TOTAL & PERMANENT DISABILITY CLAIMS – KEY INSIGHTS FOR INJURED PEOPLE

If you’ve been seriously injured or have suffered a debilitating illness, your financial future may appear uncertain due to your inability to return to work.  Total and Permanent Disability (TPD) benefits, typically attached to a superannuation policy, offer people who have permanent injury and/or illness a financial lifeline to assist during what can be one of the most challenging times of their life. In this edition of the Advantage Legal ‘Compensation Insider’ series, we look at the importance of TPD insurance, its benefits and when people are entitled to make a claim.

UNDERSTANDING TPD

TPD insurance offers a financial safety net to people who are unable to return to their employment due to a permanent disability or illness. The benefits offered under a TPD insurance policy are typically paid in the form of a lump sum payout and vary in amount based on the policy that a person has taken out.

TPD insurance is not governed purely by legislation like other forms of compensation such as motor accident compensation and workers compensation, meaning that each policy is different. To be eligible to claim TPD benefits, a person needs to satisfy the particular criteria contained within their insurance policy.  This typically includes establishing that the disability or illness is permanent and will prevent the person from working in their usual occupation or other occupation that they are qualified for based on their education, training or experience.

It is important to note that the definition of total and permanent disability varies from policy to policy, meaning some superannuation companies will have stricter definitions than others.

HOW TO MAKE A TPD CLAIM

Before commencing a TPD claim, it will be critical to undertake some basic investigations to understand the number of policies you hold, who you are claiming against and the amount of cover you have available. You will also need to ensure that the injury or illness relevant to the claim in question prevents you from returning to your employment.

• Initially, you should review your financial records such as payslips or speak with your employer or financial advisor to determine which superannuation fund was current as at the date of the accident. If you have multiple employers or have changed jobs multiple times, you should also investigate whether you have more than one superannuation provider.

• Once you have identified the superannuation fund(s) that were current as at the date you ceased working, you should enquire whether TPD coverage was included.

• When you have identified all superannuation funds with TPD coverage, you need to request a copy of:
  
  • The financial benefit amount available under the policy.
  • The PDS.
  • The claim form.
  • Details of any medical or other evidence required to be submitted with the claim form. This may include a particular type of medical report or medical certificate, details of your employer etc.

• Once all of this information has been obtained, you can then commence the claim process.  The claim process will typically involve:
  
  • Reviewing the PDS to ensure that the injury or illness which is preventing you from returning to employment meets the definition and criteria specified in the policy.
  • Gathering all of the medical evidence required to substantiate the claim.
  • Completing the claim form and submitting it along with the medical evidence to the TPD insurer.
  • Answering any additional requests for information from the TPD insurer.

• In circumstances where you have more than one TPD policy, it will be necessary to undertake this process multiple times with different superannuation funds and their TPD insurer.

SHOULD I GET A LAWYER?

Accessing Total and Permanent Disability (TPD) benefits can be a complex process, requiring detailed medical evidence and a thorough understanding of the terms and conditions of a TPD insurance policy. A law firm can guide you through the process of filing a TPD claim, help you gather the required medical evidence, and navigate the complex legal requirements. They can also ensure that all necessary documentation is correctly completed and submitted, increasing your chances of having your TPD claim accepted and avoiding the possibility of it being denied by the insurer.

Beyond the legal aspects, a law firm can also provide support and guidance during what can be a very challenging time. They can help you understand what to expect throughout the process, providing reassurance and confidence. Remember that you are not alone, and there are resources and professionals ready to assist you on your journey towards recovery and financial stability.