As TPD Lawyers we feel that people should have more knowledge as to Total Permanent Disability (TPD) claims. We have seen people suffer injuries – even catastrophic ones – that don’t have the faintest idea that they have a TPD insurance policy – as well as a TPD claim. Here are six things you should know about TPD insurance claims:

 

    1. You may have TPD insurance and not even know it
      Often, people call our firm that have been injured at work, in a car, or as a result of negligence. Some have suffered a life changing or debilitating illness. Surprisingly, many call to see whether they can sue someone – but are completely unaware of their TPD insurance position. You see, many people are insured through their superannuation and they don’t even know it. They may not have even knowingly purchased insurance – but they have often been paying premiums for years. Often the TPD insurance policies which they hold are for hundreds of thousands of dollars – and sometimes more. Sometimes people may have also arranged insurances through a financial planner or insurance broker. Such professionals may have also set up a ‘retail’ TPD insurance policy on your behalf. This would often be done, for example, when/if you set up life insurance.If you’re injured or sick, and unable to work then you should consult a TPD lawyer who can assist you in working out whether you have TPD insurance.

       
    2. TPD covers both physical and mental illness or injury and the injury / illness does not need to be work related
      Though there are various definitions under different policies, generally, the concept of ‘Total Permanent Disability’ is determined on the basis of a person being unable to return to an occupation for which they were reasonably qualified. It is generally the case that it does not matter whether that incapacity arose out of a physical and/or mental injury / illness or any combination of these. By way of example, if someone was working as a mechanic in Sydney and they have a TPD policy, and they begin to suffer from a mental illness which is not work related, they may still be eligible for TPD if they can establish that are unlikely to return to any occupation for which they are reasonably qualified. The illness or injury does not need to be work related, and can be a mental health injury. Such a person would be eligible to receive their full policy entitlement and a Sydney TPD Lawyer could claim this on their behalf.


    3. TPD is an ‘all or nothing’ lump sum
      When your TPD claim is assessed, you either ‘are’ or ‘are not’ Totally and Permanently disabled. That is to say, you either fit the definition or you do not. On that basis, you get your full lump sum policy amount if you fit the definition. However, if don’t fit the definition, you get nothing. It is not good enough to be close to being totally permanently disabled. In such a case, you would not receive any benefit. This is why it is especially important to be very particular with your case, and ideally have a TPD lawyer handle it for you. The difference in reaching the definition or not reaching it can hinge on factors that may seem trivial to you.The lump sums that are available under different policies can be hundreds of thousands of dollars – and sometimes much more.


    4. It’s got nothing to do with ‘Fault’
      As Lawyers, we find that when many people who think of ‘compensation’ or ‘injury’ claims they think there must be ‘fault’ or ‘negligence’ on behalf of a party. That is sometimes the case. However, with a TPD claim, you do not need to prove that your illness or injury was anybody’s fault. You simply need to prove that your illness or injury has caused an incapacity for work to the extent that you are Totally and Permanently Disabled within the meaning of the policy.Sometimes you may have been injured as a result of someone’s negligence. If this is the case, you may have a negligence claim which can be made in addition to any TPD claim. You should certainly take advice from a Lawyer if this is the case. You can read more about Negligence claims here.


    5. Your occupation and qualifications matter
      The entire questions that needs to be determined in a TPD claim is whether you are fit to perform your work, or for many policies, ‘any’ work for which you are reasonably qualified. It is advisable to have a TPD Lawyer review the trust deeds and policies of insurance to determine your eligibility as well as the precise pre-conditions which need to be met. For instance, TPD definitions could include ‘Own’ or ‘Any’ occupation clauses. An ‘Any’ occupation TPD policy means that a claimant would need to be declared unfit to perform any occupation which may be suited to them by virtue of their education, training or experience. It is not enough to prove that you simply could not perform your own occupation. An ‘own’ occupation definition is far easier to satisfy as you would only need to prove that you are likely to be permanently unfit for your own occupation.What this means is that the last occupation you performed prior to your injury or illness is critical – as is your work history and other qualifications. For instance, it is generally easier to prove that someone who has engaged in manual labour all their life will be Totally and Permanently Disabled if they have suffered a significant physical injury than it would be for an office worker. 

    6. You may want to consider a retail policy
      As mentioned above, an ‘own’ occupation policy is far easier to satisfy than an ‘any’ occupation policy. Unfortunately, due to Superannuation rules it is usually the case that people are not permitted to hold ‘own’ occupation policies within their Superannuation in an SMSF. Further, most ‘default’ policies under Superannuation funds are ‘any’ occupation policies. However, subject to approval from an insurer, it is usually the case that people are able to obtain ‘own’ occupation policies through an insurer or financial planner. This means that people can pay premiums for a policy which could pay a significant lump sums if they are totally and permanently disabled from performing their ‘own’ occupation as opposed to having to prove the far more onerous test that they are unfit for ‘any’ occupation. Furthermore, it is generally the case that ‘retail’ policies are usually for much larger lump sums which can often exceed one million dollars. If you need to make a claim on a retail policy you should certainly consult a TPD Lawyer. If you haven’t got a retail policy in place, you may want to contact an insurance broker or financial planner to put one in place. If something goes wrong in your life, and you’re unable to return to work, having a good TPD policy for a reasonable lump sum can provide great financial security for you and your family.
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