If you have suffered an injury, illness or disability that stops you from going back to your job and doing what you did before, you could be eligible to claim a total and permanent disability (TPD) lump sum payment. This benefit can be used to fund your present and future medical bills and to pay off any debts that might have built up during your illness or injury. It can provide you with income to go towards returning your quality of life to an extent that is possible.

If you are unable to work due to illness or disability, most superannuation funds and insurance policies come with benefits to cover you if you can’t work or if you become ill or disabled. However, it can be a lengthy, stressful and complicated process to gain access to these benefits so you would be wise to consult a lawyer.

Am I Eligible?

Whether or not you are eligible to make a claim for TPD benefits will depend on your policy, and according to the requirements of your super fund or insurer. Insurers vary in what they require, however they have some requirements in common including:

  • The level of your disability – You will no doubt have to prove you have some level of disability before making your claim for TPD, and the insurer will take into consideration whether or not you can return to work, and if so, whether you can play the same role you did before your illness or injury occurred.
  • Your superannuation fund – You will need to find out either from your documentation or from your fund if TPD cover is included in your super policy, and obviously this will affect your ability to lodge a claim.
  • Waiting time – Most policies require you to wait for a certain time period after your injury or illness before lodging a claim so that all your symptoms and injuries can stabilise, allowing for a determination as to the full extent of your injuries and damage or the prognosis of your illness.
  • History of your employment – In some cases your insurance policy or super fund will require you to prove you have worked a minimum level of employment before you are eligible to seek a TPD payout. This is usually a number of weekly work-hours or the entire length of your employment.

Making a Claim

There are certain steps that must be taken in lodging a TPD claim successfully. This depends on your insurer, your super fund and your policy, and providing your cover is adequate to make such a claim. Be aware that the claim process can be long and arduous, so it is wise to seek proper legal advice from your lawyer to make sure you end up with the TPD benefits you are entitled to receive.

TPD Lawyers

At PK Simpson, our team of specialty lawyers are highly trained in the area of running TPD and Superannuation claims. Your first consultation is free and we’ll guide you through the process and explain our ‘no win, no fee’ basis, meaning you only pay legal fees if we are successful.

If you think you may be entitled to make a claim, or simply want more information call PK Simpson on (02) 9299 1424 for a chat. Or, email enquiries@pksimpson.com.au.

Frequently Asked Questions

If you haven’t been able to work in your usual job for three to six months due to an injury or illness, you are likely to be classed as TPD.

Each superfund has their own TPD definition and this must be satisfied for the TPD claim to be approved. Common factors which are assessed in each claim are the members work history (education, training and experience), suitable jobs, and medical evidence.

Your TPD entitlements are set out in the contract (a.k.a. policy, or product disclosure document) you have with your insurer. Therefore, the definition of TPD will vary between policies and insurers.

Yes, you can have multiple TPD claims providing your insurance policies or super funds are independent of each other. Bear in mind that, unlike other personal injury claims, when you make a TPD claim, you do not have to prove that the illness or injury was work-related or caused by somebody else.

A successful TPD claim can never be 100 per cent guaranteed, but you are much more likely to win your claim if you contact a TPD specialist lawyer at PK Simpson to discuss your situation. There is a minimum level of evidence required to support your claim, which must be provided to your insurer and your super fund. This includes your claim form, a signed authority, certified ID, and two medical reports from your treating doctors showing that you can never return to work. These will need to be reviewed by a lawyer to ensure all the correct boxes are ticked, and that the evidence strongly supports your claim for TPD.

Often, terms and conditions specific to your policy need to be analysed in order to make sure the fund cannot decline your claim.

Superannuation funds will often require specialist reports. Superfunds do not pay for treatment throughout the claims process. However, PK Simpson pay for all medical reports needed to support your claim.

Yes, you can. People are now becoming more aware of depression and other mental illnesses, and while there’s a way to go before the stigma is lifted, we’re talking about it more often. Around one in four Australians suffer from a mental illness each year. However, insurers are wary of mental illness disability claims, and it can be quite hard to get cover. But what many people fail to recognise is that the automatic TPD insurance you have through your superannuation fund can pay out much-needed benefits and funds if you cannot work due to depression or any other mental illness.

Mental illness can often be a lingering side effect of a physical injury, even after full physical recovery.

Most claims are paid out and finalised within three to six months, but it all depends on how complicated the claim is, and how much good evidence you have about your injuries. There is also the matter of whether you fulfil all the criteria set by your insurer. This is why it’s crucial to have a specialist TPD team on your side when you make a claim for TPD for any reason.

As lawyers we will make sure your claim is assessed by the superfund in a timely manner. Delay tactics are deployed by funds to prolong and frustrate TPD claimants who are not legally represented.

Yes, you can. If you’re diagnosed with a serious cancer that has an impact on your ability to work, you may not realise you are entitled to claim insurance benefits through the insurance provided through your superannuation. These benefits may include income protection if your disablement is temporary, and TPD if your condition is long-term and serious. If your condition is terminal, you will be eligible for a terminal illness payment.

If you or anybody you know has ceased work due to illness or injury and they cannot return for at least six months they could be eligible to claim TPD benefits. Call PK Simpson specialist TPD lawyers today on 1300 358 057 or email inquiries@pksimpson.com.au