TPD claim examples can help explain the questions and evidence involved in an insurance assessment. They cannot establish another person’s eligibility.
The examples below are hypothetical. They are not KSC Law case results and do not predict approval or a payment. Every claim depends on the applicable cover, relevant dates, policy definition and evidence.
Physical injury and a change in work capacity
A former ADF member develops a persistent spinal condition while working in a civilian trade. They can no longer manage the lifting, bending and prolonged standing required in that role.
Under an any occupation definition, the assessment would also consider whether they are unlikely ever to work again in an occupation reasonably suited to their education, training or experience. Being unable to continue in the trade does not, by itself, establish that requirement.
In this hypothetical example, useful evidence could explain sitting and standing tolerances, lifting restrictions, treatment and prognosis. Employment records could describe the duties performed and any adjustments attempted.
PTSD and difficulty sustaining work
A veteran with PTSD attempts civilian employment but experiences symptoms affecting concentration, attendance and interaction with others.
In this example, medical reports could explain the symptoms, their effect on work capacity, treatment and expected outlook. Employment records could document reduced hours, workplace adjustments and unsuccessful returns to work.
PTSD may support a claim, but the diagnosis alone does not establish eligibility. The evidence must address the applicable policy definition, eligibility requirements and exclusions.
Several conditions affecting the same person
A veteran experiences chronic pain alongside depression. Their treating practitioners describe how each condition affects daily functioning and work capacity, including any interaction between the conditions that they can medically support.
The claim should not assume that combining diagnoses automatically establishes total and permanent disability. The relevant question remains whether the evidence meets the policy’s requirements.
In this hypothetical example, the preparation would involve identifying the conditions relied on, checking the applicable cover and organising medical evidence addressing their functional effects.
A claim involving past cover
A former ADF member discovers an old superannuation account after leaving civilian employment because of ill-health.
The account is a starting point for investigation, not proof of insurance entitlement. The next questions concern whether cover existed, which policy applied and whether its requirements were met. Cover that has since ended may still warrant investigation in relation to an earlier period.
Useful records to gather include earlier statements, insurance correspondence and documents showing when work stopped or changed.
Applying the examples to your circumstances
When investigating TPD claims for veterans, keep insurance policies, CSC decisions and DVA records together, but do not assume they involve the same assessment. A TPD claim must address the requirements of the applicable insurance policy.
KSC Law can review your cover and evidence without relying on a comparison with someone else’s outcome. Book a free consultation and bring the records you have.
Related reading: TPD claims for veterans and ADF members · Do I qualify for a TPD claim
Further reading
CSC — Accessing your benefit (invalidity / TPD) · Moneysmart — Insurance through super · DVA — Compensation for veterans · Australian Financial Complaints Authority (AFCA)