Total and permanent disability (TPD) insurance provides financial support to anyone who has sustained life-changing health problems, illnesses or injuries that cause them to be unable to go back to their usual employment.
However, in many cases, a person can be deemed to be totally and permanently disabled but can later return to the job. Returning to work after an injury will depend on a range of factors including how severe your injury was, what type of injury you experienced, your employer’s return to work policy(1), and more.
With new therapies, rehabilitation techniques and medicines, symptoms may be controlled and lessened, which would allow a person to be free to either return to their job or retrain in another occupation that is less demanding on them.
This means you may still be able to work if you are totally and permanently disabled, but depending on your circumstances this may be in a different role or industry than you were employed in previously.
How to Interpret TPD and Returning to Work
There are many misconceptions around interpreting the term ‘TPD’ because there are many different insurance companies with specific and different definitions in their policies. Whether someone can return to their job after a TPD varies from claim to claim and depends on what their policy definitions state and their situation. To find out with absolute certainty whether you can return to your employment or not after your TPD claim, it’s always best to check with your lawyer who will know exactly how to interpret your insurance policy.
Still, here is a summary of some common grounds where definitions are similar and where a person must:
- Never work again doing their usual or own job or profession
- Never work again in areas of their training, education, and experience
- Have lost the use of their vision or two limbs
- Be unable to carry out their activities of daily living (ADL)
Our TPD lawyers at PK Simpson guide you through the complexities of returning to your job after a successful TPD claim and assist with answering questions, with some of the most commonly asked questions including:
- What is considered a total and permanent disability?
- How long can you be on workcover?
- Can you claim tpd more than once?
- What if I can’t return to work after injury at all?
Are you unable to your job due to injury or illness?
A variety of reasons can mean you are entitled to receive a TPD super benefit.
You’re in safe hands with PK Simpson.
We can help you receive the compensation you deserve.
Activities of Daily Living (ADL)
The definition of ADL varies with every different insurance company and there will be different requirements and wording in their TPD policies. However, the definition of ADL insurance that is commonly required is that you can’t do any two of the following without being helped by another person:
- Dressing;
- Showering/Bathing;
- Moving (walking, standing, getting into bed)
- Eating;
- Toileting
You won’t satisfy the definition of ADL if you can do the above things with, for instance, a walking frame, crutches, or modified toilet. If you do satisfy the definition of ADL, you might be able to go back to your usual job after a TPD claim without it affecting your benefit.
To get professional and accurate advice regarding your activities of daily living (ADL) insurance and TPD claims, we advise to come and speak to the expert Total Permanent Disability Insurance Lawyers at PK Simpson today.
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Own Occupation
To be classed as TPD under an ‘own-occupation’ definition, you have to discontinue working and not be able to return to your own occupation. In other words, if you aren’t able to return to work in your current occupation, you may be entitled to Total and Permanent Disability Own Occupation payouts.
For ‘own-occupation’ TPD claims, you would need a doctor or specialist to closely examine your condition and the kind of work you are required to do, plus supply medical evidence showing why you cannot function in your usual job due to your disability.
The main point in ‘own-occupation’ is the extent of disability defined in your insurance policy – the definition is flexible. This would take into account the type and severity of your injury sustained at your place of employment and your capacity to fulfil the tasks or duties required by your occupation.
Whether or not you can function in your occupation after TPD disbursement is something you must check with your lawyer before you make any lifestyle changes that might affect your benefit. Don’t be put off if you only have income protection insurance since TPD is likely covered in this kind of policy.
PK Simpson is the only personal injury law firm with a client services department who are dedicated, 100 per cent of the time, to making sure you are receiving the best service and are happy with the way we handle your claim or claims.
Any Occupation
If you have a permanent disability and you are unable to do your own job and can’t perform any occupation that is reasonably suitable for you considering your education, training and experience, you may qualify for a TPD benefit under this definition.
However, it is not as certain as the ‘own occupation’ definition. It’s been shown by legal precedents that when deciding if you’re ever likely to work again due to a disability, an insurance company can suggest that you may be able to function doing a wider range of jobs.
Some of these may be nothing like your previous occupation, but might suit your disability and TPD claim requirements. Thus, you may be eligible to be employed in other industries and fields through further education, experience, and training.
To put it in simpler terms, the difference between ‘own occupation’ and ‘any occupation’ TPD claims is ‘own occupation’ claims only take into account whether you’re unable to continue employment in your current occupation, whereas ‘any occupation’ claims involve also assessing your capacity in returning to work after disability or injury, but in other occupations.
Due to the complex nature of ‘own occupation’ and ‘any occupation’ claims, we advise you to get professional legal advice from our team of TPD specialist lawyers at PK Simpson.
Loss of Use of Limbs
Again, the wording and definitions will be different depending on your TPD insurance policy, but generally speaking, the following will apply and require that you have lost, or have lost the use of:
- Both arms; or
- Both legs; or
- One arm and one leg.
You might be able to go back to your job after a successful TPD claim without it affecting your claim or claims provided you fall into the above category.
The Process of Claiming TPD Insurance
Millions of people in Australia have superannuation accounts but many don’t realise their super fund includes TPD insurance cover which protects them in the event of an injury and/or illness, whatever the cause. If your TPD claim is successful, you will receive a lump-sum payment.
However, the process can be stressful and long because insurance companies need certainty that your disability is total and permanent before providing you with a lump sum. The exact process involved in making a claim is different for each super fund, but generally it goes like this:
- Contact your insurer
- Lodge your claim
- Wait for it to be assessed
- Respond to the result whether positive or negative
The least stressful way to deal with a TPD claim is to contact PK Simpson Lawyers who can help you through the whole process.
What’s Required to Have a TPD Claim Approved?
To increase your chances of success in having your TPD claim approved, it’s best to have expert TPD lawyers on your side who can help you provide as much clear information to your insurer as possible.
You will no doubt need to agree to medical examinations, rehabilitation or specialist consultations. It’s your duty also to disclose to your insurer any and all information that may be relevant to your claim’s outcome.
If you have TPD insurance and you’ve been injured or you have an illness that prevents you from working at your usual job, call PK Simpson for advice today to help you interpret your policy so you can make a claim and receive what you are entitled to receive. If you need help with your TPD claim, whether it’s been accepted or rejected, or if your insurance company has kept you waiting too long, get in touch with us. Where ever and however your injury happened, it is always worth talking to PK Simpson lawyers. Call now on 1300 757 467 or email enquiries@pksimpson.com.au.
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