What is a TPD insurance claim?
The ability to be gainfully employed is at the core of being able to financially support yourself and your loved ones. If an illness or injury results in your inability to work, this can take a serious financial toll.
TPD or Total Permanent Disability insurance is a one-off lump-sum payment intended to help support you financially if you are unable to work.. Total Permanent Disability insurance is a highly regulated industry, with strict conditions for eligibility, which can make the process complex without a professional to guide you. This means that if you are looking to lodge a claim for TPD insurance you might wish to speak to a lawyer about how to maximise your chances for a successful outcome.
Are you eligible to make a Total Permanent Disability insurance claim?
In order to make a TPD insurance claim, you must fulfil a set of criteria outlined in the insurance policy. The majority of the time this includes:
- You must have a valid TPD insurance policy. In New South Wales the most common way that workers purchase TPD insurance is through their superannuation policy. Often workers may not even know that they have TPD insurance because it was simply included with their super account. TPD insurance can also be purchased as standalone cover. If you have more than one TPD insurance policy you may claim against all of them individually.
- You must have a total and permanent disability. Total and permanent disability may be defined differently depending on the insurer, however, the generally accepted definition is that you have sustained an injury or illness where you have lost a quarter of your ‘whole person function’. Common conditions include illness, paralysis, loss of a limb, loss of part of a limb, loss of sight or hearing. It might also include loss of at least two activities of daily living such as self-care, communication, physical activity, sensory function or hand function.
- You must not be able to return to work. There are two main types of TPD insurance claims, ‘Any Occupation’ TPD claims and ‘Own Occupation’ TPD claims.
- ‘Any Occupation’ TPD claims are pursued when the claimant’s injury or illness prevents them from ever returning to any occupation for which they have the required skillset, training, experience or education.
- ‘Own Occupation’ TPD claims are pursued if the claimant cannot return to their usual occupation or chosen field of employment for which they have the required skillset, training, experience or education.
- You must have fulfilled the waiting period. Depending on the circumstances of the case this might be 6 months, 3 months or no waiting period. Your lawyer should be able to guide you in how long you need to wait.
- You must have been employed when you sustained the injury or illness. This means you must provide evidence of having been employed full time or been working for a set number of hours a week.
- You must show that you are complying with medical advice and care. This means that you have listened to your doctor’s advice, undergone mandated rehabilitation and regularly attend your medical appointments.
If you have fulfilled all of these criteria then you are likely eligible for TPD insurance. If you believe that you can make a claim it is usually best to talk to a professional that can help guide you through the process and maximise your chances of success.