What is a TPD claim?
A TPD claim provides a significant lump sum payment if you’re permanently unable to work due to injury or illness. To qualify, you need TPD insurance, which is typically included in your super policy but can also be bought separately.
Here’s what you should know:
- It doesn’t matter how or where your injury or illness occurred.
- You don’t need to prove that someone else is responsible for your condition.
- You don’t necessarily have to be bedridden or in a wheelchair — it all depends on the terms of your policy. While some policies require you to be totally unfit for work, others only require evidence that you can’t do your usual job or any job related to your skills and experience.
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How to make a successful TPD claim in 7 steps
Step 1: Identify your TPD insurance policy
First, you’ll need to track down your TPD insurance policy, which you can usually get from your super fund or insurer.
If you’re not sure whether you have TPD cover, your fund or insurer isn’t being helpful, or you just don’t want to deal with them yourself, get in touch today. Our expert TPD lawyers can look into whether you’re covered and handle all the back-and-forth with the insurer for free.
As part of this initial investigation, we’ll also pinpoint any potential challenges your claim might face and map out the best strategies to overcome them. Getting a lawyer involved early sets a solid foundation for your claim, ensuring it progresses smoothly and isn’t derailed by avoidable issues.
Step 2: Check your policy is valid
You need to confirm that your TPD policy was active at the time your injury or illness occurred. This is generally straightforward for physical injuries resulting from an accident. However, if your claim involves a condition that developed gradually (such as a psychological issue or a long-term illness) pinpointing the exact date can be more complex.
Typically, the key date is when you first realised you had the condition, or when you reasonably should have noticed it.
If you’re unsure whether your TPD policy was active when your condition developed, it’s a good idea to talk to an expert TPD lawyer. They can investigate, figure out the key dates for your condition, and confirm if your policy was active during these dates.
Step 3: Understand the terms of your policy
Carefully review your TPD policy’s terms and conditions to understand how it defines TPD. Generally speaking, there are two types of TPD policies:
Whether you’re entitled to a TPD benefit depends on your policy type and its terms, so it’s crucial to understand them fully. Since policies can be complex and open to interpretation, we strongly suggest getting legal advice to understand your rights. Don’t just rely on the super fund or insurer’s interpretation — consult a specialist lawyer to ensure you get the benefits you’re entitled to.
Step 4: Prepare your TPD claim
To support your TPD claim, you’ll need to provide detailed evidence that shows the severity of your condition, its impact on your ability to work, and how it aligns with your policy’s definition of Total and Permanent Disability.
Here’s a list of key evidence to compile:
- Records from your treating doctors.
- Reports from independent medical experts.
- Statements from witnesses to the accident.
- Your employment contract.
- Employment history detailing your daily work.
This list is just a starting point — it’s crucial to provide as much evidence as possible to strengthen your TPD claim. We understand gathering this evidence can be overwhelming and expensive, but we’re here to help.
With over 25 years of experience, our lawyers know exactly what evidence your TPD claim needs and can gather it for you. We’ll also cover the cost of medical assessments and other expert evidence, so you’re never a cent out-of-pocket.
Step 5: Lodge your TPD Claim
Once your claim is ready, you’ll need to submit it to your super fund or insurance company. Along with the required documents and evidence, you’ll need to include a letter detailing why your TPD claim should be approved.
This letter is a key part of your claim. It should clearly explain how your injury or illness has affected your ability to work and demonstrate how you meet your TPD policy’s criteria. If you’re unsure about writing this letter yourself or need help meeting the requirements, a specialist TPD lawyer can draft it for you.
Step 6: Follow up with the super fund or insurer
After you file your TPD claim, your super fund or insurer will review it, which can take several months. It’s important to follow up periodically to ensure they have all the necessary information and to prevent unnecessary delays.
If you have a lawyer, they’ll manage all the follow-ups and push the insurer to keep things moving.
If you filed your TPD claim on your own and feel the insurer is unfairly stalling, reach out to us. Insurers can be tough on unrepresented claimants, and it often takes a lawyer to get them to act fairly. Our dedicated TPD team is always ready to step in, apply pressure, and make sure your claim is approved as quickly as possible.
Step 7: Receive your lump sum payment
If your TPD claim is approved, you’ll receive a lump sum payment to help cover medical and living expenses. This payment usually goes into your super fund account, and you can withdraw it from there.
If your claim is denied, there are still ways to pursue your TPD benefit. We’ll dive into those options in more detail below.
Do I need a lawyer for my TPD claim?
You can file a TPD claim on your own, but we highly recommend getting expert legal advice first. TPD is complicated, and without a lawyer, you might not get your full benefit.
An expert TPD lawyer can help with every aspect of your claim, including:
- Policy interpretation: like any contract, your TPD policy can be interpreted in different ways. For example, when it comes to work, there’s more than one definition of ‘permanently disabled.’ Some are stricter, while others are more flexible. A lawyer with TPD experience will dig into the fine legal details and build a case that fits your policy’s specific definition.
- Expert evidence: since a TPD claim requires proving you’re unlikely to work again, the evidence needs to be much stronger than for other personal injury claims. Your lawyer will connect with medical experts on your behalf, get your condition properly assessed, and gather solid evidence to back up your inability to work in the future.
- Insurer negotiations: a lawyer will manage all negotiations with the insurer, using their expertise to challenge their claims and dispute their evidence. They’ll also push back if the insurer requests additional medical tests or information, helping to avoid delays and invasive procedures whenever possible.
- Delays: in our experience, insurers often try to stall or reject claims from unrepresented people. A skilled lawyer knows how to push through these tactics, ensuring your claim is processed faster and your benefit paid out sooner.
- Costs: if you’re working with a No Win No Fee lawyer, there are no upfront costs for medical tests or expert reports. Plus, your lawyer takes on all the financial risk — so if your claim isn’t successful, you won’t have to pay anything.
Frequently asked questions
1. How long will my TPD claim take?
Most claims take about 6 months from the lodgement date to completion. For more complex claims, it might take up to 12 months for the insurer to make a decision.
The exact timeframe depends on four main factors:
- Your benefit amount.
- The severity of your injury or condition.
- The terms of your policy.
- How well your claim is prepared.
In our experience, working with a lawyer can significantly speed up the resolution of your claim. A TPD specialist will expertly manage all submissions, gather compelling evidence of your condition, and directly link it to your policy’s TPD definition. They’ll also push back against any claims from the insurer and provide strong counter-evidence. This thorough approach means fewer delays and less chance of the insurer stalling or denying your claim.
To get an estimate on how long your claim might take, contact us today. In a free consultation, we’ll go over any potential roadblocks and explain how we can help speed up the process.
2. Do I have to pay tax on my TPD benefit?
If you leave the lump sum payment in your super fund until retirement, it will be taxed minimally or not at all. However, withdrawing the funds before retirement could result in an Australian TPD tax rate of around 22%.
After a successful TPD claim, it’s wise to get financial advice before deciding to withdraw the benefit from your super fund.
3. Will my TPD claim affect my government benefits?
Since TPD payments are usually deposited directly into your super fund or insurance account, they typically won’t affect any government benefits you’re receiving. However, once you withdraw the funds and start using them, it could impact your benefits. It’s a good idea to consult a financial advisor before accessing your TPD payment to ensure you make the best financial decisions.
4. What if my TPD claim is denied?
Unfortunately, super funds and insurance companies can sometimes deny valid TPD claims — but don’t worry, you still have options.
To start with, you’ll need to request a review of the decision within 28 days. Your super fund will then have 45 days to either uphold or change their decision. If you’re dealing with an insurer, they must respond within 30 days.
If you’re still unhappy with the outcome, you can file a complaint with the Australian Financial Complaints Authority.
For more on this process, check out our guide to denied TPD claims or speak to one of our expert lawyers. We understand the review process inside out and have helped hundreds of injured Australians turn their denied claims into approvals.
5. Could I have more than one TPD claim?
Yes, it’s possible. If you hold TPD cover with more than one super fund, you may be eligible to claim from each fund for the same illness or injury.
In our experience, many people don’t realise they’re insured by multiple super funds. This is often due to changing jobs over the years without consolidating their super, resulting in multiple TPD insurance policies.
However, it’s important to remember that success in one claim doesn’t guarantee success in others. Each fund has its own policies, conditions, and definitions, and every claim needs to be approached individually. For instance, some funds may not pay out if you’ve already received a TPD benefit from another.
An expert in TPD law can help uncover all your insurance policies and explain your entitlements. Speak with one of our specialists today — it’s free and obligation-free.
To sum up
Navigating TPD claims is more than just knowing the law; it demands experience, strategy, and the ability to stand up to super funds and insurers. Whether you need help understanding your TPD policy, proving the permanence of your condition, or challenging a decision, a skilled lawyer provides crucial guidance and support.
Get in touch today to speak with a TPD lawyer. Our legal team are always ready to review your policy and offer free advice on your entitlements.
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