What Percentage of TPD Claims Are Successful?

16 May 2024 | Total and Permanent Disability

The percentage of successful TPD claims varies by the source. But one thing is clear: The importance of retaining a knowledgeable TPD lawyer cannot be overstated.

When you obtain legal counsel to handle your TPD claim, the likelihood of success increases dramatically. An experienced lawyer knows how to prepare your application, navigate disputes, and obtain maximum compensation under your specific insurance cover.

TPD Compensation Lawyers can help you lodge a claim for Total and Permanent Disability and maximise your entitlement. Call 03 9966 7188 for a FREE consultation at our office in Melbourne, VIC.

What Is the Success Rate of TPD Claims?

According to a report by the Australian Securities & Investments Commission (ASIC), the overall acceptance rate for TPD claims is 86%. However, the likelihood that a TPD claim will be accepted varies significantly depending on the type of Total and Permanent Disability insurance.

There are three types of TPD insurance cover:

  • ‘Any occupation’ cover: Pays a disability benefit if an illness or injury bars you from any work for which you are qualified. 
  • ‘Own occupation’ cover: You are entitled to a payout if a disability prevents you from resuming your prior employment.
  • ‘Activities of daily living’ cover: An entitlement is only available if you cannot do certain tasks integral to daily life.

‘Any occupation’ and ‘own occupation’ insurance are the most common TPD policies. However, many superannuation insurance companies have started to adopt ‘activities of daily living’ (ADL) cover. It is much harder to make a successful TPD claim under the ADL definition.

What Is the Success Rate for ‘Any Occupation’ and ‘Own Occupation’ TPD?

Taken together, the acceptance rate for ‘own occupation’ and ‘any occupation’ TPD claims is 88%. Statistics released last year by ASIC show that outcomes have improved significantly in the last 10 years, with the share of declined ‘any occupation’ claims dropping from 16% in 2015 to 8% in 2022 (the most recent year of data).

What Is the Success Rate for ‘Activities of Daily Living’ TPD?

The acceptance rate for TPD claims under the ‘activities of daily living’ definition is much lower than other types of cover. In 2019, ASIC sounded the alarm about the restrictive nature of ADL cover. At the time, 60% of Total and Permanent Disability claims assessed under ADL were declined.

Read More: What Is TPD ‘Activities of Daily Living’?

Since then, insurers have modified the eligibility criteria to make ‘activities of daily living’ less restrictive. However, it is still much more difficult to claim TPD successfully under this definition.

Is It Hard to Get a TPD Payout?

With an acceptance rate of only 86%, a successful TPD claim is far from guaranteed. Applicants must show that they meet the criteria for Total and Permanent Disability set by the insurer. Often, this is easier said than done.

TPD applications must be supported by compelling medical evidence. Lack of medical evidence is the number-one reason Total and Permanent Disability claims are rejected. This is especially true of policies with a narrow definition, such as ADL.

Read More: What to Do If Your TPD Claim Is Rejected

Other reasons a TPD claim may be denied include failing to satisfy the waiting period and insufficient work history. Each of these issues can make it hard to get a TPD payout.

Fortunately, you don’t have to go through the process of claiming TPD insurance by yourself. An experienced lawyer can review the available insurance cover, identify any medical assessments you may need, help you fully prepare your claim, and review the insurer’s decision. If your claim is rejected or the award is inadequate, a lawyer can also help you lodge an appeal.

At TPD Compensation Lawyers, these services are offered on a No Win No Fee arrangement, meaning there is no upfront cost to you.

How Can I Improve the Likelihood of Success?

When lodging a TPD claim, there are steps you can take to make a favourable outcome more likely. These include:

  1. Check your insurance cover: Make sure any and all policies you have are valid. You may be covered by more than one TPD policy, in which case you may have multiple TPD claims.
  2. Understand the eligibility criteria: Read over any documents you have from the TPD insurer and/or your employer to understand how Total and Permanent Disability is defined, what you need to do to apply, etc.
  3. Abide by the waiting period: You will need to be unable to work for a certain period of time (usually 3–6 months) before applying for TPD compensation. Once the waiting period has passed, the insurance company will consider your application.
  4. Make sure your disability is fully documented: You will likely need to be evaluated by a GP and one or more specialists. Be honest about your symptoms and how they affect your ability to work. This will ensure that your medical records are complete.
  5. Gather financial information: In addition to thorough medical documentation, your application will need to include proof of your employment and income prior to the disability. Take the time to organise your payslips, tax returns, communications with your employer, and other paperwork before claiming for TPD.

TPD Compensation Lawyers Can Help

Getting qualified legal representation is the best way to make a successful TPD claim. At TPD Compensation Lawyers, we represent clients on a No Win, No Fee basis. You pay nothing upfront and only owe fees if our lawyers obtain a favourable result on your behalf.

TPD Compensation Lawyers serve clients in Melbourne and throughout VIC. Contact us today for a FREE consultation.