TPD Claims Guide - Law Partners

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Superannuation/TPD, Injury and Rehabilitation | 02 April 2020

Superannuation TPD Claim Guide 2020

 

What is a TPD Claim?

A TPD claim is a claim for a lump sum payment under a Total and Permanent Disability insurance policy. Most Australians have a TPD insurance policy connected to their superannuation fund, however some people take out separate TPD policies. When you make a TPD insurance claim you’re claiming a lump sum that’s in addition to your superannuation account balance.

If you make a successful TPD claim, you’ll generally be given the option to then withdraw this lump sum from your superannuation account together with your existing superannuation account balance.

 

How do you successfully claim TPD?

To make a successful TPD claim you’ll need to contact your superannuation fund, and they will typically ask you to complete a number of forms. After an initial assessment, the super fund with pass your TPD claim onto the insurer to do an assessment. The insurer will then make a decision about whether to approve or deny your claim.

The key to successful TPD claims is completing the application thoroughly and providing all the necessary documents, such as medical records or workers compensation files, to substantiate your claim. It’s also very important to make a written submission to the superannuation fund explaining why the claim should be approved. However, since most people have never lodged a TPD claim before, they’re in a position where they’re simply responding to ad-hoc requests from the superannuation provider or the insurer, which can be a lengthy and frustrating process. If you make even one error during this process it can seriously jeopardise the success of your claim.

Many people use a specialist TPD lawyer to manage their TPD super claim on their behalf, to give themselves the best possible chance of success. Some TPD lawyers will handle your claim on a no win no fee basis, so you only need to pay the legal fees after you receive your lump sum payment.

 

What is considered a total and permanent disability?

Different insurance policies have different definitions to qualify for a total and permanent disability claim. But as a general rule, if you’ve been unable to work due to an injury or illness for an extended period (usually more than three months) with no expectation to return to work, then you may satisfy the definition of TPD that applies to your policy.

Your TPD policy might cover you for:

Being unlikely to be able to return to work in your occupation
Being unlikely to be able to return to work in any occupation

So with some TPD claims in Australia, you don’t necessarily have to be unfit for all work to make a successful TPD claim.

 

Why would a TPD claim be denied?

Some common reasons for insurers rejecting TPD insurance claims include:

  • Lodging your claim too late
  • Your policy becoming inactive – this may be because you closed your account or the account has been inactive for some time
  • Not meeting the definition of disability in your policy
  • Applying before the minimum waiting period
  • Not meeting work history requirements
  • A dispute over the evidence you have provided
  • Not meeting age restrictions
If your TPD claim has been rejected, you might still be able to get the insurer’s decision reversed. For example, if your TPD claim was rejected because it was lodged too late, there might be circumstances beyond your control that caused the delay. Speak to a specialist TPD lawyer to find out your options and whether you can get the insurer to reverse its decision.

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Can you make more than one TPD claim?

If you have more than one TPD policy, you may be able to make multiple TPD claims – one for each policy. This is quite a common situation, as many people have multiple superannuation funds as a result of changing jobs over the years, and may have a TPD policy through each fund. Making a successful TPD insurance claim against one policy has no effect on any other TPD insurance you may have, but you’ll need to submit a separate claim against each policy.

 

How long do TPD claims take?

Generally speaking, it takes 6-12 months for a TPD claim to be finalised.

Insurance companies undertake to complete their assessment of a TPD claim within six months. Some straightforward claims are finalised more quickly than this – however in more complicated claims the insurance company will often take longer than six months to make a decision.

Once the insurance company has made their decision in relation to a TPD claim, the trustee of the relevant superannuation fund must undertake their own separate assessment of the claim. This process usually takes one to two months.

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