A TPD claim is a claim on total and permanent disability insurance. It may provide a lump sum if your illness or injury meets the disability definition and other requirements in your policy.
Cover may be held through superannuation or under a policy outside super. Where insurance is held through super, the insured benefit is separate from your existing retirement savings.
What the insurer assesses
The starting point is the policy and cover that applied at the relevant time. Many policies assess whether you are unlikely ever to work again in an occupation reasonably suited to your education, training or experience. Other definitions may apply, including tests based on your ability to perform specified daily activities.
An own occupation definition generally concerns your ability to return to the occupation you performed before your disability. This cover is usually available outside super. Being unable to return to your last role does not necessarily satisfy an any occupation definition.
The evidence behind a claim
Medical evidence should address the applicable policy definition, including how your condition affects your ability to work and your prognosis. Employment information can help explain your duties, qualifications, changes in hours and attempts to return to work.
A diagnosis or a period of sick leave alone does not establish eligibility. The evidence needs to demonstrate how you meet the requirements of your particular cover.
What happens after a claim is lodged
The fund or insurer may request further medical, employment or insurance information before making a decision. Keep copies of the forms and reports you provide, and ask for clarification if a request is unclear.
For insurance held through super, the insurer’s decision is not the only assessment involved. The fund’s trustee must also assess the claim and whether the benefit can be released to you. Tax may apply when money is withdrawn from super, so the amount you receive may differ from the insured benefit.
TPD claims in Queensland
For TPD claims in Queensland, the starting point remains your insurance policy and its eligibility requirements. Do not assume that living in Queensland creates a different disability definition or that every policy uses the same test.
A TPD claim is also separate from a workers compensation claim. Your illness or injury does not necessarily need to have happened at work to support a TPD claim.
If you are asking “what is a TPD claim?” because your health has affected your working life, start with your super statements and insurance information. KSC Law can review your cover, explain the relevant requirements and help identify the next steps in a free consultation.
Related reading: TPD claims lawyers · Do I qualify for a TPD claim
Further reading
Moneysmart — Insurance through super · Australian Financial Complaints Authority (AFCA) · DVA — Overview of benefits and services