One of the most fundamental questions we get is, ‘What is a TPD claim?’. Many Aussies are unaware they have this insurance cover, let alone how it can help if they are too sick or injured to go on working.
If you are wondering what a TPD claim is, you or someone you love is likely struggling with a disability. TPD Compensation Lawyers can evaluate your situation, review your insurance cover, and assist you with all aspects of the claims process.
Our firm serves clients in Melbourne and all of Victoria. Call 03 9966 7188 today for a FREE consultation.
What Does TPD Cover You For?
‘TPD’ stands for ‘Total and Permanent Disability’. It refers to a type of insurance that may be available through superannuation or purchased separately. Total and Permanent Disability insurance provides financial cover if you become unable to work due to a serious injury or illness.
A TPD claim is an application made to your insurer. You will need to prove you are eligible for a benefit according to the insurer’s definition of Total and Permanent Disability. If you meet the eligibility criteria, a one-off lump sum payment is made into your super account (or provided to you directly, if you have TPD cover through a policy of your own).
What Are the Conditions for a TPD Claim?
There are two principal conditions you will need to meet to obtain a TPD payout:
- First, you must show that the disability completely prevents you from working.
- Second, the insurance company needs to be reasonably certain that your condition will not improve, and you won’t be able to return to work.
Super insurers typically use the ‘Any Occupation’ definition of Total and Permanent Disability. This means that a claim will only be successful if it is shown that you can’t work any job for which you would otherwise be suited.
If you have TPD cover outside of super, the disability may be assessed according to ‘Own Occupation’ criteria. Under this definition, Total and Permanent Disability is evaluated solely based on your ability to perform your current job.
Read More: Any Occupation vs Own Occupation Cover
Finally, super funds and other insurance companies may assess disability without considering your capacity for work. Instead, they may use an ‘Activities of Daily Living’ standard that only pays if:
- You can’t perform several day-to-day tasks on your own. These may include eating and drinking, bathing, getting dressed, walking without assistance, etc.
AND - The condition is not likely to change.
‘Activities of Daily Living’ (ADL) is easily the most difficult definition to satisfy. Except in profound cases of disability, very few people meet the conditions for ADL. For people who would otherwise qualify for TPD, it closes a critical lifeline.
Insurance matters are complex, and insurers scrutinise claims to avoid making payouts—especially when a lot of money is involved. No matter what type of TPD insurance cover you have, we encourage you to seek legal guidance as soon as possible.
What Medical Conditions Qualify for TPD?
A wide range of conditions may qualify for Total and Permanent Disability. If you can’t work due to any of the following, you owe it to yourself to find out if you have a viable TPD claim:
- Chronic medical conditions and illnesses such as:
- Heart disease
- Cancer
- Arthritis
- Diabetes
- Autoimmune disorders
- Vision loss and blindness
- Permanent hearing loss
- Multiple sclerosis
- Parkinson’s disease and other neurological diseases
- Asthma and other respiratory illnesses
- Chronic pain
- Mental illnesses such as:
- Depression
- Anxiety
- Bipolar disorder
- Post-traumatic stress disorder
- And more
- Physical injuries such as:
- Repetitive motion injuries, including carpal tunnel syndrome
- Brain injuries
- Spinal injuries resulting in paralysis
- Burns
- Loss of a limb
- Nerve damage
The insurance policy won’t specify whether particular medical conditions are covered. If your doctors determine that you are totally and permanently disabled, this is the time to discuss your entitlement to TPD with a knowledgeable lawyer.
Read More: What Are the Most Common TPD Claims?
How Do I Apply?
Now that you know what a TPD claim is, it’s time to discuss the process of applying. The steps involved in making a claim include:
- Verifying your insurance cover through your super fund or another policy.
- Understanding the eligibility criteria for Total and Permanent Disability.
- Determining if you’ve met the waiting period (i.e., you’ve been unable to work for a minimum of 3 months).
- If necessary, attending additional medical appointments to obtain evidence of the disability.
- Completing the application form and providing all requested information.
Next comes the hard part: waiting. The insurance company will review the application with a fine-tooth comb. Often, they will ask for more information to aid them in making a decision. The review process typically takes 6 months, though more complicated claims can take longer.
A significant number of first-time TPD claims are rejected. Industry statistics show that acceptance rates amongst insurers vary from approximately 60–90%. Experienced TPD lawyers can appeal the rejection of your claim, as well as fight for more money if you get less than you deserve.
Read More: What to Do If Your TPD Claim Is Rejected
What Is the Average TPD Payout?
Once we’ve answered ‘what is a TPD claim?’, most people’s next question is how much their claim might be worth. We emphasise that the averages don’t matter. The compensation you are due depends on the available insurance cover, as well as the specifics of your situation.
Factors that can influence the value of a TPD payout include:
- Your age
- Work history
- The terms of your insurance policy, including how TPD is defined and the type of cover
- If you are covered by more than one TPD policy, you may have multiple entitlements.
- What type of work you did prior to disablement
- The seriousness of your injury or illness
- How long you’ve been unable to work
- Whether your condition is stable
How Much Is the Total & Permanent Disability Payout?
The best way to maximise (a) the likelihood that your claim is approved and (b) the payout you receive is to present compelling evidence of the disability. Unfortunately, claimants often don’t know what kinds of evidence they need and how to include it in a TPD application.
Qualified TPD lawyers can collect evidence on your behalf and ensure that your application is complete. If the insurer asks for additional information or there is a dispute, your lawyer can advocate for you.
What Do Lawyers Charge for TPD Claims?
You shouldn’t have to pay for legal services when you have no income. At TPD Compensation Lawyers, we have a No Win, No Fee policy.
Our clients pay nothing upfront, nor do they owe us fees while their claim is in progress. If you receive a TPD benefit, you are responsible for the cost of legal services, disbursements, and an uplift fee. In Victoria, uplift fees are limited to 25% of the cost of services rendered.
What Is a TPD Claim? Get the Information You Need!
People with a disability often don’t know where to turn. Total and Permanent Disability insurance can provide critical financial support, but obtaining a benefit isn’t easy. With TPD Compensation Lawyers, you can expect the highest standards of legal service and knowledgeable handling of your claim.