Total and Permanent Disability Definition

What Is the Definition of Total and Permanent Disability?

Each insurer uses a different Total and Permanent Disability definition. If you are unable to work as a result of an illness or injury, understanding the definition of Total and Permanent Disability (TPD) is crucial for evaluating whether you are entitled to a lump sum payment.

Insurance companies don’t make it easy to claim the TPD benefit. TPD Compensation Lawyers have the expertise to determine if your situation meets the Total and Permanent Disability definition used by your superfund insurer.

For a FREE consultation, call TPD Compensation Lawyers at 03 9966 7188 today. Our expert lawyers serve clients throughout Australia.

What Is Total and Permanent Disability Insurance?

Total and Permanent Disability insurance provides cover in the event that an illness or accident makes it so you can no longer continue with your employment. Superannuation insurance policies generally include TPD cover by default.

Insurance through your superfund acts as a ‘safety net’ for individuals who become incapacitated and cannot work. The cover may include income protection insurance in the short-term, as well as TPD if the disability is permanent.

The TPD benefit is paid as a one-time lump sum. Money from the payout can be used for a variety of purposes, including:

Medical care such as surgery, rehabilitation, therapy, etc.
Home and vehicle modifications
Assistive devices and equipment
Household services and attendant care
Travelling for medical treatment
Paying off outstanding bills and debts
Replenishing your savings after the loss of income

Most people have TPD cover through their employer’s superfund insurance, although individual policies can be purchased as well. Unfortunately, around 50% of Australians who are of working age don’t know that they have cover through their superfund.

What Is Classed as Total and Permanent Disability?

Generally speaking, you may have a viable TPD claim if you suffer an injury or illness that (a) prevents you from working now, AND (b) will keep you from returning to employment in the future. Ultimately, however, you will need to meet the definition of Total and Permanent Disability imposed by your superannuation cover to claim a TPD entitlement.

Superfund insurers categorise Total and Permanent Disability in one of three ways:

Own Occupation

The most helpful definition of Total and Permanent Disability is found in TPD insurance policies with ‘own occupation’ cover. Under ‘own occupation’ cover, you are considered disabled if you can no longer work in the occupation you had prior to disability.

Any Occupation

Under ‘any occupation’ cover, the Total and Permanent Disability definition is met if you are unable to work any job that matches your education, training, and experience. This is a more difficult threshold to meet. Before making a payout, the superfund insurer will closely scrutinise the applicant’s condition to determine if there is any other suitable form of employment.

Activities of Daily Living

Recently, some Australian superfund insurers have begun writing policies with an even more restrictive definition of TPD. Known as ‘activities of daily living’, this cover will only pay if it is established that the applicant can no longer perform tasks such as bathing, feeding themselves, dressing themselves, etc.

What Are Examples of Total and Permanent Disability?

Because the definition of TPD varies from insurer to insurer, it can be difficult to say with certainty whether a particular injury or illness will be considered a Total and Permanent Disability. However, there are certain conditions that generally qualify for TPD. Examples include:

Cancer
Heart attack
Stroke
Arthritis
Depression and other psychological conditions
Multiple sclerosis
Brain injuries
Spinal injuries
Vision loss
Hearing loss
Autoimmune disorders
Respiratory diseases

If you have one of these conditions and it is keeping you from work, it’s worthwhile to explore your entitlement to a TPD benefit. TPD Compensation Lawyers have experience managing a wide range of claims on behalf of individuals who are seriously ill, suffered life-altering injuries in accidents, and more.

Do I Meet the Total and Permanent Disability Definition?

When lodging a TPD claim, you need to show that your condition meets the criteria set forth by the superfund insurer. Our lawyers will closely review the wording of the insurance policy to understand how disability is defined.

Next, we will evaluate your medical records to determine if the available evidence is likely to satisfy the insurer. Claims are often initially rejected for insufficient proof of disability. The best way to overcome this obstacle and expedite the approval of your claim is to ensure that the disability is fully documented in terms the insurer will accept.

What is considered a Total & Permanent Disability? | TPD Compensation Lawyers

As a rule, your capacity for work is at the heart of the Total and Permanent Disability definition. Insurers may use a few different terms when defining TPD in the context of work capacity:

‘Unlikely Ever’

If the policy states that an individual is considered Totally and Permanently Disabled if they are ‘unlikely ever’ to return to work, you must show that the probability of you resuming work is extremely unlikely. While you do not have to be 100% disqualified from work to satisfy this definition, the insurer is unlikely to pay TPD compensation unless your likelihood of returning to work is almost nil.

‘Unable Ever’

Where Total and Permanent Disability is only recognised if the individual is ‘unable ever’ to resume some aspect of their employment, it must be conclusively determined that incapacity is 100% and will not change. Policies that use the ‘unable ever’ threshold usually state that TPD applies when the individual cannot perform one or more aspects of an occupation; you do not have to be unable to do every aspect of a job to qualify for TPD.

Retraining

Your entitlement to a TPD benefit may be contingent on whether the insurer believes you could return to gainful employment with the proper retraining. The retraining proposed by the insurer must be reasonable based on the limitations you face.

If your TPD claim is rejected for not meeting the Total and Permanent Disability definition, it may be possible to challenge the insurance company’s decision. Our knowledgeable lawyers can appeal your claim promptly and provide compelling support for your entitlement to TPD compensation.

Additional medical examinations and testimony from experts may be needed to prove that you meet the definition of TPD. We will collect all of the evidence necessary to get your claim approved and maximise your benefit.

Find Out If You Are Entitled to TPD

TPD Compensation Lawyers have more than 40 years of experience helping clients through the complexities of the insurance process. With our No Win, No Fee policy, you don’t pay any fees until we obtain a favourable outcome.

Unsure if you or a member of your family meets the Total and Permanent Disability definition? TPD Compensation Lawyers can help! Call 03 9966 7188 today for a FREE consultation.