Can I work after my TPD claim has been accepted?

‘Total and permanent disability’ (TPD) insurance is an insurance product that lets you claim benefits if you become sick or injured (or both) and are unable to work as a result. What you might not know is that you can still make a successful TPD claim even if you still have capacity to do some form of work. If you can no longer work in your current job or occupation, being able to receive TPD benefits will be an important part of ensuring your financial wellbeing. This blog provides practical information on what you need to know.

My TPD claim has been accepted. Does this mean I’m not allowed to work again?

Every insurer and TPD policy is different. This includes how ‘total and permanent disability’ is defined, and the limitations this places on you in terms of working after your claim has been accepted. However, ‘TPD’ is usually defined to mean that that:

1. you must not ever work again within your education, training and experience,

2. you must not ever work again within your usual or own occupation,

3. you must be unable to do your activities of daily living, or

4. you must lose the use of two limbs or your vision.

Some policies use only one of the above ‘definitions’ while others apply two or more. While the detail of your particular policy will require close review, it is possible to make a successful TPD claim without being required to cease all kinds of work all together. In addition to helping to pay the bills, we understand that for many of our clients, having the option of working in some capacity provides important social and health benefits.

Let Littles help. We can do a free super claims check and review your policy to see what it allows. Know where you stand today.

My TPD policy uses the phrase “education, training and experience”. What does this mean?

The majority of TPD policies require that you must stop working due to illness or injury and be permanently unable to work within your “education, training or experience”. This is a very important phrase to understand. Put briefly, it describes work that you can do without having to be retrained or without further education. Accordingly, if you have stopped work in your current field because of illness or injury and you can’t do any other job without retraining or further education, you may be able to make a successful TPD claim. For example, a boilermaker who is no longer able to work in that capacity (for example, conducting welding work on a mine site)but can return to work as a site workplace health and safety advisor after conducting retraining may still be entitled to a TPD benefit.

Again, every insurer and every policy is different. Your individual circumstances will be important. Generally:

  • you must cease work entirely for at least the waiting period set out in the TPD policy, and
  • while there is no hard and fast rule, retraining or further education will generally involve at least an AQF certificate. Courts have upheld insurers’ decisions to refuse TPD claims on the basis that a person was not temporarily or permanently disabled because they were able to work in a different role without ‘significant’ additional retraining or further education, or that they can return to work in a new area based on their ‘transferrable skills’.

We understand that if you cannot work in your chosen occupation, being told by your insurer that you may be ineligible for TPD insurance because they think that you that you could work in an unfamiliar field can be daunting. Let Littles help. We are TPD experts, and can assist if your insurer has rejected or is delaying your claim, and provide advice on all of the options available to you.

My TPD policy uses the phrase “own occupation”. What does this mean?

Every insurer and TPD policy is different. Some TPD policies use the phrase “own occupation” in the definition of TPD. This means that in order to have a total and permanent disability, you must cease work and not be able to return to work in your own occupation (for example, a boilermaker returning to work as a boilermaker). In order to make a successful TPD claim, you would need to show medical evidence from your GP and a specialist doctor based on a close examination of your “own occupation” duties as to why you can no longer perform those duties. If you can establish this, you may be able to make a successful TPD claim and return to a new or different role.

Let Littles help. We can do a free super claim check, and review the details of your policy so that you know where you stand.

My TPD policy uses the phrase “activities of daily living”. What does this mean?

Every insurer and TPD policy is different. Where a TPD policy uses the phrase “activities of daily living” in the TPD definition, it usually requires that to have a total and permanent disability, you must be unable to do any two of the following activities without the assistance of another person:

  •  bathing
  • ·eating
  • ·dressing
  • moving (e.g. walking), and/or
  •  toileting

Your individual circumstances will be important. For example, if you are unable to do any two of the following activities without the use of an aid, such as a walking frame or modified shower or bath, you may not satisfy the definition. However, if you rely on a carer to assist with moving or eating, you may be able to make a successful TPD claim and still return to work.

My TPD claim uses the phrase “loss of limbs”. What does this mean?

Every insurer and TPD policy is different. Where a TPD policy uses the phrase “loss of limbs” in the definition of TPD, it usually requires that to have a total and permanent disability, you must have lost the use of

  •  both legs, or
  • ·both arms, or
  • ·one leg and one arm, or
  • the sight in one or both eyes.

If you have suffered the loss of limbs, or lost of use of your limbs or sight, you may be able to make a successful TPD claim and be able to return to work.

Let Littles help. We can do a free super claim check, and review the details of your policy so that you know where you stand.

I can not work in my own occupation, but my insurer has rejected my claim based on the “loss of limbs” definition. What can I do?

This can happen. The terms of your TPD policy may be open to interpretation, and insurers are likely to interpret those terms in their favour! For example, some policies may use different definitions of TPD depending on how many hours you work. If you work fewer hours, the policy may allow the insurer to apply a more onerous definition of TPD – such as the “loss of limbs” definition.

Let Littles help. We are TPD experts and can provide legal advice on whether the insurer has assessed your claim correctly. 

Don’t delay – seek advice now

If you have an illness or injury that prevents you from working, you might be worrying about how you are going to pay your bills and put food on the table. You could be entitled to receive a TPD lump sum, as well as other insurance benefits. Get in touch with Littles for a free super claims check. We can help you understand what you’re entitled to. Know where you stand, and get peace of mind.

Free advice and no upfront fees

Not only do we offer a FREE claims check – we handle most insurance claims on a no win, no fee basis. 

Our Head of TPD and General Insurance, Rowan McDonald, is an insurance law expert. If you think you might have a claim, get in touch with Rowan and his team for high quality legal advice.

Contact us.

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