Your TPD claim FAQs – answered (Part 1)

Our TPD experts have put some of our most frequently asked TPD questions in one handy document. Given it’s there to support you if you are unable to work because you’re ill or injured, it’s worth getting across. Let us know if it comes in handy! There are so many ins and outs to the process, so watch this space for Part 2.

What is TPD insurance?

TPD insurance is an insurance product that lets you claim benefits if you become sick or injured (or both) and unable to work again as a result – regardless of what caused the injury or illness. Most people will have TPD benefits available through their superannuation fund – they just don’t know it! If you cannot work because of injury or illness, being able to receive TPD benefits will be an important part of ensuring your financial wellbeing.

Does my TPD insurance cover mental illnesses and disorders?

Yes! Unfortunately, there’s still a way to go in recognising the impacts of mental illness and conditions on people, especially in their ability to work. The insurance industry needs to do better when it comes to recognising the importance of mental health. However, while TPD insurance claims for mental illness and conditions are harder, they are possible. If you have sought and obtained regular treatment from your GP and a mental health professional, such as a psychologist or a psychiatrist, you can likely make a successful claim. What matters is that you can no longer work due to your illness or condition. There is greater recognition now of different kinds of mental illnesses and how they affect people. This means that you might be able to make a TPD claim if you are suffering:

· depression

· anxiety

· bi-polar disorder

· post traumatic stress disorder (PTSD)

· schizophrenia

· schizoaffective disorder

· borderline personality disorder

· obsessive-compulsive disorder

or a number of other mental illnesses or mental health conditions.

We know that some government programs and other insurance products provide different frameworks and criteria for eligibility. These might require an assessment of your level of ‘whole person impairment’. Even if you have been refused eligibility for disability support benefits or workers compensation, you should consider making a TPD claim.

Income protection or salary continuance benefits

Some superannuation funds have weekly or monthly payments if you can’t perform your normal work duties for a temporary period of time. These are called salary continuance or income protection payments. Typically, payments can be up to 75 percent of your wage plus super and may be able to be paid for up to 2 years. You may even have benefits payable to age 65. However, you’ll often have a waiting period of up to three months, meaning it can take a while before your payments actually start. Income protection payments can stop if your employment is terminated, if you are paid out a TPD benefit, or if you receive a common law lump sum payment of compensation.

What is the process?

Check out our 5 step guide to making a successful TPD claim here! Many of us already have a lot of different kinds of insurance – be it health insurance, home and contents insurance, income protection insurance – and we’re comfortable making insurance claims without any assistance, dealing directly with the insurer. However, TPD claims are more complex. As a consequence, we’ve seen TPD claims rejected by insurers, even where it is an eligible claim that should have been approved. Given the high stakes that are often involved, including the future financial wellbeing of your family, people often decide to enlist the help of expert TPD lawyers to manage their claim.


The key steps to making a claim are:


· check your super fund to see if it has TPD insurance. If you have more than one super fund, and they all have TPD insurance, you may be eligible to make more than one claim!


· check which policies were in place at the time the illness or injury started


· check and understand your insurance policy criteria. Each super fund and insurance policy is different, and this includes key definitions and eligibility requirements


· put your best foot forward and prepare a thorough application, including all records needed to substantiate your claim, and · follow the dispute process if your claim is rejected.

Why is my TPD claim taking so long?

It can take insurers some time to make a decision on your claim – anywhere from three to 12 months. We know that this can be frustrating if you’ve already had to hold off on submitting your claim form due to lengthy waiting periods. There are a number of factors that affect how fast, or how slowly, an insurer processes your TPD claim. The key one will be the length of time it takes for them to gather the relevant information and documentation they need to assess your claim and make a decision. They may also ask for you to attend an interview with an investigator. We get that this kind of behaviour can be frustrating. If you are unhappy with how your insurer has handled your claim, you can complain directly to the insurer, or to the industry regulator, the Australian Financial Complaints Authority. Before making a complaint, you should consider seeking legal advice. Let Littles help. We are TPD experts, and can communicate directly with the insurance company and help to speed up the assessment of your claim. We will focus on communicating with the insurer, so that you can focus on your health.

How much is the TPD benefit?

The amount of the benefit that you can claim depends on your super fund’s policy and your own personal circumstances. Again, it is very important to read the fine print in your policy. Many people who cease work due to sickness or injury look at their superannuation statement or insurance schedule at the time that they are claiming and assume that this is the amount of the TPD benefit that they will be paid if they win their TPD claim. This is incorrect. The amount that you are paid if your TPD claim is successful is worked out based on the level of insurance cover when you last worked. Changes in the amount of your insurance cover after you finish working are unlikely to change the amount that you will be entitled to if you get sick or injured and make a successful claim.If your claim is accepted by the superannuation fund and insurer, you will usually be paid the full amount which you are insured for at the time that you cease work. It is very rare for a superannuation fund or insurer to make an offer to pay you an amount less than the insured amount. However


· some funds may pay the amount in instalments, rather than a lump sum, or vice versa, and


· some funds pay only a percentage of the insurance benefit if you cease work and will only pay the remaining percentage if you satisfy a more difficult test.


As you can see, decisions of insurers and super funds based on the fine print in your insurance policy can make a major difference to whether you make a successful claim, and the benefit that you are paid. Don’t assume that the insurer or super fund is always right! Littles can help you push back against insurers that are deploying loopholes and technical legal definitions against you.

Do I need a lawyer to make a TPD claim?

It depends who you ask! While insurers say that the system designed for people to manage their own claims, there’s little regulation to ensure unrepresented claimants aren’t mistreated. We’ve seen many clients struggle with the convoluted superannuation claims process, and complex legalese in their insurance policies. If you’re unable to work due to serious injury or illness, you probably want to focus on getting well and looking after your family – you don’t want to spend your time filling out complicated paperwork and providing evidence to support a superannuation insurance claim. he right lawyer can streamline the superannuation claims process, and make your life easier. But remember – not all lawyers are created equal. If you’re going to consult a lawyer, consult an insurance law expert. At Littles, that’s what we are

Don’t delay – seek advice now

Do you have an injury or illness that prevents you from working, or just want to know more about what insurance you have under your super? 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 fee

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.

Please note that this information is intended to provide general guidance only. You should not act or refrain from acting on the basis of such information. Appropriate professional advice should be sought based upon your individual circumstances. For further information, please contact Littles. 

Like? Share it with your friends.

Contact the Author

Topics

More Articles

新州工傷賠償:什麼是獨立醫療檢查 Independent Medical Examination(“IME”)?

獨立醫療檢查 Independent Medical Examination (“IME”) 是由具有適當資格和經驗的醫生進行的醫學評估,以幫助解決工傷賠償管理中的問題。  保險公司可以安排 IME 來確定:   • 診斷   • 工傷是怎麼發生的  • 治療原因和是否合理必要   • 建議療程  • 公傷前工作能力和工時  • 恢復的可能性和時間範圍  • 其他合適的工作職責和能力   • 工傷引起的喪失能力   • 身體能力和任何必須避免的活動   • 評估您的永久性損傷程度 (“Whole...

Read More