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Making a TPD claim –  a Comprehensive Guide

October 21, 2020

 

What is TPD?

In the case you have suffered a permanent and severe disability there can be a profound effect on you physically, emotionally and financially. The majority of superannuation funds provide Total and Permanent Disability (“TPD”) cover and subject to criteria being met, you may be entitled to receive a lump sum.

TPD definitions vary from policy to policy. However, if you have suffered an injury or condition which prevents you from working in any capacity for which you are suited then you may be entitled to a TPD benefit under your superannuation policy.

Importantly, it doesn’t matter whether your disability has been caused by a work injury, accident, hereditary disease or condition.   Even if your injury / condition arose in the past, you can still qualify for a TPD payment.

Do I have TPD cover?

If you’ve recently been employed then it is a legal requirement for your employer to have paid superannuation contributions on your behalf. You simply need to contact your superannuation fund to find out if you have cover for TPD. You can also refer to your fund’s product disclosure statement (PDS) which may be available on their website or your annual member’s statement.

If you haven’t worked for some time and cannot recall the applicable superannuation fund you can contact the Australian Taxation Office (ATO) to request details of what superannuation has been paid in the past.

It also pays to check with the applicable superannuation fund if you have cover for income protection, salary continuance or temporary disability benefits. These types of payments are often paid for up to two years.

In the case that you don’t have TPD cover, you may be eligible to request an early release of your superannuation on medical or compassionate grounds.

Previous work injury or compensation claim?

Even if you have received workers compensation through the Return to Work (SA) scheme or damages from a motor vehicle accident or public liability claim you may still be eligible to pursue a TPD claim.

Waiting period

Under most superannuation policies there is a waiting period before the insurer of the superannuation fund considers your claim and makes a decision. This is often for between three and six months.

What is the TPD claim process?

Following the waiting period, the superannuation fund will seek information from you about your injury / condition, employment, general circumstances and medical evidence from your treating doctor(s). There will be claim forms to complete as well as medical attendant statement(s) which need to be completed by your treating doctor(s).

The superannuation fund will essentially be looking for evidence to support that your injury / condition prevents you from ever working again in employment for which you are suited. They will need to give due regard to your previous work experience and qualifications.

Whilst you can complete the relevant paperwork yourself and make a claim for a TPD benefit, the evidence you provide to the fund is critical in deciding whether or not your claim is accepted. It is not uncommon for funds to reject claims based on one piece of information or evidence provided by the claimant.

Therefore, it pays to have the assistance of an experienced lawyer to look over all of the evidence before submitting the claim to the fund.

It is also important to note that treating doctors who are asked to complete medical attendant statements often have little understanding of the criteria that you must meet in order for your claim to be successful.  If there is an error in the statement or if the information provided by the doctor fails to satisfy the TPD definition this can lead to your claim being denied.  

Can I make claims under multiple policies?

You can potentially make claims under multiple superannuation policies. However, it is important to seek legal advice before deciding how to go about making claims through the applicable superannuation funds. It also pays to seek financial advice about rolling over your superannuation into one policy.

Time Limits

There are no legislated time limits on making TPD claims. However, in the event your claim is rejected, there are time limits on making a complaint – see below.

What happens if my claim is denied?

It is possible to dispute the denial of a TPD benefit claim. The usual first step is to request an internal review with the applicable fund / insurer.

If an internal review fails then it may be possible to lodge a complaint with Australian Financial Complaints Authority (ACFA). There are time limits involved in making a complaint with ACFA.  For example, if you permanently ceased employment because of a physical or mental condition which gave rise to the TPD claim then you must have submitted a TPD claim to the relevant fund within two years of permanently creasing employment and you must make a complaint to AFCA within four years of the decision being made.

It is also possible to take your matter Court but it highly recommend to seek legal advice about your potential options.

Crescent Lawyers offer a Free Initial Appointment to provide an honest assessment of your TPD claim.  Further, there are no legal cost payable unless your claim is successful and you receive a TPD benefit.  Phone 8312 7055 or admin@crescentlawyers.com.au.

Free Initial Consultation to discuss matters involving Workplace Injury, Personal Injury, Wills & Grants of Probate.