TPD Claims – Total & Permanent Disability – Summary

‘TPD’ stands for Total and Permanent Disability. Most good superannuation funds include TPD insurance as part of the policy – you might not even know you are covered. A total and permanent disability claim entitles you to payment of a lump sum if you have suffered an injury or illness that prevents you from returning to work in the same capacity. Most personal injuries which impact your ability to work are caused by motor vehicle accidents, or workplace accidents. However even a slip and fall in a public place can cause serious injuries.

TPD insurance cover usually ranges from around $10,000 – $2,000,000. The coverage amount typically decreases as you get older. The cover is for current and future medical costs, to clear any debts that you’re not able to pay for anymore since you stopped work, and provides you with a source of income to replace the income you’re no longer receiving.

Your eligibility to make a TPD claim will depend on your specific superannuation policy, as decided by the insurer or super fund in question.

Some people have more than one active superannuation fund and can therefore have multiple TPD insurance policies. It is often possible to claim on more than one TPD policy.

The steps required to successfully claim TPD insurance depends on the super fund you are with, and whether or not your cover falls inside your super policy. The usual first step is to obtain independent medical evidence from the most suitable doctor(s) to prove your inability to perform your usual work duties.

You do not have to prove your injuries were caused by the fault of someone else.

Other Compensation Claims

Young man with broken leg at home. Using smartphone.

If your injuries are not permanent and you are eventually expected to return to work, you may still be entitled to receive weekly payments whilst you’re recovering if your superannuation policy includes income protection insurance.

Income protection provides regular payments to you if you are temporarily absent from work due to an injury or illness. We need to check with your superannuation fund to see if the policy contains terms providing for such temporary disability payments. These payments are usually a percentage of your usual wages and not a 100% income replacement. The terms may also contain other conditions about when such payments can be made and when they cease.

Some people also pay for private life insurance. In this case, these people can usually make an additional claim on the private policy as well as through their superannuation policy.

If you can prove your injuries were caused by the fault of someone else, you may have additional claims to make. The process depends on how exactly you were injured, such as:

You should seek legal advice to increase your chances of making a successful claim to receive the full range of benefits you are entitled to.

Frequently Asked Questions – TPD Claims

Do I have TPD insurance?
Finding out whether you can make a claim begins with a simple phone call to ROCHE Legal. You will discuss your situation directly with a lawyer who will tell you in plain English whether you have a claim or not. We can review your Superannuation policy and advise you whether you have TPD insurance. This advice is 100% free to you.

If you prefer to meet and discuss in person, you can call us to arrange a free initial appointment in one of our three offices.

Although, we understand that it isn’t always easy to travel or meet with a lawyer when there are other things on your mind following an accident. At your request, our lawyers are willing to travel to meet you in person. Strict time limits apply to making compensation claims, so our first priority is to make sure that you maintain your right to be fairly compensated – and not miss out just because you missed a deadline.

Will you run my TPD Claim No Win No Fee?
Yes. 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.

Who can I bring the claim against?

TPD claims are made to the insurer of your Superannuation Fund and, if applicable – your Life Insurance Company.

If fault can be shown, then an additional claim may be made against the party at fault. In this case, the insurer of that party will be responsible for any compensation payable under a court order or an agreed settlement.

What has to be proven for my TPD claim to be successful?
To be successful in your claim for TPD insurance, you need to prove that it is unlikely you can go back to your employment or any other that you are qualified for – due to your injury or illness.
Are there any important time limits to bring a claim?
Quite possibly. This depends upon the terms of the superannuation trust deed or policy. Some insurance funds place a time limit within which such claims can be made so it is critical that you get legal advice immediately.
How much compensation will I be paid?

This depends on the superannuation policy. You can find out your level of cover by contacting your superannuation fund and asking them for your Member Statement which should set out the details of the amount of cover you have under the policy for total and permanent disablement.

If your superannuation fund drags its feet or appears reluctant to provide you with assistance, contact us at ROCHE Legal and we can take it from there.

Who pays me the compensation?

If your TPD claim is approved, the insurer of the superannuation fund will make the payment directly to your super fund. It is then up to you as to how/when you withdraw the funds. You do not have to withdraw your TPD insurance sum in full immediately and can elect to keep it in your super fund to grow, or withdraw it in stages. We recommend seeking financial advice on how to minimise tax that may be payable on the compensation sum and not compromise any other benefits that may be available to you (such as Centrelink’s Jobseeker payment or Disability Support Pension).

How much do lawyers charge for TPD claims?

ROCHE Legal charge fixed fees for TPD Claims, and only if your claim is successful. We do not charge a percentage of your compensation amount. On average, our fixed fees typically work out to be around 10-15% of the TPD insurance value.

Your TPD insurance value is determined by the policy in your superannuation fund. Different superannuation funds have different TPD insurance values.

How long does a TPD claim take?
The Australian Financial Complaints Authority (AFCA) considers the timeframes set out by the Financial Services Council Life Insurance Code of Practice (‘the Code’) to be the minimum standard of accepted industry practice and expects insurers to meet them. Key timeframes in the Code include:
  • Making a decision on TPD claims within 6 months unless exceptional circumstances apply.
  • Making a decision within 10 business days of receiving all information necessary to assess the claim.
  • Providing updates on the claim process every 20 business days.
  • Replying to update requests within 10 business days.

If insurers don’t comply with these timeframes AFCA requires insurers to provide compelling reasons. AFCA also expects super funds to hold insurers to these timeframes – so your super fund is actually charged with assisting you with your claim against the TPD insurer.

If the insurer is not meeting the timeframes set out by the Code, you are entitled to raise a complaint to the insurer, your super fund, or AFCA.

We try to resolve claims for Total and Permanent Disability within 6 months from the time you consult us however we have experience making successful TPD claims within as little as 10 days from lodgement. On average, we complete TPD claims within 3 months.

Will my employer sack me if I make a TPD claim?

If you are worried that you might get fired if your employer finds out you are making a TPD claim, there is a strong chance that you do not qualify to make a TPD claim in the first place. However, there are some circumstances where you can remain employed so long as it is in a role that is substantially different to the job you have training and experience in.

There are laws against employers terminating employees for making insurance claims, so you should not be discriminated against for claiming on your policy.

Can I make a claim on behalf of the estate if the injured person passes away?

Yes. This is known as a dependency claim. TPD policies usually allow for dependency claims to be made in the event of death. The spouse or children who relied on the deceased may be able to make the claim. We can help you determine if there are any death benefits provided for in the deceased’s superannuation fund and in the event the deceased had any life insurance cover.

I'm on Workcover... Can I still make a TPD Claim?

Yes – If you were injured at work, chances are you have already applied for Workers’ Compensation through Workcover Queensland or another provider. If Workcover are paying you weekly benefits, you are still entitled to make a TPD claim at any time without impacting your payments.

What kind of injuries are covered by TPD insurance?

TPD insurance covers any kind of injury.

For example:

  • a fractured ankle from a motorcycle accident
  • a back injury from lifting something heavy at work
  • a neck injury from slipping over in a public place
  • a psychological injury from witnessing a traumatic event

It generally doesn’t matter who caused your injuries or how they occurred, so long as the injury is not minor in nature and wasn’t self inflicted. The injury must be serious enough that it impacts your ability to work.

An injury that is minor in nature is typically one that you are expected to make a full recovery from.

Do I need a lawyer to make a TPD claim?
Generally speaking, we don’t believe that everyone requires the assistance of a lawyer to make a successful TPD claim. However, we have seen injured clients who attempted to run their own claim without legal assistance have their claims rejected in circumstances where the claim should have been approved. It is important to complete the TPD claim forms properly and prepare the correct evidence at the right time. If a TPD claim is rejected, the applicant usually requires the assistance of a lawyer to get the claim back on track for reconsideration. In this case, the legal fees are substantially higher than if a lawyer was used in the first instance.

If you intend on making a TPD claim without the use of a lawyer, we recommend at very least you read our blog on how to win a TPD claim.