TPD claims for firefighters depend on the TPD insurance you held and whether your illness or injury meets the definition in the applicable policy. Being unable to return to firefighting does not automatically establish total and permanent disability under every policy.
Career and volunteer firefighters can also have different employment and insurance arrangements, so the first step is to identify the cover that actually applies.
Explain the duties you cannot perform
Describe the duties you actually performed and the restrictions that now affect them. This might include physically demanding work, carrying equipment, climbing or working in protective clothing.
Under an “any occupation” definition, the assessment generally goes beyond whether you can return to firefighting. It considers whether you are unlikely ever to work again in a job suited to your education, training or experience. Other policies may use an “own occupation” or activities of daily living definition.
Include any modified duties, reduced hours or return-to-work attempts and explain what happened.
Physical illness and psychological injury
TPD insurance can respond to illness or injury, including psychological conditions, provided you meet the applicable policy definition and other requirements.
Medical evidence should explain more than the diagnosis. Ask your treating practitioners to address the effect of the condition on your functioning and work capacity, together with treatment and prognosis.
Workers compensation is a separate system. Records from a workers compensation claim may form part of your broader medical and employment history, but the TPD claim must still satisfy the insurance policy that applies to you.
What volunteer firefighters should check
Volunteer firefighting does not, by itself, establish that you hold TPD insurance through a superannuation fund. Check any TPD cover held through your paid employment, superannuation or a separate personal insurance policy.
Volunteer-related benefits should also be identified separately. In Queensland, for example, the Queensland Fire Department states that it provides workers compensation cover for volunteers while attending training and operational activities. That is workers compensation cover and should not be treated as the same thing as TPD insurance.
Keep each potential entitlement separate and check the terms that apply to it.
Find the relevant policy history
Ask your fund or insurer for your insurance history, cover amounts and the policy documents applying at the relevant time. Do not assume your current TPD cover is the same as the cover you previously held.
Changes in employment and superannuation arrangements can affect insurance. ASIC’s Moneysmart specifically recommends checking what happens to TPD cover if you change jobs and whether insurance can end if a super account becomes inactive.
KSC Law can help review your insurance documents and prepare evidence that addresses the applicable definition. If a fund or insurer has already made a decision, bring the decision and reasons with you.
Book a free consultation with KSC Law about TPD claims for firefighters and the next steps available in your circumstances.
Related reading: TPD claims lawyers · Do I qualify for a TPD claim
Further reading
Moneysmart: how TPD insurance works · Australian Financial Complaints Authority (AFCA)