TPD claim eligibility depends on the insurance you held, the policy terms that applied and the evidence about your health and work capacity. A diagnosis alone does not establish that you meet the policy’s requirements.
If you are asking “do I qualify for a TPD claim”, the following questions can help identify what needs to be checked.
Did the relevant cover exist?
Check current and previous superannuation funds, as well as insurance held outside super. Ask for your insurance history and the applicable policy documents, rather than relying only on your latest statement.
The relevant dates and cover requirements depend on the policy. Do not assume that the date symptoms began, the date you stopped working and the date you apply are interchangeable. Previous cover may still be worth investigating even if you have changed funds or the cover has since ended.
Which definition applies?
An any occupation definition commonly considers whether you are unlikely ever to work again in an occupation reasonably suited to your education, training or experience. It does not simply ask whether you can return to your last job.
An own occupation definition generally concerns your ability to return to the occupation you performed before your disability. Other definitions may assess your ability to perform specified daily activities. Your employment status and the policy terms can affect which definition applies, so another person’s claim may have been assessed differently.
What does the medical evidence show?
Medical evidence should address the applicable policy definition. When preparing your claim, consider whether the reports explain your limitations, treatment, prognosis and capacity for the relevant work. Include information about reduced duties, changes in hours and unsuccessful attempts to return to work.
Physical and psychological conditions may support a claim, but the evidence must meet the policy’s requirements. Exclusions, eligibility conditions and any waiting period also need to be checked. Do not assume that every policy requires the same period away from work.
Do I need to stop work before seeking advice?
You do not need to wait until you have stopped working to speak with us about your cover. Seeking advice and establishing eligibility for payment are separate matters.
Do not resign, reduce your hours or change treatment simply to try to meet an insurance definition. Discuss work and treatment decisions with your treating practitioners and obtain advice about your employment position and insurance cover.
KSC Law can investigate your TPD cover, explain the applicable requirements and identify the evidence needed. Bring your super statements, insurance information and any existing claim correspondence to a free consultation.
Related reading: TPD claims lawyers · Claiming TPD through your super
Further reading
Moneysmart: how TPD insurance works
Could you have a TPD claim?
Total and Permanent Disability cover is held inside most super funds. Answer a few quick questions to see if you may be able to claim. This is a guide only, not a determination.
This is a general guide only, not an assessment of your policy or eligibility. TPD outcomes depend on your individual super fund or insurance policy terms. This does not constitute legal, financial or medical advice. Book a free consultation for a personalised assessment.