TPD Claims: Superannuation and Personal Life Cover

If you have sustained an injury or illness that results in a permanent inability to work, you may be eligible to lodge a Total and Permanent Disability (TPD) claim. These benefits are typically available through insurance held within a superannuation fund or via a standalone personal life insurance policy.

Kare Lawyers provides legal assistance to individuals navigating the TPD claims process, from initial applications to the internal review of denied claims.

Understanding TPD Insurance

Total and Permanent Disability (TPD) insurance provides a lump sum payment to individuals who are unable to return to work due to a permanent disability. This payment is intended to assist with ongoing costs such as medical expenses, rehabilitation, and general living requirements.

TPD cover is generally categorised into two types:

1. Superannuation-based cover: Insurance held within your super fund.
2. Personal life cover: A policy purchased directly from an insurer outside of superannuation.

TPD Insurance Within Superannuation

Most superannuation funds include TPD insurance as a default benefit. If you are a member of a fund, you may be covered even if you did not manually opt-in.

Key Features:

• Automatic Enrollment: Many Australians hold TPD cover through their default superannuation settings.
• Eligibility Criteria: Claims usually depend on proving you are unlikely to ever engage in “any occupation” for which you are reasonably qualified by education, training, or experience.
• Trustee Involvement: The claim is submitted to the superannuation trustee, who then liaises with the underlying insurer.

The Claims Process:

1. Policy Identification: Review your member statement to confirm the level of cover active at the date you ceased work.
2. Notification: Inform the superannuation fund of your intent to claim to receive the necessary documentation.
3. Evidence Submission: Provide medical reports and employment history to satisfy the policy’s definition of “permanent disability.”
4. Assessment: The insurer evaluates the medical evidence, which may include an Independent Medical Examination (IME).

Personal Life Cover TPD Claims

Personal life insurance policies are separate from superannuation. These policies often provide different levels of coverage and alternative disability definitions.

Key Features:

• “Own Occupation” Definitions: Unlike superannuation (which often uses “Any Occupation”), personal policies may allow you to claim if you cannot perform the specific job you were trained for.
• Variable Benefit Amounts: Cover levels are typically determined by the individual at the time the policy was established.
• Direct Management: Claims are managed directly with the insurance provider.

The Claims Process:

• Policy Review: Specific attention is paid to the “waiting period” (usually 3 to 6 months) and the precise definition of TPD.
• Documentation: Submission of clinical evidence from treating specialists regarding your long-term prognosis.
• Insurer Determination: The insurer assesses the claim based on the contractual terms of your specific policy.