Total and Permanent Disability (TPD) Claims

You don’t necessarily have to be bedridden or confined to a wheelchair to have a TPD claim. Many policies only require proof that you’re unable to do your regular job, or any job within your education, training and experience. For example, if you’ve spent your life working in construction, you may still have a TPD claim even if doctors say you’re well enough to work in an office.

It doesn’t matter where your injury or illness happened: you still have a TPD claim even if you were injured outside of work. However, if it did happen at work, you may also be entitled to Workers’ Compensation and other benefits.

You don’t have to prove that someone else was at fault to make a successful TPD claim.

Talk to one of our lawyers about your situation. Most likely, this lawyer will see your claim through to its successful completion.

To help us advise you, your lawyer will identify and obtain all the relevant documents for your case. It costs you nothing, and it’s completely obligation free.

Your lawyer will give you free advice about what you’re entitled to and the best way to proceed. They’ll also let you know if you have other possible claims, in addition to TPD.

Your lawyer will collect evidence from third parties to support your claim. This includes doctors, medical specialists, the ATO, WorkCover, Centrelink, and any other relevant sources. We then fine tune your case: preparing detailed legal submissions, completing your claim forms, and sending these to your super fund.

You tell us how you want to receive your benefit. We make sure that you get your money as soon as possible.

Most claims take around 6 months from lodgement date to completion. If your claim is more complex, it may take up to 12 months for your insurer to reach a decision.

The exact length depends on 4 main factors:

• The amount of compensation.
• The severity of your injury or condition.
• Your policy terms.
• How well your claim is prepared.

The amount of compensation

Insurers are often reluctant to pay substantial settlements. They may use delay tactics to avoid giving you the compensation you deserve. This includes having you undergo unnecessary medical tests or challenging your doctor’s evidence.

The severity of your injury or condition

Severe injuries often result in large payouts — but they also require extensive medical evidence. Your claim may be delayed by insurer investigations, including medical assessments, requests for information and requests for retraining. While some of these are essential, others are merely delay tactics. An expert TPD lawyer can help you differentiate between the two, ensuring your claim progresses as quickly as possible.

Your policy terms

If your policy has a broader definition of TPD, your claim may be resolved faster. On the other hand, policies with a strict definition of TPD may require more evidence and your claim can take longer to prove.

After you file your claim, the insurer may request you undergo rehab or retraining. It’s important to understand whether this is a fair request under your policy. If you’re unsure, an experienced TPD lawyer can review your policy for you.

How well your claim is prepared

To speed up the process, we always suggest having a specialist TPD lawyer prepare your claim. When claims aren’t prepared properly, insurers can drag them on for years.

Your lawyer can also challenge unnecessary requests. In our experience, insurers use this delay tactic often. We know what your entitlements are under your policy and will ensure your insurer does not overstep their rights.

If your insurer continues to use delay tactics, we will send them official warnings and — if necessary — refer the matter to the Tribunal or the Ombudsman.

If you’re unable to work, chances are you’re in a difficult financial situation, and eager to get your TPD claim resolved fast. There are a number of reasons your claim could be taking longer than expected.

Wait period

Before commencing a TPD claim, you typically have to be off work for a designated wait period. This wait period is usually either three or six months, after which you can start your claim.

Delay tactics

In our experience, insurers can use tactics to delay claims and discourage unrepresented claimants from pursuing their entitlements. A dedicated TPD lawyer can help you overcome insurer tactics, meaning that your claim may be paid out sooner.

Unexpected circumstances

There may also be ‘unexpected circumstances’ which prevent a speedy decision. Generally, your insurer has 6 – 12 months to make a decision on your claim. The only exceptions are ‘unexpected circumstances’.

If unexpected circumstances delay your claim, your insurer must issue an ‘unexpected circumstances letter’ outlining why they have been unable to reach a decision. At this time, they will also cover the next steps. Your lawyer will be help you understand your rights and the best way to proceed.

Requests for information

When assessing your TPD claim, your superfund or insurer will commonly request additional information. This can include your:

• Medicare and Pharmaceutical Benefits Scheme (PBS) history.
• Tax and financial documents from the ATO.
• Centrelink documents.
• Medical records or reports from medical professionals.

While these documents are not requested in every instance, gathering documents from companies, medical providers, experts and government organisations and can often delay your claim. To speed up this process, your lawyer can challenge the relevance of the requested documents, or help you procure the documents through other channels.

Getting your full TPD benefit isn’t always as simple as having a policy and submitting a claim. Claims can be denied for a variety of reasons, like not meeting your policy’s terms, lacking sufficient medical evidence, or the insurer suspecting fraud. The good news? A denial doesn’t mean it’s over — you have the right to appeal.

Every super fund’s appeals process is slightly different, but most follow these key steps:

1. Request an internal review.
2. Submit a complaint to the Australian Financial Complaints Authority (AFCA).
3. Go to court.

You can read more about each option in our complete guide to appealing a denied TPD claim. If you’d prefer to speak with a lawyer about your situation, simply get in touch. Our dedicated TPD team are here to help with every aspect of your claim, including:

• Reviewing your case: we’ll carefully analyse your denial letter and TPD policy to identify the best approach for your appeal.
• Gathering evidence: our team will help you compile the necessary medical reports and documentation to support your claim.
• Drafting your appeal: we’ll create a clear and persuasive appeal letter that highlights why the denial was incorrect, backed by strong evidence.
• Negotiating on your behalf: with experience handling insurers and super funds, we’ll push for the best possible outcome during negotiations.
• Representation in mediation or court: if it comes to mediation or court proceedings, we’ll prepare you thoroughly and provide expert representation, including briefing a barrister if required.

Yes, it’s possible. If you hold TPD cover with more than one super fund, you may be eligible to make a claim with each fund for the same illness or injury.

Many people aren’t even aware they are insured by multiple super funds. This can happen if, for example, you’ve changed jobs over the years and haven’t consolidated your super. Multiple super fund memberships mean you may have multiple TPD insurance policies.

It’s important to note that success in one claim does not guarantee success in any other claims. Every fund has their own policies, conditions and definitions, and each case will need to be approached uniquely. For example, some funds will have a policy stating that a TPD payment will not be made where a claimant has already been paid a benefit.

An expert in TPD law will uncover all your insurance policies, and help you understand your entitlements. Speak to one of our specialist team today—it’s free and obligation-free.

When making TPD claims, many people are concerned their employer will be liable to pay their compensation. While your employer may have to provide a statement, they are not legally involved in the claim.

In the case of insurance and superannuation claims, it’s the insurer who will pay your benefit. In some instances, this is through your private life insurer, superannuation fund, employer sickness and accident insurer, or even your mortgage and credit card insurer.

The benefit you receive corresponds to the date that you last worked or the date that you first became injured or ill (and therefore unable to work). The lump sum payment will be made into your super account and then, based on your specific payment instructions, released by the Funds Trustee.

When we think of superannuation, we usually think of an account balance paid upon retirement, or after reaching the designated age. However, in particular circumstances, you may successfully apply to release your super account balance earlier. These circumstances can include, but are not limited to:

• Financial hardship.
• Compassionate grounds.
• Permanent incapacity.
• Temporary incapacity.
• Terminal illness.

In addition, your super benefit can be released early if the money is required for:

• The cost of medical treatment (provided it is not commonly available in the public health system).
• Medical transportation costs (required by either the fund member or their dependant).
• Loan repayments (to prevent mortgage sale of property).
• Special needs modifications to the home or transport of a severely disabled fund member (or dependant).
• Palliative care or funeral expenses of a fund member or their dependant.

A claim for early release of super funds is similar to a TPD claim, in that they are both assessed under similar criteria. Namely, that the claimant ceased work due to an injury or illness and, as a result of that injury or illness, is unable to return to any work that is within their education, training or experience.

In order to satisfy the criteria, the Fund’s Trustee requires sign off from two qualified medical practitioners, confirming that you are permanently incapacitated. At Monaco, we focus primarily on permanent incapacity and TPD. Our team are experts at helping clients gain early access to their super in situations where they can no longer work.

If you are unable to work due to permanent incapacity or TPD, or you’re unsure of whether your injury or illness qualifies, get in touch today. For more information on the early release of super funds, head to the ATO online guide.

While you can make a claim on your own, it’s crucial to understand that TPD is a complex area of law, and without strong legal advice you may not secure your full benefit.

A specialist lawyer can assist with every aspect of your case, including:

Delay

Insurers tend to dismiss unrepresented claimants, using tactics to reject or delay their claims. A skilled TPD lawyer not only understands these tactics, but knows how to get around them, often resulting in your claim being processed and approved faster.

Medical evidence

In the last few years, the courts have also determined that an insurer is legally entitled to use their own experts to test the assertions made by a claimant. For example, instead of relying on medical evidence submitted by the claimant’s doctors, insurers will insist on tests conducted by their own medical professionals. In our experience, this makes it more likely for an insurer to reject your claim. Your lawyer will challenge each of the insurer’s assertions, and ensure you have the best possible chance of success.

Policy interpretation

Like any contract, your TPD policy is open to interpretation. For example, in the context of work, there is more than one definition of ‘permanently disabled’. Some definitions are more restrictive, whilst others are less so. A lawyer with TPD experience will tease out the finer legal detail and prepare a case that fits within the definition of your policy

No Win No Fee

Importantly, you’ll be covered by our No Win No Fee guarantee. Your initial consult is free, and you pay nothing until we’re successful. We’ll also cover the upfront cost of any medical assessments or expert reports.