Operating Since 1983
Operating Since 1983
Total and permanent disability (TPD) claims generally involve identifying your TPD insurance cover, checking the relevant policy definition, gathering supporting evidence and lodging a claim with the insurer or superannuation fund.
The exact TPD claims process can vary between insurance policies. Your policy wording, medical evidence, employment history and the way your cover is held can all affect how a total and permanent disability claim is assessed following an injury or illness.
Try our free 30 second claim checker or please contact us for a free assessment.
Although every TPD insurance claim is different, most claims follow a similar process from identifying your cover through to receiving an insurer’s decision.
Start by identifying any TPD cover that may apply. Many people have TPD insurance cover included through a super fund, while others may hold separate TPD insurance policies.
It can also be worth checking previous superannuation accounts to establish your TPD coverage when your illness or injury affected your ability to work. If you identify multiple policies, you may have potential TPD entitlements under more than one policy, with separate claims considered according to their individual terms.
A TPD claim is assessed against the definition and conditions in the relevant insurance policy. Depending on the policy, this may involve your capacity to return to your previous occupation, work suited to your education, training and experience, or other specified criteria.
The policy should also be checked for matters such as applicable waiting periods and whether you held a valid TPD insurance policy at the relevant time. Because definitions and requirements vary, permanent disability insurance should always be assessed against the wording of the particular policy rather than a general definition of disability.
Supporting evidence is central to the TPD claims process. To gather evidence for a claim, you may need medical records, medical reports and information about your diagnosis, medical treatment, symptoms and prognosis.
Employment history may also be relevant, including your previous duties, qualifications, education and training. The evidence required will depend on the definition being assessed and may differ between physical injuries, mental health conditions and other causes of permanent disability.
The next step is to complete the required claim forms and provide the supporting information requested by the insurer or superannuation fund.
Where you have multiple TPD claims available through different policies, you may need to lodge separate claims and complete the relevant claim forms for each insurer or super fund. Each TPD insurance claim is assessed according to its own policy terms.
The insurer reviews the claim forms, insurance policy and supporting evidence to determine whether the relevant TPD requirements have been met.
Insurer investigations can involve reviewing medical evidence and employment information, seeking further medical reports or contacting treating practitioners. Insurance companies may also request further medical assessments or an independent medical examination where additional information is reasonably required.
Insufficient medical evidence, missing employment information or unanswered requests can prevent the insurer from completing its assessment and contribute to unnecessary delays. Straightforward claims may require fewer enquiries, while complex claims can involve additional medical evidence or investigation before a decision can be made.
A request for further evidence does not, by itself, mean that a TPD claim will be declined.
If your TPD claim is approved, the next steps depend on the relevant policy and how the TPD benefit is held. TPD insurance generally provides a lump sum benefit where the policy requirements are satisfied, although the payment process can differ where insurance is held through superannuation.
An approved claim may therefore result in a TPD payment or lump sum payout based on the amount of insurance cover held.
Learn more about TPD payouts and how they are paid.
The evidence required for a successful TPD claim depends on the policy definition and your individual circumstances. There is no single evidence checklist for a successful TPD insurance claim, and the medical, employment and other information required can vary between policies.
Medical evidence may include records and reports from treating doctors or other healthcare professionals. This can help establish your medical history, treatment, symptoms, prognosis and ongoing capacity.
For some claims, particularly complex claims or those involving mental health conditions, evidence showing how the condition has affected you over time may also be important.
Where the policy considers your ability to work, evidence about your employment history may also be required. This can include your previous occupation, work duties, education, qualifications, training and experience.
The purpose is not simply to establish that you cannot return to one particular job. The relevant question depends on the TPD definition contained in your insurance policy.
The insurer or superannuation fund may request other information depending on the claim. Providing comprehensive medical evidence, an accurate medical history and any requested employment information can help the assessment progress and reduce avoidable delays.
Once a TPD insurance claim has been lodged, the insurer may seek further information before making its decision. This can include updated medical or employment evidence, clarification from treating practitioners or additional medical assessments.
Straightforward claims may require fewer enquiries, while complex claims can involve further investigation. Responding to requests as they arise can help the assessment continue without avoidable delays.
There is no single timeframe for every TPD claim. The time required can depend on the policy, the complexity of the claim, how quickly medical and employment evidence can be obtained and whether the insurer needs further information.
Some claims take longer where additional medical reports or assessments are required. Keeping requested information complete and up to date can help reduce avoidable delays during the claims process.
Learn more about how TPD claim timeframes and potential delays.
The Personal Injury Lawyers can assist at different stages of the TPD claims process, whether you are preparing to make a TPD claim or already dealing with an insurer or super fund.
Our TPD lawyers can help you:
If you are unsure where you stand, contact The Personal Injury Lawyers to discuss your TPD claim.
The Personal Injury Lawyers handle eligible TPD claims on a No Win No Fee basis. Our costs agreement explains how legal fees and outlays are treated and when fees may become payable.
Yes. You do not have to use a lawyer to claim TPD insurance or make a TPD claim. However, the claims process can involve detailed policy wording, medical evidence, employment information and communication with the insurer or super fund.
TPD lawyers can assist with reviewing your cover, preparing supporting evidence and progressing a TPD insurance claim if you would prefer legal assistance.
Not every TPD claim requires an independent medical examination. An insurer may request one where it needs additional medical information or an assessment of your condition and capacity.
The medical evidence required will depend on the policy and circumstances of your claim.
There is no single typical TPD payout. A TPD claim payout generally depends on the amount of insurance cover provided by the relevant policy rather than a standard compensation scale.
Where a successful claim satisfies the policy requirements, the TPD benefit is generally paid as a TPD lump sum. This lump sum payment may provide financial support for living costs, rehabilitation, medical expenses or other needs following permanent disability.
You may be able to make multiple TPD claims if you held more than one relevant TPD insurance policy. Separate claims generally need to be lodged and assessed under the terms of each policy.
Having multiple policies does not mean every claim will necessarily be approved, so each policy and its requirements should be reviewed individually.
If your claim appears to be delayed, it can help to determine whether the insurer is waiting for medical records, further evidence or another response before progressing the assessment.
The reasons for the delay and the insurer’s recent communications should be reviewed before deciding what steps to take next.
A denied claim does not necessarily mean the claims process is over. The insurer’s decision should be reviewed against the insurance policy and the medical and other evidence considered during the claim.
Depending on the circumstances, further evidence may be provided, an internal review may be available or another dispute pathway may apply. The Australian Financial Complaints Authority (AFCA) can consider eligible life insurance complaints.
No. Being permanently disabled does not automatically result in a successful claim or mean that a TPD claim will be approved. The insurer assesses whether your circumstances satisfy the total and permanent disability (TPD) definition and other requirements contained in the relevant policy.
The overall claims process is generally similar, but TPD claims involving mental health conditions can require detailed evidence about symptoms, treatment history, prognosis and how the condition affects a person’s capacity for work.
The claim is still assessed against the definition and requirements contained in the relevant TPD insurance policy.
Not necessarily. Terminal illness can involve different insurance benefits or superannuation rules from a total and permanent disability claim. The applicable cover and policy terms should be checked before assuming the same claims process applies.
Not sure whether you may be able to make a TPD claim? Our quick TPD claim checker can help you understand whether you may have a potential claim based on your circumstances. It takes around 30 seconds to complete, or you can contact our team if you would prefer to discuss your situation directly.
The Personal Injury Lawyers are long-term members of several professional legal organisations and are also listed across recognised legal directories, including the Australian Lawyers Alliance, Gold Coast District Law Association, Queensland Law Society, LawConnect and Doyle’s Guide.
Try our free 30 second claim checker or please contact us for a free assessment.
