Outside of the insurance industry, TPD definition changes receive very little attention. That’s unfortunate, because changes in how Total and Permanent Disability is defined can have a major impact on one’s eligibility for a TPD payout.
In recent years, several of Australia’s largest superannuation funds have added a retraining clause to their definition of TPD. Companies that consider retraining when making TPD determinations include:
- AustralianSuper
- Aware Super
- Brighter Super
- CareSuper
- Hostplus
- QSuper
- TAL (some policies)
- Vision Super
Retraining clauses in TPD insurance policies may make it more difficult for you to obtain an entitlement. TPD Compensation Lawyers have been closely monitoring TPD definition changes so we can provide the best service to our clients.
Call 03 9966 7188 today for a FREE consultation. We can review the insurance policy thoroughly to assess your eligibility, as well as discuss the next steps for making a claim.
How Is TPD Defined?
Before we start talking about how the definition of TPD has changed for the members of certain super funds, it is important to know how insurers define Total and Permanent Disability. The Superannuation Industry Supervision (SIS) Regulations mandate that members of a super fund are only eligible for a TPD benefit if a disability ‘makes it unlikely that the member will engage in gainful employment for which the member is reasonably qualified by education, training or experience.’ As such, superannuation insurers may only use the ‘Any Occupation’ definition of TPD.
With ‘Any Occupation’ cover, the insurer needs to be satisfied that you can no longer work (and are unable ever to work again) in any occupation for which you are suited. Per the SIS regulation above, suitability is based on your educational background, job training, and work experience.
Say someone (we’ll call him Bob) worked as a tradie until a back injury left him unable to perform manual labour. The superannuation insurer may determine that, though Bob can no longer meet the physical demands of his prior job, he is able to do office work. In such a situation, Bob would likely not qualify for TPD under the ‘Any Occupation’ threshold.
The wording of TPD insurance policies can be difficult to understand. At TPD Compensation Lawyers, we can review your policy, explain the different types of cover (including ‘Any Occupation’ vs ‘Own Occupation’), and assess your eligibility for making a TPD claim.
What Is a Retraining Clause?
For TPD insurance cover that includes a retraining clause, you need to prove not only that you (a) can’t return to your job or do other work for which you are qualified, but (b) you can’t be retrained for a different role. If the insurer believes that re-education or re-skilling is a possibility, your TPD claim may be denied.
Let’s return to our tradie with a back injury, Bob. He has TPD cover through his employer’s super fund. Effective last year, TPD definition changes have resulted in the addition of a retraining clause. When Bob goes to apply for a TPD benefit, the insurer tells him he will need to submit to a retraining course. Only if Bob’s condition prevents him from retraining and working in a different role will TPD benefits be paid out.
Why Do Insurers Add Retraining Clauses?
The answer is fairly simple: cost. Changing the definition of TPD to include retraining requirements gives insurance companies additional grounds to reject TPD claims. Fewer payouts mean less cost to the insurer. (Though the insurance industry likes to suggest that such changes lead to greater ‘long-term sustainability’ for super funds.)
For claimants, TPD definition changes that include a retraining clause make it that much harder to qualify for an entitlement. Court decisions like the one in the Shuetrim case have affirmed that TPD insurers are within their rights to deny claims unless it is all but certain that the claimant will never return to work. Retraining makes the definition even more restrictive.
Having trouble getting a TPD payout? Contact TPD Compensation Lawyers for FREE today.
How Do Retraining Clauses Work?
Retraining looks different for everyone. In addition to physical rehabilitation and mental health counselling, the TPD insurer may require you to complete retraining programs or vocational training. The insurer may also assess prior volunteer experience and other pursuits in determining potential retraining opportunities.
Most TPD insurance policies require claimants to exhaust all ‘reasonable’ retraining options before they are entitled to compensation. Our TPD lawyers may be able to argue that the insurer’s retraining requirements are unreasonable based on your individual circumstances. This may include:
- Whether retraining is realistic, based on your condition
- Lack of retraining opportunities in your area
- Retraining is prohibitively expensive
- You are near retirement age and retraining is impracticable
- Limitations on transferable skills due to minimal schooling or narrow job responsibilities
- Employment opportunities are limited in your community
Each of these arguments must be supported by strong evidence. Our team will review all medical records to determine the feasibility of retraining, as well as collect additional evidence to prove to the insurer that their insistence on retraining is unreasonable. All of this will allow our lawyers to prove your entitlement to TPD benefits and overcome insurance company denials.
Can You Work Again After a TPD Claim?
When you are disabled, it is natural to hold out hope that you will be able to return to work, and a normal life, with time and medical treatment. Unfortunately, not everyone with a Total and Permanent Disability will be able to attain this dream. Similarly, the insurance company doesn’t want to issue a payout only for the claimant to go back to work a few months or years down the track. If such happens, the insurer may even suspect fraud and be inclined to take legal action.
TPD retraining clauses are designed to confirm that claimants only get a benefit if they are truly unable to return to work, even after rehabilitation and re-skilling. If you have questions about returning to work after a TPD payout, our knowledgeable lawyers can provide you with expert advice.
Do You Meet the TPD Definition?
Many people don’t realise that TPD definitions change with some frequency. These changes are often buried in the terms and conditions page, which the bulk of people don’t read. At TPD Compensation Lawyers, we know how to decipher these complicated documents and help you lodge a strong claim for Total and Permanent Disability.
Clients often come to us when their TPD application has been denied. We start by reviewing your insurance cover in full. This includes definitions, retraining clauses, etc. Then, we explore all avenues for appealing or disputing the decision.
Get your FREE claim check or call 03 9966 7188 for FREE today. TPD Compensation Lawyers serve clients in Melbourne and throughout Victoria.