When a person makes a total and permanent disability claim, i.e. TPD claim, they may be entitled to receive payment if they’ve suffered an injury or illness. A person may be suffering from an injury or illness that prevents them from returning to work.
This injury or illness need not be work-related, but they can make a TPD claim only if it has prevented them from working. Moreover, if they get an injury from an accident, they can claim for workers compensation benefits along with a TPD claim.
In such an instance, they can make a TPD claim. This will enable them to receive a lump sum payment in addition to their superannuation fund. In other words, superannuation funds contain an insurance policy for total and permanent disability.
As a fact, the insurance industry in Australia is governed by many laws like the Insurance Act 1973.
In this article, we explore certain important points in relation to TPD claim in Australia such as:
- What is total and permanent disability?
- Who is eligible to make a TPD claim?
- How to make a successful TPD claim?
More importantly, people always wonder if they need legal advice while making such claims. In this article, we will also highlight the importance of legal advice.
What Is Total and Permanent Disability?
If a person has not been able to work at all due to an illness or physical injury for an extended period of time (3 months and more), it is total and permanent disability. Moreover, the person must have no expectation to return to work.
A person may be eligible to receive TPD insurance benefits if they:
- stop working due to an injury or sickness;
- do not work for the waiting period that can be around 3-6 months; and
- are unlikely to return to work that is in their education, experience and training after this period
Eligibility to Make a TPD Claim
While you can use the above definition to check if you can make a TPD claim, sometimes different insurance policies will have different conditions. Therefore, you need to check your policy to see what it covers.
As an example, see below to understand what your policy may or may not include:
- If you are unlikely to return to work in your occupation; or
- If you are unlikely to return to work in any occupation.
You can determine your eligibility depending upon what’s mentioned in your policy. Moreover, if a person has been injured due to an accident, they can make other claims in addition to this one. It is important to speak with a lawyer to understand which claims you are eligible to make.
Amount You Can Receive From TPD Claim
The amount a person can receive from their claim will depend entirely on the insurance arrangements in their specific super funds. Generally, this amount is determined by checking how old the person was when they ceased working due to an illness or injury.
Moreover, people have to check the insurance cover that they had when they last worked, and not the one they have when making an enquiry regarding TPD claims. Why is this so? Because it is quite possible for the amount of the insurance cover to change over time.
Provide Your Medical and Occupational History for Successful Claims
People making this claim need to provide their full medical and occupational history. This is because you have to prove to the insurer that your claims are valid. They must show that they are no longer capable of meeting the physical and/or mental demands of their work due to the illness or injury.
They also need to consult a doctor, and get their opinion on whether or not they can continue working. Moreover, employers will need to provide a statement to confirm that the party had stopped working from a certain date due to injury or illness.
Also, they need to prove the significance of their injury. Hence, they need to meet with a medical specialist who can review their injuries and illnesses. The specialists can then confirm that the person cannot work due to their illness/injury.
In some cases, it is better to consult a specialist doctor, rather than your usual doctor. This is because they might be better suited to clarify the nature of injuries or illness.
What Is Procedural Fairness?
When you make a TPD claim, it can either be accepted or rejected by insurers. Previously, insurers would reject claims without providing any reasons behind their decision. However, insurers are now required to issue a “procedural fairness” letter.
These letters detail why the insurers are rejecting a person’s claim. Moreover, it also gives people the opportunity to respond to the refusal or rejection. Lastly, such a letter can also enable people to gather more evidence to support their claims.
TPD Claim and How Lawyers Can Help
It can be quite complicated to lodge a TPD claim by yourselves. Therefore, it is better to engage a lawyer who can help you with this matter.
Firstly, each insurance provider and policy may have a slightly different definition of “total and permanent disability”. Therefore, a lawyer can help you understand exactly what you are eligible for.
Moreover, quite often people make a claim only to be unsuccessful. Before you lodge a claim, you can seek advice from lawyers who can help you understand whether or not your claim will be viable.
Furthermore, when you make a claim, you will need lot of evidence and paperwork to support your claim. When people run behind gathering this evidence, they often lose focus of what matters – recovery. If you are suffering from an illness or injury, you need to use your energy to recover.
Lawyers can take care of every other aspect related to filing a claim such as gathering paperwork, and collecting necessary evidence.
Lastly, it is quite possible that you have to attend court hearings or trials in order to settle your TPD claim. While this may be rare, you cannot rule this possibility out. Therefore, it is essential to have a lawyer who can represent you in your case if required.
Contact our lawyers for more information.