Generally speaking, any permanent injury or condition that prevents you from returning to work qualifies as Total and Permanent Disability (TPD). The injury doesn’t need to be work-related or caused by someone else’s negligence.
The exact definition of TPD that applies to you depends on your individual superannuation policy. Most policies fall into 1 of 2 broad categories: ‘your occupation’ or ‘any occupation’ policies.
‘Your occupation’
‘Your occupation’ policies will allow you to claim TPD if you’re unlikely to return to your occupation, or any occupation within your education, training and experience. This means you can claim TPD even if you’re still suitable for some work.
‘Any occupation’
‘Any occupation’ policies limit TPD claims to situations where you’re unlikely to return to work at all, regardless of the occupation. In this case, you must be totally unfit for all work before receiving a TPD payout.
Understanding the difference between policies
Say, for example, a labourer injures their back and can no longer lift heavy objects. They are assessed by a doctor who says they can work at a desk instead.
If the labourer had a ‘your occupation’ policy, they would most likely be entitled to TPD because desk work is not within their education, training or experience. However, if they had an ‘any occupation’ policy, they would only be eligible for TPD if they could not perform the desk job (or any other job). This would require expert evidence to counter the initial doctor’s assessment.
What injuries or illnesses are considered TPD?
Any physical injury, physical illness or psychological injury that permanently prevents you from working can be considered TPD.
Physical injuries
The physical injuries which may qualify as TPD include (but are not limited to):
- Back injuries
- Carpal Tunnel Syndrome
- Loss of speech or hearing
- Loss of limb or use of a limb
- Paraplegia or quadriplegia.
Physical illnesses
Many chronic physical illnesses can qualify you for TPD, including:
- Stroke
- Cancer
- Multiple Sclerosis (M.S.) and other degenerative conditions
- Autoimmune diseases
- Heart conditions
- Dementia
- Chronic Lung Disease.
Psychological injuries
It can be more difficult to prove a TPD claim for psychological injury simply because the symptoms are less visible. The process is usually easier if you’re receiving regular treatment from a psychologist, psychiatrist or GP. However, your claim can still succeed without a record of consistent treatment.
Over the years we have successfully won TPD claims for psychological injuries such as:
- Anxiety
- Depression
- Post-Traumatic Stress Disorder (PTSD)
- Schizophrenia
- Bipolar Disorder.
Can I make a TPD claim?
Yes, you can make a TPD claim if you have a permanent injury or condition. You must also have met the requirements set out in your super policy, including waiting periods and the specific definition of TPD.
Waiting periods
You’re required to serve the waiting period outlined in your policy before making a TPD claim. The waiting period is an extended period of time (usually 3–6 months) where you’ve been off work due to your medical condition.
The good news is, most policies do not include a time limit for making TPD claims. This means that once your waiting period is over, you can begin your TPD claim anytime—even after leaving the job where you were injured.
If you’re off work for less than 3 months, consider making an Income Protection or salary continuance claim instead. These provide temporary financial assistance while you recover from your injuries.
The definition of TPD
Your policy may only require proof that you’re unfit for a job within your education, experience and training. In this situation, you’ll need to explain why you’re unfit for any previous roles you held, as well as any other roles within your training.
If your policy requires you to be unsuitable for all work, you’ll need to specify why you’re unable to work another job outside of your education and training. For example, you might require a carer or be unable to travel.
In either case, you’ll need detailed medical evidence to support your claim. This involves briefing doctors on the definition of TPD in your policy, as well as how the definition might be interpreted.
Since TPD claims rely so heavily on definitions and expert evidence, it’s crucial to engage a specialist lawyer. With decades of experience and a national network of medical experts, we’ll help you take on your insurer and get the compensation you deserve.
What if my insurer has already denied my claim?
We offer a free second opinion if your insurer has already denied your claim. While your injury or condition may qualify as TPD, your claim may have been denied for another reason.
Our team are experts at overturning unfair insurer determinations. Since many of us previously worked for national insurance companies, we know the most effective strategies to get insurer decisions reversed. Speak to us today for free advice on your denied claim.
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