance policy.
Once we have established that you have a TPD insurance policy and the benefit you are entitled to. We will request all relevant claim forms. We will liaise with your treatment providers such as your GP and specialist who have been treating you primarily for your injury or illness as well as your employer.
Statement of Support
Your treating doctors and employer will be required to complete a statement which supports your claim for TPD. You will also need to complete a claim form and we will assist you in completing the same.
Obtain All Medical Records
We will also obtain all your clinical notes, medical reports and medical imaging which we will rely on as evidence in support of your claim. Your medical evidence together with the completed claim forms and statements from your doctors and employer will be submitted to the TPD insurer.
The Payout amount
The TPD insurer will review your application and determine the amount of your payout. This means that the superannuation insurer will issue a cheque or deposit the payout amount into the nominated bank account.
In the event that your claim for TPD is denied; we will request the insurer to review their decision with further medical evidence. If the insurer makes a determination that is not favourable to you, we can lodge with the Superannuation Complaints Tribunal or alternatively commence proceedings in court to challenge the determination that was made by the superannuation fund.
Income protection insurance is an insurance cover to secure your income in the event that you are unable to work as a result of an injury or medical condition. Every insurance policy has different terms and conditions which are set out in the disclosure statements available on the superannuation fund’s website.
Every income protection insurance policy is different in relation to the actual period that a benefit is paid. For example, an income protection benefit can be paid for a period of 2 years, a period of 5 years or up to the age of 67. This is determined by the insurance cover that was taken up with the superannuation fund. Benefits make under an income protection claim are paid on a monthly basis and they go up to 75% of your gross wages.
In the event that you are unable to continue working in your usual employment or any other suitable work; you are entitled to make a claim. You may also be entitled to make a claim for temporary loss of earnings. For example, you injured your leg at work and you were not able to continue working for a period of 6 months; you may be entitled to make a claim, receive compensation and resume your usual employment.
This of course will depend on the terms and conditions of the policy
Death benefit or life insurance claims
An accidental death benefit is paid to a beneficiary on an insurance policy when the annuitant (the person who pays the premium of the insurance policy) passes away.
Superfunds in Australia make payments in addition to other insurance benefits. Other government super funds may pay pensions to the surviving partners and dependants.
Any dependant; spouse or child can make a Death Benefit Claim. A trustee will determine the status by dividing the super or giving it to the estate through Letters of Administration. We will explain to further to you during our free consultation.
Death Benefits claims can be lodged at any time. Together with all claim forms necessary, documents showing the relationship of the deceased and the financial dependents must also be lodged.
No Win No Fee
There are no upfront fees associated with TPD claims. We will provide you with free consultation and advice, prepare your claim on a no win no fee basis. You will only pay us when you receive your payout from the insurer. We will also advise you of our fixed fee during our initial consultation.
If the superfund insurer does not accept your claim and you wish to commence proceedings in court; we will inform you immediately whether we believe that there is a minimal chance in winning the case. We will withdraw the claim to avoid unnecessary court fees.
Frequently Asked Questions.
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