Total and Permanent Disability (TPD) claims can be complex and confusing for many people who have been injured in an accident or who are suffering from a debilitating illness. In this edition of the Advantage Legal ‘Compensation Insider’ series, we explore the four common misconceptions about TPD claims and why seeking expert legal advice is a crucial step to ensuring your claim succeeds.
MISCONCEPTION ONE – TPD COVERAGE IS LIMITED TO ACCIDENTS
One of the most common misconceptions about TPD insurance is that it only relates to injuries. The reality however is that TPD insurance coverage extends beyond injuries and includes a wide array of illnesses and conditions. These may include, but are not limited to chronic disease, mental health disorders and degenerative conditions. A TPD policy will typically respond when an individual’s ability to work and perform daily activities has been permanently compromised. The cause of the injury, disability or illness is usually of less significance.
MISCONCEPTION TWO – YOU CAN’T CLAIM COMPENSATION TWICE
Another misconception about TPD insurance is that if a person has already received compensation for an injury from a statutory compensation scheme such as the NSW workers compensation scheme or from the NSW motor accident injury scheme (CTP) there is no entitlement to pursue a TPD claim because it would result in ‘double compensation’. In the vast majority of circumstances, a TPD policy will provide a payout even if compensation has already been paid under a statutory compensation scheme, provided the TPD policy criteria has been met.
MISCONCEPTION THREE – YOU CAN ONLY CLAIM ON ONE TPD POLICY
A further misconception is that a person can only claim on one TPD policy, even if multiple policies exist. Quite often, people forget to consolidate their superannuation entitlements into a single superannuation fund after changing jobs. Some people may also actively elect to make payments into more than one superannuation fund. What ever the reason, if a person has more than one active superannuation fund, an active TPD policy is often attached. Under such circumstances, multiple claims can be lodged, providing the policy wording permits it and the policy criteria is met.
MISCONCEPTION FOUR – THE CLAIMS PROCESS IS SIMPLE
The final most common misconception is that the TPD claim process is simple and can be done directly with the insurer without legal assistance. TPD claims require an analysis of TPD policy documentation and satisfaction of the policy criteria in order to be successful. These documents have been deliberately worded to ensure that benefits are only paid in very specific circumstances. A TPD claim needs to be supported by specific and detailed medical evidence which substantiates the injury or illness preventing them from returning to work. Claims are regularly denied due to inconsistent or incorrect medical evidence being provided to an insurer. So, in our experience, TPD claims are rarely simple and often require considerable experience in policy and medical evidence interpretation.
SHOULD I GET A LAWYER?
Lawyers provide a very important function in the TPD claim process. They are familiar with the intricacies of TPD policy wording and provide valuable assistance to people who can ill afford for a TPD claim to fail. Lawyers can interpret policy definitions, provide timely advice on entitlements and obtain the relevant evidence required to ensure that the claim succeeds. Most importantly however, lawyers act as an advocate for the person pursuing the TPD entitlement. This means that the lawyer will also take on the burden and stress associated with pursuing the claim, allowing the sick or injured person to focus on their treatment.
THE KEY POINTS TO REMEMBER
- A TPD policy will typically respond when an individual’s ability to work has been permanently compromised. The cause of the injury, disability or illness is usually of less significance.
- You can typically pursue a TPD claim in addition to other personal injury claims like workers compensation and motor accident injury claims (CTP).
- It is possible to claim on more than one TPD policy provided you have active policies and meet the policy criteria.
- TPD claims are more complicated than what they appear. Seeking expert legal assistance is recommended to give yourself the best possible chance of succeeding with your claim.
NEED ASSISTANCE?
Advantage Legal’s Principal Solicitors are Accredited Specialists in NSW personal injury law and are the Exclusive Compensation Legal Partner of Bicycle NSW. We offer no-win, no-fee billing and guide you through every step of the compensation claim process including working with treatment and rehabilitation providers to fully understand how your injuries are impacting you. We also pay your upfront claim investigation fees such as specialist medical reports to ensure there is no financial burden on you throughout the progression of your claim, and only seek reimbursement at the successful conclusion of your claim.
This article is for educational purposes only and should not be relied upon as legal or financial advice. Readers should be aware that compensation law and policy documentation changes regularly and may impact the accuracy of the information contained within this article, which is current as at 1 March 2024. Any person relying on the information contained within this article does so at their own risk.