What qualifies for TPD?

Rowan McDonald

Rowan McDonald

Head of TPD and General Insurance Claims | Canberra

No matter what stage of your career you are in, experiencing a sickness or accident that prevents you from working in your industry or at all can be a difficult life transition.  

Therefore, it should come as no surprise that many people opt to get permanent disability insurance, either through a super fund or directly from an insurance provider.  

Three different forms of insurance are often available to superannuation fund members: death insurance, income protection, and total and permanent disability (TPD) insurance. You might want to think about lodging a TPD claim if you have been injured or are dealing with a chronic condition that is affecting your capacity to work. 

What is TPD?

The fact that there is no one definition of TPD contributes significantly to the complexity of superannuation claims. Instead, each superannuation fund will establish its own definition of the word in its rules or trust agreements. Be cautious since the definition in any applicable group insurance contract to which you may be party may take precedence over the definition in your super policy.  

Reg 1.03C of the Superannuation Industry (Supervision) Regulations 1994 (Cth) offers the following definition of “permanent incapacity,” notwithstanding the lack of a standard definition:  

“…if a trustee of the fund is reasonably satisfied that the member’s ill-health (whether physical or mental) makes it unlikely that the member will engage in gainful employment for which the member is reasonably qualified by education, training or experience.” 

Superannuation funds are often required to align their TPD policies with this concept. 

What qualifies for TPD?

In super policies, TPD definitions often fall into one of two categories:  

You are unable to return to work in any occupation; or 

You are unable to return to work in your own occupation. 

The any occupation definition is the more common of the two. 

Additionally, it’s usual for super funds to demand that you be disabled for a minimum of six months. Some TPD definitions, especially those where you weren’t previously employed, will classify a member as permanently disabled if they are losing two or more limbs, have completely lost their vision, or are unable to perform basic daily tasks or work-related tasks like moving around, communicating, using their hands deftly, seeing clearly, lifting objects, etc.  

You can submit a TPD claim if you have a specific ailment such as a stroke, heartbreak, diabetes, pancreatic cancer, other cancers, heart disease, HIV/AIDS, or many other conditions. 

Some insurance companies place additional limitations on a determination of TPD and demand that a member participate in active medical care and rehabilitation for a predetermined period of time. 

How do I claim?

Know your rights. 

If you are yet to make a TPD claim, you are entitled to legal representation and Littles can help you. 

If you have already lodged a claim and it has been rejected by a superannuation fund or insurer, you may be entitled to have the decision reviewed through an internal resolution procedure. 

If your complaint has been upheld, you may be able to litigate in a court or lodge a complaint with the Australian Financial Complaints Authority (AFCA). 

There are strict time limits to challenge an insurer’s decision, so it’s important you seek legal advice as soon as possible. 

What is the Littles difference?

Put simply, Littles are experts in superannuation and insurance law matters. 

Our insurance team has helped thousands of consumers claim their entitlements, and our Head of TPD and General Insurance has extensive industry knowledge and insight on how to maximise your prospects of success. 

We also speak your language, at sixteen languages and counting.  Forget paying for a translator or for a lawyer who doesn’t understand you and your cultural background. 

All our superannuation and insurance law matters are conducted on a no win, no fee basis, and we don’t charge you upfront for any disbursements necessary to prosecute your claim.  

If you would like superannuation and insurance law advice, reach out to Littles today by using our free Claim Checker. 

About the author

Littles’ Head of TPD and General Insurance, Rowan McDonald, is an expert in insurance and superannuation law.  Rowan is an experienced litigator and has prosecuted thousands of successful insurance claims for consumers. 

Having worked in the insurance industry for over fifteen years, Rowan has an extensive industry contact list and regularly presents to disability support groups, financial industry professionals and multicultural organisations.

Rowan has also advised some of Australia’s top insurers, giving him unrivalled insight into the claim process from all perspectives.  Rowan takes a pragmatic and common-sense approach to the advice he provides his clients. 

For your free, personal consultation get in touch with Rowan today.  

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