If you’re injured or sick and you’re unable to work then you may have a TPD claim. The following outlines the general process by which a TPD claim is made. We would suggest, however, that you consult a TPD lawyer to give your case the best chance of success.

Confirming a Policy

In the event that you’re injured or sick and unable to work, you need to determine whether you have any TPD coverage. There are generally 2 types of policies which include:

  1. Policies taken out within your superannuation (often put as a default option by your Superannuation company) and
  2. Retail policies which have been purchased by you – often directly through an insurer or other financial professional such as a financial planner.

If you are unsure whether you have cover you should:

  1. Confirm with your superannuation account holder(s) whether you have TPD insurance;
  2. Confirm with any Financial Planner / advisor and/or bank which you have obtained a policy through;
  3. Confirm whether you have any superannuation accounts which you are unaware of (usually through the ATO website) and check whether those accounts have any TPD insurance associated with them; and
  4. Engage a TPD lawyer with TPD experience to assist you with the above process

Once it is confirmed that you have TPD insurance, the policy must be reviewed to determine the definition of ‘Total Permanent Disability’ that needs to be satisfied. Many policies vary in their definitions. For instance, some policies have what is called an ‘own occupation’ clause – and others have an ‘any occupation clause’.

In our experience, most TPD policies vary from $30,000.00 to $700,000.00 but can in some circumstances be even more.

Making the Claim

You must consider the information that needs to be provided to the Insurer in order for them to determine your claim. Usually, the insurer will require:

  1. A detailed claim form to be completed
  2. Specific TPD medical certificates to be completed and perhaps a medicolegal report
  3. Details and perhaps clinical notes of treating medical practitioners
  4. A comprehensive history of your employment
  5. Information from your last employer

It is often best to provide the insurer with a statement of your own evidence relevant to their decision-making process. It is strongly advised that you seek the assistance of a TPD lawyer with this process as significant caution should be undertaken when you are submitting information to an insurer.

After all the information has been submitted, your TPD lawyer will generally ask the fund to make a determination as to whether you satisfy the relevant definition of ‘TPD’. If you do, then you will be entitled to the insured benefit specified. If not, then you are not, in their opinion, eligible for the benefit.

If the insurer declares that you are not eligible for the benefit then there are a few things which can be done. Such avenues include:

  1. Asking for a review based on further submissions
  2. Asking for a review based on further evidence and/or submissions
  3. Taking the matter to Court
  4. Making a complaint

* Disclaimer: The information provided here is to be considered general information only. It is not legal advice, and does not consider your personal circumstances in any way. It should not be relied upon for any purpose – legal, financial or otherwise.

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