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How To Win A TPD Claim

If you’ve found this article, chances are you already know that many superannuation funds contain an insurance policy for total and permanent disability (TPD). These policies, often worth $100,000’s, can be claimed on if you experience a personal injury or disability which prevents you from being able to return to work. Understanding the TPD claim process and requirements is fundamental to winning your TPD Claim.

When it comes to TPD insurance, each superannuation fund’s insurer has their own policy requirements – so, prior to spending any time or money on a TPD claim, we recommend that you read the fine print first to understand the criteria you must meet to be eligible for the pay out. However, most of the time, the insurer requires the applicant to have not worked for a period of time and to be able to provide specific evidence to prove that they are permanently and totally incapacitated. 

If you have more than one superannuation fund, it is possible that you therefore hold more than one TPD policy with different insurers. If this is the case, be sure to read each policy to ascertain whether you can or cannot claim on the multiple policies at one time. 

Starting Your TPD Application

To begin your TPD application process, you must first obtain the relevant TPD application forms from your superannuation fund. Superannuation funds do not make this easy – you generally cannot download the forms from their website – you must specifically ask for the forms.

Once the correct TPD forms have been obtained, you should notice that statements are required to be completed by:

  • yourself (as the applicant);
  • your previous or most recent employer; and
  • your treating medical provider(s) (typically your GP, but sometimes your psychologist). 

Sometimes the insurer may require and additional medical specialist opinion to confirm that you are unlikely ever to be able to work again in a job for which you are qualified by education, training or experience. 

If you have an ongoing civil personal injury claim regarding your injuries, we do not recommend making a TPD claim at the same time unless your lawyer has advised you to do so or runs it for you. If you make your own TPD claim without telling your lawyer, not only do you run the risk of breaching your agreement with your lawyer running your concurrent claim, you could potentially derail both of your claims inadvertently.

The more information you can provide the insurer at the commencement of your TPD claim, the quicker the claim process will be.

TPD Eligibility & Requirements

Not all superannuation funds come with TPD insurance. So it’s important to first ascertain whether your superannuation fund holds, or more importantly, held TPD cover at the time of your injury/incapacity. You may even have an old superannuation fund that you’ve forgotten about that has a TPD policy. You can perform a “Find My Super” search through the ATO website, or ask Roche Legal to assist you. 

Once you have determined whether your superannuation fund has TPD insurance, the terms and conditions of claiming on the insurance policy must be read in detail to understand your eligibility to claim and the particular policy’s requirements. Each TPD policy can have a different definition of what ‘total permanent disability’ means so it is possible to meet the definition of TPD for one policy, but not another.

The most common definitions of total and permanent disablement allowing an injured person to make a claim TPD insurance is that the applicant is either:

  • unable to return to work for which you are suitably qualified by education, training or experience; or
  • unable to return to any form of employment.

Many TPD insurance policies also have time limits to make a claim. It is important to review the policy to identify the limitation period to make sure your claim is made “in time”. 

Your Medical and Occupational History

Your full medical and occupational history is required to be presented to the TPD insurer to help explain why you cannot meet the physical or mental demands of your usual occupation. Typically, a history of any injuries or illnesses you have suffered in the past is required to be provided. Your list of past injuries and illnesses should be comprehensive and including anything as minor as temporary childhood asthma to more serious psychiatric or physical injuries sustained in traumatic events such as a car accident.

Your full occupational and educational history will usually need to be presented to your doctor so that they can form an opinion as to whether you can no longer work in any capacity which you are qualified by education, training or experience.

Important Evidence to Obtain for Your TPD Claim

If you are now suffering from a new permanent physical injury or psychiatric condition, you would almost certainly have been attending upon medical specialists for treatment. It’s important that you consult with your regular treating practitioners to let them know you are considering making a TPD claim to gauge whether they would be supportive of your claim and would agree that your condition meets the relevant definition for TPD. 

If you have a concurrent claim relating to your injuries (for example, if you were injured in a motor vehicle accident, workplace accident, or public liability claim scenario), your personal injury lawyer would already be taking steps to help you obtain the best and most relevant evidence to support your injuries. If you do not have a concurrent civil personal injury claim, your TPD lawyer will be able to guide you as to which medical specialist is best to review your injuries to confirm the extent of your disability. 

Medical evidence is best presented to the TPD insurer in a form that is short and sweet. Most of the time, TPD insurers provide you with their own short-form TPD medical certificates to be completed by your medical practitioners. Once the TPD medical certificates are completed, never submit them to the insurer without first reading and understanding the certificates provided to you. You may not always be issued with a certificate that satisfies the relevant definition of TPD and if you submit an unsupportive certificate, your claim may get rejected.

If your injuries or illnesses are complex, perhaps in a scenario where you have more than one condition or your work history is sporadic, inconsistent, or largely varied, it could be beneficial to obtain independent reports from specialists rather than your usual doctor. Whilst specialist reports are often expensive, they can be the best way to convince your ordinary medical providers that your injuries totally and permanently disable you in an employment sense.

Evidence of your occupational and educational history is also required. Usually, TPD insurers will accept a short statement or form from you which attaches your must current resume/CV.

Your previous employer will also have to submit an ‘Employer Statement’ to confirm that you were employed by them at the time you were injured and the date which you ceased working. If you have a concurrent workers compensation claim where you are effectively suing your previous employer, obtaining the Employer Statement can be very difficult. In such circumstances, you can request that the insurer seeks the statement directly from your employer.

Injured in an Accident?

If you were injured in a motor vehicle accident, workplace accident, or from a slip or fall in a public/private place, you may have an additional claim to make on top of your TPD claim. In these circumstances, we strongly recommend consulting a personal injury lawyer to minimise the risk that the evidence obtained in the course of either of your claims does not negatively impact the other prospects of success in your other claim claim.

Submissions to Accompany Your TPD Application

Now this is what it all comes down to – the submissions. A successful TPD application should never simply rely on submitting a completed TPD claim form along with medical and occupational evidence. Insurers decisions on whether to pay out on your TPD claim are made much easier when they fully understand your story and new set of circumstances.

You can accompany your TPD application with any additional document or statement you wish. A good personal injury lawyer will accompany your application with a written submission outlining in detail your pain, suffering, history, injuries, illnesses, employment and everything in between.

Your lawyer will elaborate on your work history and the severity of your medical condition(s) preventing you from returning to work. Whether your disablement is due to a physical or psychiatric condition, your lawyer will explain the circumstances of the injury, the medical intervention or rehabilitation assistance you have undergone, and the unfortunate debilitating consequences you continue to suffer because of your condition.

A good TPD lawyer will also review your entire medical history to locate and extract important records that include comments made by your previous doctor’s about your incapacity for employment. Appropriately quoting your doctors or highlighting relevant records to the insurer can provide your insurer with additional medical opinions to help convince them to pay out on your TPD claim.

A decision on your TPD claim is usually made in around 3 to 6 months from when your lawyer submits your claim. If you submit your own claim, it can take much longer than this.

Summary

In summary, a winning TPD claim requires that you:

  1. Identify whether you have TPD insurance and obtain the correct claim forms
  2. Review the TPD policy / policies to understand the eligibility requirements
  3. Complete the required claim forms with your medical and occupational history and obtain the additional medical evidence required
  4. Compose a detailed submissions including additional supporting evidence as to why you satisfy the relevant definition of total and permanent disablement

Your chances of winning a TPD claim are enhanced significantly by engaging a lawyer to complete the application on your behalf. 

Roche Legal offers No Win No Fee representation to everyone with a qualifying TPD claim. Contact us for a free initial consultation. We have offices in Brisbane, Springwood, and the Sunshine Coast.

Our firm has never been unsuccessful in claiming TPD insurance for our clients. Our success rate is 100%. You pay nothing up front, and if we are not successful in claiming compensation through your policy, you will not be charged a cent.

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About the Author:

This post was authored by one of the Solicitors at ROCHE Legal. Should you have any questions, please contact our office.
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