Successful TPD Insurance Claims: 3 Steps You Must Take When Claiming
Should you need to claim on your total permanent disability (TPD) insurance, then it’s crucial that you fully comprehend the conditions that apply. For successful TPD claims, it’s vital that claimants meet the exact eligibility criteria required by their particular policies. While all insurance and superannuation policies will have different requirements, case studies show some of the more common reasons claimants fail the eligibility tests include:
Failing to meet the required disability level
Failing to satisfy minimum wait times
Failing to fulfil requirements around work history
The best advice is to read your policy carefully, and if you have any questions about your total and permanent disability superannuation claim, contact your provider or a law firm’s Superannuation experts. The process can be long and arduous unless you take the necessary steps.
For over 38 years, the PK Simpson law firm has been helping the people of Australia win the TPD payout to which they are entitled. PK Simpson lawyers have the skills and experience to make sure you are successful in your TPD claim.
Ensure that you fully understand the reasons why TPD claims can be disputed.
Check your policy or have an expert check it to make sure you’re eligible to make a claim.
Follow the right steps to claim. This will be dependent upon whether your TPD is a standalone policy or is included in your Superannuation fund.
If you are going through the difficulties that come after the death or total and permanent disability of a member of your family, Superannuation and disability insurance benefits may help to ease your financial burden. At PK Simpson, our TPD Claim lawyers can help to make sure you win the maximum lump sum payout under your benefit.
Understand Why Your TPD Claim Might Be Disputed
One of the primary reasons many TPD claims are disputed stems from the fact that the definitions between the different insurers are so varied. Also, there is no standard definition of TPD. Examples of variations include:
Long wait times
Before you receive any payments, your policy might require you to wait for up to three months.
Your policy might specify that you receive ongoing advice from a specialist or that you have a rehabilitation program in place.
Your policy could exclude you from receiving a TPD payout if you have pre-existing medical problems.
Check if You’re Eligible to Claim
Being crystal clear about what your policy requires is of the utmost importance for a successful TPD claim. You also need to be clear about the definition under which you policy falls, so there are no disappointments or nasty surprises after you claim. Providing you satisfy the conditions set out in the policy you have with your insurer or your Superannuation fund you can make a TPD claim. This will typically involve proving you can no longer work. Insurers will usually rely on the following criteria when they assess a TPD claim. Remember, the requirements set by the different insurers usually varies greatly.
Level of Disablement: You will most likely need to prove you suffer from a minimum degree of disablement which will often consider your ability to go back to your previous job, or ever to work again.
Your Superannuation Fund: Whether you can lodge a claim will depend on whether TPD cover is part of your Superannuation policy.
Wait Times: Before you lodge a TPD claim, there will possibly be a stipulation in your policy that you wait for a certain period after your injury so your symptoms can stabilise and the full extent of damage can be ascertained.
Your Employment History – Before you are eligible to claim a TPD payout your policy could require that you have had a minimum level of work in the form of weekly hours or total length of employment.
Follow the Appropriate Steps to Claim TPD
Making a claim from a standalone TPD insurance policy is similar to claiming TPD from your Superannuation; however, there are some differences in the claim processes. While every claim process will be different, depending on your insurer and the type of claim, it is generally the case that the following steps should be taken:
Call Your Insurer’s Claims Department: You will need to get the proper forms, and it’s advisable to let your lawyer help you to fill them out correctly.
Prepare the Documentation: This includes the completed claim forms, a statement from a certified doctor or specialist to verify your injury or illness, whether physical or mental, details of other health claims, plus your bank details for your benefits to be deposited.
Submit Claim Forms and Documents: Makes certain you have every document and all the information required by your insurer to avoid any unnecessary delays.
PK Simpson prides itself on being a firm that takes on any case relating to compensation, including TPD, whether it’s big or small. Call us today on 1300 757 467 or enquire online now so we can help you.
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 email@example.com