TPD, or Total and Permanent Disability, is a lump sum payment that you may receive from your superannuation fund insurance if you have suffered an injury or illness that affects your ability to return to your usual job. There are two types of TPD insurance cover, so you need to know which one you have before you can make a claim. There is a process you will have to go through and a time frame in which to make your claim for TPD.
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Types of TPD Policies
Own occupation:
This insurance policy provides a definition of TPD as satisfied if you cannot perform in your own occupation. An example would be a mechanic with a spinal injury. However, the mechanic might be able to do another type of job that doesn’t require the same physical effort.
Any occupation:
This policy covers you if you are deemed unfit to work in your usual occupation for up to six months, and if you are unlikely to ever be able to work in any job that you are trained, educated and experienced to do.
Our experienced TPD lawyers are old hands at processing super or other insurance TPD claims and we’ll take on the stress, keeping you in the loop about your case at all times.
The TPD Insurance Claims Process
TPD claims processing is often different from the usual personal injury claims. The differences are in the entitlements available as stated in the contract you have with your superannuation fund or insurance company.
The crucial factors in the contract generally refer to the time frame in which a TPD claim can be made, the entitlements or benefits payable, and the definition of the TPD, which differs with each of the policies.
The claims process is usually as follows:
- Definition and time limits: Our lawyers will review your insurance contract before filing your claim to make sure the medical evidence meets the TPD definition and that any possible mandatory time frames are met (depends on your policy).
- Gather evidence and make the claim: This involves medico-legal expert reports to support your TPD claim. These reports should establish that your claim has met the criteria in your insurance policy.
- Considering the insurance company’s response: Insurance companies generally want TPD claims assessed by their medico-legal experts. This will be in your contract. After the doctors examine you and send their report back to the insurer, the insurance company will either accept or decline your TPD claim.
- What if the insurer rejects the TPD claim? In this case, you should allow PK Simpson to try to dispute the decision in either a court or the Superannuation Complaints Tribunal. You will have two years in which to make a complaint to the Tribunal, and the legal proceedings must commence within six years of your insurer denying liability.
Let PK Simpson specialist TPD lawyers handle the application, any time frame issues and the process of making your claim so you need not stress.
Your experience with your superannuation fund can be hassle-free with PK Simpson TPD Claim Lawyers on your side.
The TPD Time Frame
The time frame for lodging a TPD claim after your injury or illness, most allow years, but some policies or superannuation fund rules require claims to be made before you cease your employment and others want claims made within a specified period your employment ends.
Superannuation funds and insurers are usually not legally bound to make TPD decisions within a certain time frame. The time it takes to deal with your case will depend on your TPD superannuation insurance claim type. This means it could be resolved in a matter of weeks or up to 18 months or longer.
The TPD claim time frame and processing also depends on the severity of your injury or illness. Once we’ve submitted your initial claim forms, you are likely to need to have at least one independent medico-legal examination. You could also be asked to supply more evidence, like specialist reports. TPD claim decisions usually arrive within 12 to 18 months after the claim forms have been lodged.
At PK Simpsons, we are experts at winning TPD benefits for our clients in NSW. Bring your matter to us so we can get the ball rolling as soon as possible. Once we understand your situation we can give you a more accurate estimate of the TPD time frame and process. As mentioned, should your claim be denied, you have two years to dispute the decision and make a complaint to the Superannuation Complaints Tribunal and six years to mount a legal case.
Call us at PK Simpson on 1300 358 057, fax: (02) 92624497, email enquiries@pksimpson.com.au. You can also fill in the online form and we’ll contact you.
Frequently Asked Questions
Yes, you can. If you’re diagnosed with a serious cancer that has an impact on your ability to work, you may not realise you are entitled to claim insurance benefits through the insurance provided through your superannuation. These benefits may include income protection if your disablement is temporary, and TPD if your condition is long-term and serious. If your condition is terminal, you will be eligible for a terminal illness payment.
Yes, you can. People are now becoming more aware of depression and other mental illnesses, and while there’s a way to go before the stigma is lifted, we’re talking about it more often. Around one in four Australians suffer from a mental illness each year. However, insurers are wary of mental illness disability claims, and it can be quite hard to get cover. But what many people fail to recognise is that the automatic TPD insurance you have through your superannuation fund can pay out much-needed benefits and funds if you cannot work due to depression or any other mental illness.
Mental illness can often be a lingering side effect of a physical injury, even after full physical recovery.
Yes, you can have multiple TPD claims providing your insurance policies or super funds are independent of each other. Bear in mind that, unlike other personal injury claims, when you make a TPD claim, you do not have to prove that the illness or injury was work-related or caused by somebody else.
A successful TPD claim can never be 100 per cent guaranteed, but you are much more likely to win your claim if you contact a TPD specialist lawyer at PK Simpson to discuss your situation. There is a minimum level of evidence required to support your claim, which must be provided to your insurer and your super fund. This includes your claim form, a signed authority, certified ID, and two medical reports from your treating doctors showing that you can never return to work. These will need to be reviewed by a lawyer to ensure all the correct boxes are ticked, and that the evidence strongly supports your claim for TPD.
Often, terms and conditions specific to your policy need to be analysed in order to make sure the fund cannot decline your claim.
Superannuation funds will often require specialist reports. Superfunds do not pay for treatment throughout the claims process. However, PK Simpson pay for all medical reports needed to support your claim.
Most claims are paid out and finalised within three to six months, but it all depends on how complicated the claim is, and how much good evidence you have about your injuries. There is also the matter of whether you fulfil all the criteria set by your insurer. This is why it’s crucial to have a specialist TPD team on your side when you make a claim for TPD for any reason.
As lawyers we will make sure your claim is assessed by the superfund in a timely manner. Delay tactics are deployed by funds to prolong and frustrate TPD claimants who are not legally represented.
If you haven’t been able to work in your usual job for three to six months due to an injury or illness, you are likely to be classed as TPD.
Each superfund has their own TPD definition and this must be satisfied for the TPD claim to be approved. Common factors which are assessed in each claim are the members work history (education, training and experience), suitable jobs, and medical evidence.
Your TPD entitlements are set out in the contract (a.k.a. policy, or product disclosure document) you have with your insurer. Therefore, the definition of TPD will vary between policies and insurers.
If you or anybody you know has ceased work due to illness or injury and they cannot return for at least six months they could be eligible to claim TPD benefits. Call PK Simpson specialist TPD lawyers today on 1300 358 057 or email inquiries@pksimpson.com.au