A TPD claim provides financial assistance to individuals who are permanently unable to work due to a serious injury or illness. Total and Permanent Disability (TPD) insurance offers a lump sum payout to eligible individuals, helping them manage living expenses, medical costs, and financial commitments when they can no longer earn an income. This type of coverage is also referred to as a Disability Insurance Benefit.
Many people are unaware that they already have TPD insurance as part of their superannuation. However, it’s important to verify your coverage rather than assume it’s automatically included. Additionally, if your super account remains inactive for too long, ongoing fees could reduce your balance, leading to the cancellation of your policy due to non-payment of premiums.
Who Can Make a TPD Claim?
A TPD claim is available to individuals who can no longer work due to a permanent injury or illness. However, eligibility requirements can vary depending on the specific policy and insurer. Generally, to qualify, you must demonstrate that you are unable to continue working in your previous role or transition into another type of employment for which you are reasonably qualified by education, training, or experience.
Key Eligibility Criteria
Most TPD insurance policies assess eligibility based on factors such as:
- Your work history: Insurers evaluate whether you are permanently unfit to continue working in your current job or any other occupation relevant to your skills.
- The severity of your condition: Your injury or illness must be serious enough to prevent you from working indefinitely. Temporary disabilities typically do not qualify.
- Medical evidence: You will need medical reports from one or more doctors confirming that your condition prevents you from returning to work in any suitable capacity.
- The duration of your work incapacity: Most policies require you to be out of work for a minimum period (usually six months) before lodging a TPD claim.
Examples of Eligible Claimants
Eligibility for a TPD claim depends on the nature of your previous employment, qualifications, and work experience. Here are some examples of how this applies:
- Manual workers: If you have spent your career in physically demanding roles, such as construction or warehouse work, and a spinal injury prevents you from continuing in such jobs, you may be eligible. Even if a desk job is physically possible, you may still qualify if you lack the required education or experience to transition into an office-based role.
- Office professionals: Someone with extensive experience in administrative or corporate roles who develops a chronic illness, such as multiple sclerosis, which affects cognitive function and mobility, may qualify if they can no longer perform essential job tasks.
- Self-employed individuals: Business owners or tradespeople who are unable to continue running their business due to a permanent disability may also be eligible, provided their TPD insurance policy covers them.
- Serious illness cases: Conditions such as cancer, degenerative neurological diseases, or mental health disorders that make it impossible to continue working may also qualify under TPD insurance policies.
Does a Work-Related Injury Matter?
Your TPD claim does not require your injury or illness to be work-related. Unlike workers’ compensation, which applies to workplace injuries, TPD insurance covers any disability, regardless of how or where it occurred.
For example, you may be eligible if:
- You were in a car accident that caused severe physical impairment.
- You developed a chronic illness that progressively worsened, making employment impossible.
- A mental health condition, such as severe depression or PTSD, prevents you from working long-term.
Reviewing Your Policy
Each TPD insurance policy has unique conditions, so it’s important to review your specific policy’s wording. Some policies have strict definitions of “total and permanent disability,” requiring claimants to prove they are unable to work in any occupation, while others may focus only on whether they can return to their previous line of work.
Since navigating a TPD claim can be complex, seeking professional advice from an insurance lawyer can help you prepare the strongest possible case and maximise your chances of a successful outcome.
How Much is a TPD Payout?
The amount paid out through a TPD claim varies depending on individual circumstances and policy terms. Successful claimants may receive a lump sum payment or structured instalments over time.
These funds can be used to cover medical expenses, provide ongoing financial support, or pay off debts accumulated while waiting for claim approval.
What Happens if Your TPD Claim is Denied?
A TPD claim may be denied if the insurer or superannuation provider believes you can still work in some capacity.
If your claim is rejected, you have the option to dispute the decision through the Financial Ombudsman or pursue legal action in the District Court, Supreme Court, Federal Court, or the Superannuation Tribunal.
If your TPD claim has been denied, our compensation lawyers in Townsville help you explore your options and fight for the benefits you deserve.