As a general rule, a lump sum TPD payout is only awarded once it is determined that an illness or injury completely precludes you from work. In effect, the name of the benefit says it all: Total and Permanent Disability. In most instances, super insurers will only pay up if the disability is complete (i.e., total) and permanent (i.e., you are not expected to recover to a point where you will be able to resume employment).
However, medical advances happen regularly. What’s more, the terms of TPD insurance cover may allow a return to work in some capacity.
Total and Permanent Disability claims are complicated. You shouldn’t have to worry about how returning to work might affect your lump sum TPD payout.
Call TPD Compensation Lawyers at 03 9966 7188 if you have questions or concerns. We handle your claim on a No Win, No Fee basis.
How Is the Capacity to Work Determined in a TPD Claim?
TPD cover pays a one-time lump sum if you meet the definition of Total and Permanent Disability. Insurers define TPD in one of two different ways, both centred on your capacity to work:
Own Occupation
Under ‘own occupation’ cover, you are entitled to a TPD benefit if the disability prevents you from working in the occupation you currently hold. For example, a carpenter who loses the use of his hand would likely qualify for Total and Permanent Disability.
‘Own occupation’ cover should only take into account whether the claimant can return to his current occupation. It is conceivable that a disabled worker who qualifies for the TPD benefit under an ‘own occupation’ policy could take up a new profession or work in a different role in the same field.
Any Occupation
Being the policy favoured by super funds, ‘any occupation’ cover is more common than ‘own occupation’. The insurer will compare your education, training, and skills to the medical evidence of your disability. Under ‘any occupation’ cover, a TPD lump sum payout will only be awarded if it is determined that you cannot (a) work in your current occupation, AND (b) your skills are not transferable and/or you cannot be retrained for another occupation.
What If I Am Able to Return to Work?
Most people who are disabled would gladly go back to work if their health and/or physical capabilities improved. New medications, treatments, therapies, and assistive technologies have made it possible for some people with disabilities to enjoy enormous improvements in their day-to-day lives—including the opportunity for employment.
If you start a new medication or try a new therapy that improves your health, it may be worth talking to your doctor about the potential to re-enter the workforce. You should also speak with a specialist lawyer to gain a full understanding of the insurance policy if you were previously awarded a lump sum TPD payout.
Do I Have to Return TPD If I Go Back to Work?
Generally, no. The super insurer is typically not entitled to repayment of the TPD benefit if you are able to return to work through retraining or improvement in your condition.
A lump sum TPD payout is made one time, and the funds are provided in full. Once the matter is settled, both the claimant and the insurer sign an agreement finalising the claim. This usually precludes reimbursement, as well as any further legal action (unless fraud is discovered).
Some people put their TPD money towards education and training that enables them to start a new career. Others, meanwhile, are able to resume work by focussing on their recovery and exploring innovative treatment options. These are the exceptions, however. As a rule, TPD payments are only awarded when the insurer is confident that the applicant will not be able to work again.
Maximise Your Lump Sum TPD Payout
For people with a Total and Permanent Disability, going back to work is a distant consideration. But hope springs eternal. A survey by one superannuation insurance company found that more than 35% of successful TPD claimants eventually returned to work in some capacity.
While such a number may seem encouraging, insurers take notice of these statistics, too. Realising that a substantial portion of people applying for TPD may one day return to work could factor into the high rate of denials for TPD claims. It may also result in changes to how TPD insurance policies are structured.
You need qualified legal guidance when lodging a Total and Permanent Disability claim. It is also important to understand how your lump sum TPD payout may be affected if you are able to resume employment in some capacity.
Contact a Specialist Lawyer Today
At TPD Compensation Lawyers, we have an in-depth understanding of how insurers operate and what is required to make a successful claim. With our No Win, No Fee agreement, you pay nothing unless we achieve a favourable outcome on your behalf.