Facing Total & Permanent Disability
Facing a total and permanent disability (TPD) is life-altering. It brings significant physical, emotional, and financial challenges. During such times, having TPD insurance and understanding your rights and entitlement to claim benefits can provide essential financial security for you and your family.
This article provides general information only. You should obtain professional advice relevant to your circumstances. If you are considering making a TPD claim, we recommend seeking legal advice. A lawyer can assess your eligibility, help gather the necessary evidence, file your claim correctly, and negotiate with the insurer on your behalf.
What is Total & Permanent Disability?
Total and permanent disability generally refers to a condition that prevents someone from returning to work or engaging in any gainful employment for which they are reasonably qualified by education, training, or experience. TPD can arise from various illnesses and injuries, such as serious medical conditions like cancer, heart disease, or mental health disorders, or severe accidents resulting in permanent impairment, including spinal cord injuries or traumatic brain injuries.
Types of TPD Insurance
In Australia, TPD insurance is generally obtained through:
- Superannuation: many superannuation funds include TPD insurance as part of their default cover.
- Private insurance: individuals can purchase standalone TPD insurance policies from private insurers.
TPD insurance provides a lump sum payment if you can no longer work in your usual occupation or another type of employment suited to your qualifications, experience, and training. Carefully review your policy to understand eligibility requirements and any exclusions. Note that TPD cover through your superannuation fund may end if you change funds, stop contributions, or reach a certain age.
Eligibility for TPD Benefits
Eligibility criteria vary depending on the policy or superannuation fund. Some general requirements typically apply:
- Definition of TPD: the policy defines what constitutes TPD, often including inability to work in your occupation or any occupation for which you are reasonably suited.
- Waiting period: most policies require a waiting period (for example, six months) of continuous disability before you can claim.
- Medical evidence: you must provide comprehensive medical evidence from your treating doctors to support your claim.
The TPD Claim Process
Navigating a TPD claim can be complex and time-consuming. The general process includes:
- Notify your insurer or superannuation fund: inform them of your intention to make a TPD claim as soon as possible.
- Gather supporting documentation: collect medical reports, employment history, and any other relevant evidence.
- Complete the claim form: fill out the claim form accurately, providing all requested information.
- Assessment of your claim: the insurer or fund will assess your claim. They may request further medical examinations or interviews.
- Decision: you will receive a decision, which may be approved, denied, or require additional information.
Tips for a Successful TPD Claim
Following these tips can increase your chances of a successful outcome:
- Seek professional advice: a compensation lawyer specialising in TPD claims can guide you, ensure procedural compliance, and advocate on your behalf.
- Be organised: keep all documents and correspondence in one place. Consider asking a trusted family member or friend to assist.
- Be thorough: provide detailed evidence to support your claim.
- Be patient: the assessment process takes time, so remain persistent.
- Don’t give up: if denied, you may have the right to appeal. Seek professional advice to explore your options.
How a Compensation Lawyer Can Help
A compensation lawyer can be invaluable during a TPD claim. They can:
- Assess eligibility: review your policy and medical evidence to confirm TPD benefit eligibility.
- Gather evidence: help collect and organise all necessary documentation. Lawyers often have access to medical and professional networks to assist with evidence preparation.
- Liaise with the insurer: lawyers communicate with insurers or superannuation funds on your behalf, ensuring your rights are protected and documents are lodged on time.
- Negotiate a fair settlement: assess approved claims to ensure they reflect the full impact of your disability on future earnings.
- Represent you at the Australian Financial Complaints Authority (AFCA): help lodge complaints regarding delays, miscalculations, or denial of claims.
- Represent you in court, if necessary.
Conclusion
Claiming TPD benefits can be complex and emotionally challenging. Understanding your rights, eligibility, and claim process is essential to securing your financial future. Seeking advice from a personal injury lawyer can strengthen your claim.
You don’t have to navigate this journey alone. Support and guidance are available. If you or someone you know needs more information or help, please call 02 6621 2481 or email [email protected].