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If you’ve suffered an injury or illness that prevents you from returning to work, you may be entitled to a TPD insurance benefit through your superannuation.
What is a TPD claim
A TPD claim refers to a claim made under a Total and Permanent Disability (TPD) insurance policy. TPD insurance provides coverage to individuals who become totally and permanently disabled and are unable to work as a result of an illness or injury.
What is TPD insurance
TPD insurance, or Total and Permanent Disability insurance, is a type of insurance policy that provides financial protection to individuals who become totally and permanently disabled due to an illness or injury. TPD insurance can provide a lump sum payment or ongoing income support to help cover the costs of medical expenses, ongoing care, and other living expenses.
Eligibility to make a TPD claim
If you’re unable to work or are unlikely to work for at least 6 to 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 to 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.
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 in Jameson Law about the specifics of your case as soon as possible.
What is considered a TPD
The definition of “total and permanent disability” can vary between insurance policies and providers, but it generally includes conditions that are severe and permanent in nature, such as:
- Loss of sight in both eyes
- Loss of hearing in both ears
- Loss of limbs or amputation
- Paralysis
- Traumatic brain injury
- Severe mental health conditions such as schizophrenia, bipolar disorder or PTSD
- Cognitive impairment or dementia
- Severe back injury that affects mobility and prevents work
- Chronic pain or illness that prevents you from performing any occupation
- Terminal illness with a life expectancy of less than 12 months
In addition to being unable to work, some policies may also consider a person to be totally and permanently disabled if they are unable to perform certain activities of daily living, such as bathing or dressing themselves.
It is important to review the specific terms and conditions of your TPD insurance policy to understand what conditions are covered and what level of coverage is provided.
How to successfully claim TPD
Making a successful TPD claim can be a complex and challenging process, but there are some steps you can take to increase your chances of success:
- Understand your policy: Before making a claim, it is important to review the terms and conditions of your TPD insurance policy to understand what is covered, what is excluded, and what level of coverage you have.
- Seek medical advice: You will need to provide medical evidence to support your claim, so it is important to seek advice from your treating doctor or specialist. They can provide documentation about your medical history, the nature of your disability, and the impact it has on your ability to work and perform daily activities.
- Gather evidence: In addition to medical evidence, you may also need to provide other forms of evidence to support your claim, such as statements from colleagues or employers about your work history and ability to perform your job.
- Contact Jameson Law: It is recommended that you engage a lawyer who specializes in TPD claims to help guide you through the process and provide legal advice. Jameson Law can help you to prepare and submit your claim and negotiate with the insurance company on your behalf.
- Be patient: The TPD claims process can be lengthy and may involve several rounds of documentation and negotiation with the insurance company. It is important to be patient and persistent in pursuing your claim.
- Be honest and transparent: It is important to be honest and transparent throughout the claims process. Any attempts to misrepresent or exaggerate your disability or medical history could jeopardize your claim.
Follow up: Keep in contact with the insurance company and Jameson Law to ensure that your claim is progressing and that any required documentation is provided in a timely manner.
What to do if your TPD claim is rejected?
If your claim is initially rejected, don’t be fooled into thinking this is the end and that no further action can be taken.
Once you understand why the claim has been rejected, there are numerous options available for seeking a review of your provider’s decision, including:
- Submitting a personal complaint to your insurance or superannuation provider;
- Lodging an official complaint with your provider’s internal dispute resolution services;
- Sending a written complaint to the Financial Ombudsman Service; or
- Seeking urgent legal advice from Jameson Law.
Why would a TPD claim be denied
A TPD claim can be denied for a variety of reasons, some of which include:
- Insufficient evidence: The insurer may require medical evidence to substantiate the claim that the policyholder is totally and permanently disabled. If the policyholder fails to provide enough medical evidence to support their claim, the insurer may deny the claim.
- Not meeting the definition of TPD: Different insurance policies have different definitions of what constitutes total and permanent disability. If the policyholder’s condition does not meet the definition of TPD as defined in the policy, the claim may be denied.
- Failure to meet waiting period: Some TPD policies have a waiting period before a claim can be made. If the policyholder becomes disabled during the waiting period, they may not be able to make a claim until the waiting period is over.
- Policy exclusions: Some TPD policies may exclude certain conditions or disabilities from coverage. If the policyholder’s condition falls under an exclusion, the claim may be denied.
- Fraud or misrepresentation: If the insurer discovers that the policyholder made a false statement or misrepresented information on the application for coverage, the claim may be denied.
- Incomplete or incorrect information: If the policyholder fails to provide complete or correct information during the claims process, the insurer may deny the claim.
It’s important to carefully review your insurance policy and the requirements for filing a TPD claim to ensure that you meet all the necessary criteria and provide all the required information to support your claim.
Can I have a worker's compensation claim or motor vehicle accident claim at the same time as a TPD claim?
Yes, it is possible to have a worker’s compensation claim or a motor vehicle accident claim at the same time as a TPD claim, but the specific rules and requirements can vary depending on the terms of your insurance policies.
In general, a worker’s compensation claim is intended to provide benefits to employees who are injured or become ill as a result of their job. If you have suffered a work-related injury or illness, you may be able to make a worker’s compensation claim to cover your medical expenses and lost wages. If your injury or illness is permanent and total and prevents you from working in any occupation, you may also be able to make a TPD claim.
Similarly, if you have been injured in a motor vehicle accident, you may be able to make a personal injury claim to cover your medical expenses and other losses. If your injury is permanent and total and prevents you from working in any occupation, you may also be able to make a TPD claim.
Can I make a TPD claim if I’m on Centrelink?
Yes, you may be able to make a TPD claim even if you are receiving Centrelink payments. Centrelink payments are intended to provide income support to those who are unable to work due to disability or other reasons, but they do not necessarily impact your ability to make a TPD claim.
However, it’s important to note that some insurers may take Centrelink payments into account when assessing your claim. For example, if you are receiving a disability support pension from Centrelink, the insurer may consider this as evidence that you are disabled and unable to work. However, this will depend on the specific terms and definitions outlined in your policy.
When making a TPD claim, you will generally need to provide evidence that you meet the definition of total and permanent disability as defined in your policy. This may include medical evidence and documentation of your inability to work. If you are receiving Centrelink payments due to a disability, this may be one piece of evidence that you can provide to support your claim.
It’s important to carefully review your policy and seek professional advice from Jameson Law before making a TPD claim, especially if you are also receiving Centrelink payments.
