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What are the chances that your total and permanent disability insurance (TPD) claim will be approved rather than denied?
According to the Australian Prudential Regulation Authority (APRA), 64% of non-advised individual TPD claims were approved in 2021. So, how can you increase the likelihood of your insurance claim being approved?
This article provides some general information about TPD claims. It covers what a TPD claim is, what makes people eligible for TPD claims, what illnesses and injuries qualify for a TPD claim, and important details about the TPD claims process.
We discuss what is needed to make a TPD claim, how much you can expect to receive from a successful claim, how long the process takes, how to win TPD claims, and why TPD claims are denied.
Jump straight to…
What Exactly Is a TPD Claim?
Total and permanent disability (TPD) grants a lump sum in circumstances where you are permanently disabled due to an accident or illness.
TPD insurance is typically available through a superannuation fund.
If you cannot work due to a disability caused by a serious injury or illness and you hold TPD insurance, you should file a TPD benefit claim.
When Are You Eligible for a TPD Claim?
In terms of eligibility in most TPD claims, you qualify by proving that you’re permanently unable to work.
It’s important to note, that your TPD insurance policy may cover you for your own occupation or any occupation.
If you are covered for your own occupation: this means you can make a TPD insurance claim if your disability prevents you from working your current job. This cover is more expensive and typically only available outside superannuation.
If you are covered for any occupation: you can make a claim if you can never work again in any job suitable for your experience, training, or education.
Proof of your disability generally comes in the form of a medical certificate provided by your treating doctor, which will need to be submitted to the insurer when you make a claim.
Various TPD policies have different definitions and provisions to qualify for payouts. So, it is important to check your insurance policy for specific eligibility requirements.
What Injuries and Illnesses Qualify for a TPD Claim?
The following injuries, illnesses, and mental health conditions may qualify for a successful TPD claim depending on your policy:
Injuries
- Carpal tunnel
- Back injuries
- Loss of a limb
- Loss of speech
- Loss of hearing
Illnesses
- Cancer
- Stroke
- Heart attack
- Kidney failure
- Muscular dystrophy
- Rheumatoid arthritis
- Chronic lung disease
- Multiple sclerosis
- Alzheimer’s disease
- Parkinson’s disease
- Dementia
- Chronic fatigue syndrome
Mental Health Conditions
- Schizophrenia
- Bipolar disorder
- Depression
- Post-traumatic stress disorder (PTSD)
- Anxiety
Does Your TPD Claim Have to Be Work-Related?
TPD Insurance Policies generally cover you for work-related accidents as well as non-work-related accidents.
You may qualify for a TPD claim after sustaining accidental injuries and illnesses at various locations. Examples of this include work, home, sporting fields, or roads involving motor vehicle accidents.
TPD Claims Related to an Old Injury or Sickness
Typically, it doesn’t matter if you had an illness or injury before obtaining TPD cover through a super fund. However, it is vital that you read the Product Disclosure Statement (PDS) prior to purchasing TPD cover for complete information.
A PDS contains the policy’s terms and conditions as well as any exclusions. For example, an insurance company’s TPD policies may exclude pre-existing conditions.
What is the TPD Claims Process?
When making a claim, you will need to speak to the person or company from which you bought the policy. Here’s how the TPD insurance claims process works.
If you purchased insurance through:
- An insurer, contact the insurance company
- An insurance broker or financial adviser, talk to them first
- A superannuation fund, contact the super fund
- An employment arrangement, speak to your employer
Enquire about how the claim process works, ask about the forms you must fill out, and ensure your policy number is available.
Select a financial adviser with an Australian Financial Services License (AFSL). It is also a legal requirement for companies who provide financial advice to have an Australian Business Number (ABN).
If you’re struggling physically or emotionally due to your illness or injury, a financial adviser can help you to complete the claims process.
What You Need To Make a TPD Claim
Understanding what documents and information you need will help make the claim process simpler.
It’s also important to understand how you can avoid the common errors and pitfalls that can result in denied TPD claims.
After contacting the policy’s source, the TPD claims process includes the following steps:
- Provide evidence of your illness or injury.
- Submit a written explanation of why your claim should be approved.
- Follow up on the insurer’s assessment and ask whether your claim was approved or denied. It usually takes anywhere from three to twelve months for a decision to be made on your claim.
You can use specialist TPD lawyers rather than a personal injury lawyer to file a claim. TPD lawyers are located in all major cities, including Sydney, Melbourne, and Brisbane, in addition to many regional areas can provide valuable assistance to you in dealing with TPD claims.
These lawyers usually handle cases on a no win, no fee basis. Meaning, there are no upfront fees, plus you get free advice. You’ll pay them only after they win the case and you receive your TPD payout.
If you have previously worked with a financial adviser to secure your TPD policy, they should be able to help you make your claim as well.
Need help with your TPD Claim? Let us help you find the best solution for your needs.
Talk to a Finance ExpertHow Much Will You Receive for Your TPD Claim?
Your entitlement is based on the insurance arrangements in your policy, which is determined by the level of cover and monthly premiums.
Common factors that determine the amount of your TPD payout include your age when you ceased work.
If you have multiple TPD policies (for example if you have one in and out of your super), you can usually make multiple TPD claims.
When Can You Make a TPD Claim?
Time is certainly of the essence when making a TPD claim. You should make a claim immediately. That said, you can also make a claim a long time after your illness or injury has occurred.
Obtaining good legal advice or financial advice before submitting your claim is also advantageous. Time limits do exist for challenging insurer and super fund decisions.
What Benefits Are Paid Out for a TPD Claim?
Your TPD insurance benefit is typically a lump-sum payment calculated at the particular date you last worked.
A TPD benefit through a super fund is typically added to your superannuation account balance. The benefit of this being that no tax is payable at this point.
Superannuation payouts are taxed using a concessional rate.
Such payouts may also impact your entitlement to government benefits, such as Centrelink payments. However, you may be able to transfer some of the lump sum into a superannuation rollover fund.
How Long Do TPD Claims Normally Take?
The time needed to evaluate and process your TPD claim depends on several factors, including the individual’s health condition and the complete filing of the application.
A claim’s processing time and the waiting period can range from a few weeks to several months.
You can also consider making an income protection insurance (IP) claim in the meantime if you hold this type of insurance. You may also qualify for regular payments while your TPD claim is assessed.
What Makes a Strong TPD Claim?
A strong case can increase the chance of your TPD claim being approved. You can strengthen your position and the chances of your claim being successful with these steps:
1. Verify you meet basic requirements
Ensure that:
- Your policy was active on the date you became ill or were injured.
- You were under 65 years when you stopped working.
- You actively participated in your field of work until the injury occured.
2. Submit a complete application
The application must tick all the right boxes. Insurers often reject non-watertight claims. Providing clear evidence of injuries like medical reports, workers compensation claims, and X-rays will greatly assist.
How to Win a TPD Claim
Follow these simple steps to improve your chances of winning a TPD claim.
Step 1: Identify your TPD policies. In Australia, many people have multiple superannuation policies from multiple jobs over the years which may hold multiple TPD policies. Look into all of your policies.
Step 2: Check for valid policies when you became ill or were injured. This process can be a grey area, so ensure you know the date you became aware of your illness or injury.
Step 3: Learn the approval criteria. Read the Target Market Determination policy’s terms to learn what qualifies for lump-sum payouts.
A TPD policy may cover you for:
- Being unlikely to return to work in your own occupation
- Being unlikely to return to work in any occupation
Some TPD policies allow for successful TPD claims if the insured is unfit for all work.
Step 4: Submit a completed application. Use documents and medical records to support your claim forms. The insurer may ask for more information.
Individuals who make their own claims frequently fail to obtain a TPD payout. Enlisting the service of a TPD claim specialist can certainly help get your TPD claim approved, in addition to providing support to you throughout the claim process.
Step 5: Explain why your TPD claim ought to be approved. Submit a well-written statement with valid claims about your personal circumstances.
Step 6: Follow up with an insurer. Consistent and regular communication with a claim assessor can help avoid unnecessary delays in the TPD claim process.
Step 7: Follow the dispute process even after your claim has been rejected. A denied claim is not always the end of the matter!
What Can Get Your TPD Claim Denied?
An insurer may deny your TPD claim for various reasons, including:
- Submitting an insurance claim too late
- Dispute over provided evidence
- Lack of evidence
- Not meeting work history requirements
- Not meeting age restrictions
- Inactive insurance policy
You may be able to reverse a TPD claim rejected by re-submitting stronger evidence or missing details. You can also include legitimate reasons why a late claim was made via this submission process.
If you make a claim yourself, you may like to seek personal advice from a financial adviser or Insurance Specialist who may be able to help you secure a successful TPD claim.
Note that missing information and evidence can result in a TPD claim rejection even though you may be entitled to receive a TPD payout.
What If Your TPD Claim Is Rejected?
Your claim may also be rejected if your super fund or insurer believes you can still work or you need further treatment.
In cases like these, you may like to seek legal or financial advice from an Insurance Specialist who may be able to help you secure a successful TPD claim.
Can You Claim Over One TPD Payout?
It is possible to have more than one TPD claim. This typically occurs when you have multiple insurance policies operating at the same time.
However, some policies won’t make payouts if the claimant has received or is entitled to claim a different TPD benefit. So it is important to check your policy’s terms and conditions prior to making a claim.
Getting Help With Your TPD Claim
The claim process can be complicated if you have multiple super funds or insurance policies, such as a life insurance policy.
If you need help with your TPD claim, My Money Sorted’s Insurance Partners can support you.
Specialist TPD lawyers can also help manage claims. Keys to successful TPD claims include the following:
- Submitting a fully complete TPD claim application
- Necessary supporting documents, including proof of identity
- Providing a written submission justifying your claim’s approval
Financial Advisers can also check superannuation funds to determine your insurance coverage.
Other factors related to your TPD claim application include:
- Time limits
- Minimum waiting periods or waiting times
- Work history requirements
- Your age
- Your medical evidence and whether it’s clear enough
- Exclusions or eligibility clauses in a TPD insurance cover’s policy
Your claim must include accurate and detailed information.
A successful total and permanent disability claim after an injury or illness can help provide financial support for you and your family.
Still not sure where to start, or want help securing the right insurance faster?
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Call Our Team TodayReferences
1. Life Insurance Claims and Disputes Statistics
https://www.apra.gov.au/sites/default/files/2021-10/Life%20Insurance%20Claims%20an
d%20Disputes%20Statistics%20June%202021.pdf
2. How super works
https://moneysmart.gov.au/how-super-works
3. Superannuation TPD claim guide
4. Disclosure statement
https://www.investopedia.com/terms/d/disclosurestatement.asp
5. Making a life insurance claim
https://moneysmart.gov.au/how-life-insurance-works/making-a-life-insurance-claim
6. No win, no fee
https://dictionary.cambridge.org/us/dictionary/english/no-win-no-fee
7. Concessional contributions and contribution caps
8. Centrelink
https://www.servicesaustralia.gov.au/centrelink?context=1
