TPD Claim Process
What Is the Process for TPD Claims?
The TPD claim process can be difficult to navigate on your own.
Superannuation insurers for TPD claims do not make it easy, and claims are often initially rejected. In addition to understanding the process of making a Total and Permanent Disability (TPD) claim, it is also crucial to know when to seek an experienced legal firm.
Do not be intimidated by the TPD claim process and, especially, do not give up because the insurance company has denied your claim. TPD Compensation Lawyers can help with all aspects of your claim, from lodging the initial application and getting it accepted to ensuring that you receive the maximum payout you deserve.
For information on the steps involved in the TPD claims process, click the links below:
- Understand Your Insurance Cover
- Make Sure the Policy Is Valid
- Speak to a Lawyer
- Determine Your Eligibility
- Undergo Medical Assessments
- Complete and Submit the Application
- Wait for the Insurance Company’s Decision
- Review the Decision
- Appeal (If Necessary)
- Get Your TPD Payout
Call TPD Compensation Lawyers at 03 9966 7188 today if you need help navigating the TPD claim process. Your consultation is FREE, and you pay nothing until we obtain a favourable outcome on your behalf.
The Steps of Lodging a TPD Claim
Total and Permanent Disability insurance is managed by private insurance companies. It is usually included as part of superannuation cover—sometimes automatically—through an employer or an individual policy.
Unlike with public compensation schemes, there is no standardised procedure for claiming TPD. Each insurer is slightly different, which means the process of lodging a claim depends on the policies of each insurance company.
Broadly speaking, however, the TPD claim process involves the following steps:
1. Understand Your Insurance Cover
The first step of the process consists of understanding the insurance coverage available to you. Many Australians do not know they have TPD cover through their superannuation policy.
If you suffer an injury or develop an illness that prevents you from working, it is crucial to know all of the options available to help you cover your expenses, pay for medical care, etc. This may include Income Protection Insurance as well as Total and Permanent Disability—both are generally included in superannuation insurance.
On your annual member’s statement are provisions for how much super is in your account as well as whether there is any insurance, be it income protection and/or Total and Permanent Disability. Such policies may provide you and your family with desperately needed income.
If you are unsure as to what the Member’s Statement says, you can contact the superfund and ask. Please note our lawyers can also provide expert assistance.
2. Make Sure the Policy Is Valid
Before applying for TPD, you need to confirm that the insurance cover is still active. For example, you may have lost TPD insurance cover if you closed the fund or transferred the fund to another superfund.
TPD insurance is considered valid if the policy is in effect when the claimant’s Total and Permanent Disability begins. We can identify the point at which your incapacity for work began and assess what insurance cover was in place at this time.
3. Speak to a Lawyer
No one relishes the thought of dealing with insurance companies. As such, even the first few steps of the TPD claim process can be intimidating.
We strongly suggest you contact TPD Compensation Lawyers as soon as possible for qualified assistance. You will find that hiring a lawyer is beneficial for each and every one of the steps involved.
4. Determine Your Eligibility
The definition of Total and Permanent Disability should be specified in the insurance policy. You will need to meet the criteria to qualify for a TPD payout. Furthermore, you will need to satisfy the waiting period for TPD cover to become available; most insurers require claimants to be unable to work or care for themselves for a minimum of 3–6 months.
Insurance jargon can be difficult for the average person to understand. There is no shame in asking for help from a lawyer specialising in these matters. At TPD Compensation Lawyers, we review your claim for FREE and fully explore your eligibility under the terms of the insurance cover.
5. Undergo Medical Assessments
Your entitlement to TPD compensation depends in large part on how well documented the disability is. Once you understand how the insurance company defines Total and Permanent Disability, you may need to get additional medical evaluations from your GP and/or a specialist.
Read More: What Are the Most Common TPD Claims?
With our knowledge of the TPD claim process, TPD Compensation Lawyers can advise you of any additional medical evidence that may be needed for your application. In addition, we can review your medical records and any reports from your doctors to determine whether the language used will meet the insurer’s eligibility requirements.
6. Complete and Submit the Application
Pay close attention to what the insurer asks for when lodging a TPD claim. If you are unsure what to include and/or the TPD claim process is not clearly laid out for you, our lawyers can help.
Generally speaking, the following items should be included in an application for Total and Permanent Disability cover:
- The TPD application form: This is the primary form you’ll need to fill out to initiate your TPD claim. It typically asks for personal information and details about your disability. You will also be asked to authorise the insurance company to access your medical records.
- Medical reports: You will need to include a minimum of two statements from different doctors involved in your care. The first is a statement from your attending doctor certifying that you are totally and permanently disqualified from work or the ‘activities of daily living’. The second is usually a statement from a specialist concerning the specifics of your diagnosis, treatment, and incapacity for employment.
- Results from laboratory tests, imaging, and other diagnostic procedures: Additional documentation of your condition and symptoms can help prove that you have a Total and Permanent Disability and support your entitlement to TPD.
- Employment verification: You may need to provide documentation to verify your employment status. This may include a letter from your employer and other relevant employment records.
- Financial documents: Payslips and tax returns document your income prior to disability.
Lack of evidence is the #1 reason for delays in the TPD claim process. The best way to avoid frustration on your end and delays or even rejection on the part of the insurer is to submit a complete, thorough application upfront with all of the requested information and documents.
7. Wait for the Insurance Company’s Decision
The wait may seem interminable when your financial future is in the hands of someone else. Although you can follow up with the insurance claims assessor to check on the status of your application, you should expect the insurer to take their time.
Read More: How Long Does a TPD Claim Take?
You may be asked for additional information to aid the insurance company in making a decision. In some cases, the insurer may require you to undergo one or more additional medical assessments. Aggravating as it might be, it is important to comply with the insurer’s requests. Failure to do so can prolong the review process and may even lead to your claim being rejected.
8. Review the Decision
Once a decision is made, the insurance company will contact you in writing. Either your application will be approved, or it will be rejected.
If your application is approved, the insurer should specify the amount of the Total and Permanent Disability benefit you will receive. TPD Compensation Lawyers can review the entitlement to ensure that the payout is fair based on your specific situation and the terms of your super policy.
9. Appeal (If Necessary)
When it comes to the TPD claim process, rejection of your application is the worst-case scenario. Fortunately, you have the right to appeal the decision if you believe the insurer denied your claim in error.
An appeal should be made as soon as possible. TPD Compensation Lawyers will review the insurer’s decision, compile any necessary documentation and other evidence to prepare a strong dispute, and guide you through the appeals process.
Read More: What to Do If Your TPD Claim Is Rejected
10. Get Your TPD Payout
If your application is approved or the insurer reverses its decision on appeal, the TPD entitlement should be paid shortly thereafter. Most superfunds pay Total and Permanent Disability benefits as a one-time lump sum.
How Do You Successfully Claim TPD?
Many people describe the TPD claim process as an uphill battle. Applicants often face lengthy delays, repeated requests for more information from the insurer, and rejection of their claims when all is said and done.
There is no guarantee of success when lodging a claim for TPD. However, following these steps will generally improve the likelihood of your claim being approved:
- Read your insurance policy carefully to understand the eligibility criteria, definitions of disability, and the process for making a TPD claim.
- Collect any and all medical records, test results, and other documentation before you apply.
- Fill out all required forms accurately and thoroughly. Provide clear and concise information about your Total and Permanent Disability and its impact on your ability to work.
- Include all supporting documents with your claim, such as medical records, physician statements, employment verification, etc. Make copies of everything for your records.
- Consult a specialist lawyer who can help you navigate the process, ensure that you meet all the requirements, and assist with the application.
Every TPD claim presents unique challenges. That is because disability affects everyone differently. What doesn’t change is the fact that super insurers have an obligation to provide compensation to covered individuals who meet the definition of Total and Permanent Disability.
At TPD Compensation Lawyers, our sole focus is helping claimants get their maximum entitlement. Whether you are exploring your right to disability benefits or your application has been rejected, our firm is ready to assist you.
Get Help Navigating the TPD Claim Process
Total and Permanent Disability insurance is a critical lifeline for people who are no longer able to work due to a serious illness or injury. Unfortunately, the TPD claim process can be complex and burdensome for claimants to take on themselves.
People often hesitate to talk to a lawyer because they are concerned about cost. TPD Compensation Lawyers represents clients on a No Win, No Fee basis. No matter the course of your claim, you don’t owe us legal fees or disbursements unless we achieve a positive result.
For a FREE consultation, call TPD Compensation Lawyers at 03 9966 7188 today. We are well-versed in the TPD claim process throughout Australia.