TPD FAQs: What do I need to disclose under my TPD policy?

TPD FAQs: What do I need to disclose under my TPD policy?

Total and permanent disability (TPD) insurance can be an important source of income if you are unable to work because of illness or injury. Across Australia, people are paying for TPD insurance through the hard-earned money in their super funds. However, many of our clients are completely unaware they’re covered by insurance in their superannuation fund, let alone what they’re entitled to claim. What’s worse is that thousands of Australians who have gone to claim on their TPD insurance at their time of need struggle to access benefits paid for by their super. Sometimes, this is because they are unaware of what they were required to disclose under their insurance policies, and exclusion that apply as a result.

Is your insurer pushing back on your claim? Littles can help. We are TPD experts, and can help you push back against insurers. Want to know how having high quality lawyers on your side can make all the difference to your TPD claim? Find out more here.

What is a TPD claim?

TPD claim entitles you to payment of a lump sum if you have suffered an injury or illness that leaves you unable to return to work in the same capacity. This payment can fund your current and future medical costs, clear any debts you may have accrued, and provides you with a lump sum to help restore your quality of life as much as possible. Depending on your personal circumstances, you may be able to continue to work in a different capacity. You can be eligible to make a TPD claim whether you have a mental or physical illness or injury, including a chronic illness. Some are even able to claim against more than one insurance policy. If you want to know what you’re entitled to, Littles can perform a FREE super claims check.

What are my disclosure obligations?

When applying for standalone TPD cover, you must disclose any relevant information to the insurer to allow them to appropriately assess the level of cover and cost of premiums.

If you fail to disclose any information later to be determined as relevant when you make a claim, the insurer may refuse to accept the claim. Further, if you fail to provide relevant information and the insurer is later informed of the failure, even in the absence of making a claim, the insurer may terminate the policy all together.

Disability caused by certain medical conditions can be excluded from TPD policies, particularly if you have suffered the condition in the past. Most commonly, exclusions for prior mental health conditions or complications resulting from underlying conditions such as diabetes, high blood pressure or other chronic diseases may result in a claim being denied.

Similarly, any disability or permanent condition caused by intentional self-harm will generally not be covered by TPD insurance.

Does your job involve high risk work? The insurer may place certain exclusions on your policy, particularly if the injury or illness was caused by your employment. In addition, injuries arising from “dangerous” hobbies may be excluded by the policy.

For tailored advice you should speak with your insurance broker to find out what insurance product is best suited to you.

The insurers playbook – delay and deny!

In a nutshell, insurers work by delaying and denying claims. They work on the basis that the harder it is to pursue a TPD claim, the less likely it is that you’ll persist with it. We don’t think that’s good enough. Too many Australians needing urgent financial assistance and medical treatment are having to do battle with their insurers to access the TPD insurance benefits they are entitled to, while insurers seem to put all their effort into delaying claims, denying access to TPD benefits and offering inadequate TPD payment amounts. It’s bad enough that many Australians have seen their super be eaten away by administrative fees – but we think putting you through the ringer when you’re worried about putting food on the table is going too far.

It can be heartbreaking if you’ve done everything the insurer asked for – filled out the forms, provided the documents, attended the medical appointments – only to receive a paltry offer, or for your claim to be rejected entirely. There are a range of reasons for this vary. Insurers can ‘cherry pick’ from medical evidence, or rely on outdated medical definitions to deny valid claims. Or the insurer will say that you did not get sick or injured and become unable to work, and assess your claim under a more onerous TPD definition.

At Littles, we’re on your side. Getting high quality legal advice before you make a claim can ensure the process runs smoothly from the start. But even if you’ve already commenced your claim, don’t worry – we can still assist. We manage all communication with the insurer on your behalf, so that you can concentrate on the things that matter – getting well, and planning for the future.

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.

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