Facing a total and permanent disability is life-altering, bringing about significant physical, emotional, and financial challenges. In such trying times, having total and permanent disability insurance and understanding your rights and entitlement to claim benefits can provide much-needed financial security for you and your family.

This article provides general information only and you should obtain professional advice relevant to your circumstances. If you are considering making a total and permanent disability claim, we recommend seeking legal advice. A lawyer can help assess your eligibility, assist in gathering the necessary evidence, correctly file your claim, and negotiate with the insurer on your behalf.

What is Total & Permanent Disability?

Total and permanent disability (TPD) generally refers to a condition that prevents someone from returning to work or engaging in any gainful employment for which they are reasonably qualified by education, training, or experience. A TPD can arise from various illnesses and injuries, for example, serious medical conditions such as cancer, heart disease, or mental health disorders; and severe accidents resulting in permanent impairment, such as spinal cord injuries or traumatic brain injuries.

In Australia, TPD insurance is generally obtained through:

• Superannuation: many superannuation funds include a TPD insurance component as part of their default cover.
• Private insurance: individuals can purchase standalone TPD insurance policies from private insurers.

TPD insurance provides a lump sum payment if you can no longer work in your usual occupation or other type of employment, based on your qualifications, experience, and training. It is important to carefully review the policy documents to understand the specific eligibility requirements and any exclusions that may apply. Note also, that TPD cover through your superannuation fund can potentially end if you change funds, stop making contributions to your superannuation, or reach a certain age.

Eligibility for TPD Benefits

The eligibility criteria for TPD benefits can vary depending on the specific insurance policy or superannuation fund. However, some general requirements typically apply:

• Definition of TPD: the policy document will define what constitutes TPD, often including conditions like being unable to work in your occupation or any occupation for which you are reasonably suited.
• Waiting period: most policies have a waiting period (for example, six months) during which you must be continuously disabled before you can make a claim.
• Medical evidence: you will need to provide comprehensive medical evidence from your treating doctors to support your claim.

The TPD Claim Process

Navigating a TPD claim can be complex and time-consuming. The general process is as follows:

1. Notify your insurer or superannuation fund: inform them of your intention to make a TPD claim as soon as possible.
2. Gather supporting documentation: this includes medical reports, employment history, and any other relevant evidence.
3. Complete the claim form: fill out the claim form accurately and comprehensively, providing all the requested information.
4. Assessment of your claim: the insurer or superannuation fund will assess your claim, which may result in requests for further medical examinations or interviews.
5. Decision: you will receive a decision on your claim, which can either be approved, denied, or require further information.

Tips for a Successful TPD Claim

While the TPD claim process can be daunting, following these tips can increase your chances of a successful outcome:

• Seek professional advice: a compensation lawyer specialising in TPD claims can help guide you through the process, ensure you meet the procedural requirements, and advocate on your behalf.
• Be organised: keep all your documents and correspondence related to your claim in one place for easy access – you might consider asking a trusted family member or friend to assist with this.
• Be thorough: provide as much detail and evidence as possible to support your claim.
• Be patient: the assessment process can take time, so be patient and persistent.
• Don’t give up: if your claim is denied, you may have the right to appeal the decision. If you haven’t already, seek professional advice to explore your options.

How a Compensation Lawyer Can Help

A compensation lawyer with expertise in TPD claims can be invaluable throughout the process of making your TPD claim. Your lawyer can:

• Assess eligibility: review your policy and medical evidence to determine your eligibility for TPD benefits.

• Gather evidence: assist in collecting and organising all necessary documentation to support your claim. Lawyers generally have a network of medical and other professionals who can be retained to assist with preparing evidence. 
• Liaise with the insurer: this can be particularly helpful given the insured person will often be facing a traumatic and difficult period. Your lawyer can communicate with the insurer or superannuation fund on your behalf, ensuring your rights are protected and that the correct documents are lodged within any specific timeframes.
• Negotiate a fair settlement: if your claim is approved, your lawyer can assess it to ensure it reflects the full extent of your disability and its impact on your future earning capacity.
• Represent you at the Australian Financial Complaints Authority (AFCA): The AFCA helps resolve disputes between consumers, insurers and superannuation funds about products such as TPD insurance. Your lawyer can help lodge complaints about delays in processing claims, the calculation of entitlements under a policy, and an insurer’s denial to pay a claim.
• Represent you in court, if necessary.

Conclusion

Claiming total and permanent disability benefits can be a complex and emotionally challenging process. Understanding your rights, eligibility criteria, and the steps involved is crucial to securing your financial future. Seeking professional advice from a personal injury lawyer can strengthen your chances of a successful claim.

You don’t have to navigate this journey alone – support and guidance are available to help you through this difficult time. If you know someone who may need assistance or advice on how to proceed please contact us on (08) 8155 5322 or email [email protected].