Making a TPD (total and permanent disability) claim in New South Wales, Australia, can be a complex process, so it’s important to understand your rights and the steps involved. You need to know about this because TPD often results in complete or partial loss of income. Now, this leads to financial hardship which impacts the financial security for the individual and their dependents.
What Is a TPD Claim?
Total permanent disability insurance provides a lump sum payment if you become permanently disabled due to illness or injury. This can help cover living expenses, medical expenses, your life cover, and other financial needs you may have.
Your total permanent disability can have a significant impact on your financial situation. Thus, processing your claim can help support you and your family and pay for medical and rehabilitation costs.
Moreover, the benefits are provided by many superannuation funds and if you can demonstrate your eligibility for the benefits, you will receive a payout. If you’re injured at work in NSW, depending on your whole person impairment rating (also known as permanent impairment rating), you might be entitled to a lump sum benefit up to a maximum of $713,660.
For permanent impairment claims made on or after 19 June 2012, the minimum level is more than 10 percent permanent impairment, except for primary psychiatric and psychological impairments which require a minimum level of 15 percent.
TPD insurance provides a financial safety net in the event that you will be unable to provide for your family due to an illness that will disable you from going to work on a regular basis.
Eligibility for TPD Claim
Eligibility for a total permanent disability claim in NSW depends on several factors specified in the insurance policy. Some general requirements for the claim include the following:
- Injury or illness. You must have an injury or illness that prevents you from working for three or more months, with no prospect of returning to work.
- Work capacity. Your work capacity is a significant factor that you should consider when lodging a claim. You must be unlikely to return to work in any occupation that you are reasonably suited to training or experience.
- Education, age, and work history. These factors are also considered when determining eligibility for a claim.
- Superannuation fund. You must have an active superannuation fund or have contributed to one in the past.
To successfully claim a TPD insurance benefit, you will need to provide substantial medical evidence that demonstrates your injury or illness makes it unlikely for you to return to employment (or volunteer work) that you are suited for.
Review your insurance policy terms diligently and consult with a legal expert to understand the specific requirements and increase your chances of a successful claim.
Making a TPD Claim
The process of making a total permanent disability claim may vary depending on the insurer or superannuation fund. Here is a general step-by-step guide:
Step 1: Understand your TPD cover policy. Review the terms of your policy to understand what qualifies for a lump sum payout. For example, your policy might cover you for being unlikely to be able to return to work in your occupation or any occupation.
Step 2: Gather medical evidence. To establish your suitability for TPD benefits, you will need to provide substantial medical evidence that demonstrates you have an injury or that you suffer an illness that makes it unlikely that you will return to employment (or volunteer work) that you are suited for.
Step 3: Complete the TPD claim form. Contact your superannuation fund or insurer to obtain the claim form and complete it accurately. Include all documents and medical records to substantiate your claim, and provide a written submission explaining why the claim should be approved.
Step 4: Submit the TPD claim. Submit the claim form and supporting documentation to the insurer or superannuation fund. Seek professional help from a legal expert or financial advisor if you are unsure about the claims process or the required details.
Step 5: Follow up with the insurer. Follow up with the insurer to make sure they have everything they need and to avoid unnecessary delays and frustration in making a claim.
Step 6: Wait for approval. The insurer or superannuation fund will review the claim and determine if the applicant is eligible for benefits. The time frame for the approval of the claim varies depending on the case’s complexity, but it typically takes several weeks to several months.
What Happens if TPD Claim is Denied?
If your TPD insurance claim is denied, follow the dispute process to appeal the decision. To challenge the decision, here’s what you should do:
- You can request an internal review by the superannuation fund’s internal dispute resolution team. This review will involve a fresh assessment of your claim by a different claims assessor.
- Refer the decision to the Australian Financial Complaints Authority (AFCA). If the internal review does not resolve the issue, you can refer the decision to the AFCA, which is an independent dispute resolution scheme that handles complaints about financial products and services.
- If the internal review and AFCA do not resolve the issue, you can challenge the insurer’s decision in court. A judge will determine the case, and by doing so, you may have the decision overturned and your benefits paid.
Get Help from Legal Experts
Have you suffered from a serious injury or permanent disability due to a work accident?
A Total and Permanent Disability claim could offer you financial security and support as you deal with life’s changes. But you’re going to need the help of an experienced legal advisor to help you with the process.
Our lawyers at JB Solicitors can help you understand the process of making a TPD claim, TPD insurance premiums, or calculate your permanent disability insurance total. We can advise you on the best course of action to take in case of denial of TPD claims.
Contact us today.
