Tyla Leo is a Litigation Lawyer and Senior Associate at O’SheaDyer Solicitors Townsville. She practices exclusively in Compensation Claims acting for Plaintiffs.
A TPD Claim is a ‘total and permanent disability’ claim. Often it is part of your superannuation, or you may have a specific insurance policy that covers you for total and permanent disability.
If you are unable to work due to an injury or illness and you have total and permanent disability insurance, you can make a claim to your insurance fund for a lump sum payment.
If you have had an injury or have been diagnosed with an illness and you can no longer do the type of work you have always been able to do – but you are able to work in a different occupation – if you have total and permanent disability insurance – you still may be able to make a claim.
Dates
The dates you are injured or diagnosed with an illness, and the date a doctor confirms that you are permanently impaired, are very important. They are important because they determine who the relevant insurer is and the extent of your insurance cover. Also – if relevant, these dates determine if an exclusion contained in the policy applies to you.
Dates can be very important. They may end up determining whether the application is initially accepted.
We always recommend you have a lawyer prepare your application/claim. This ensures dates (and information submitted with your application) are carefully considered.
The 5 Steps to Making a TPD Claim
These are the steps we follow when lodging a TPD (Total and Permanent Disability) claim for our clients.
Step 1: Call us
Call us so we can identify if you have TPD (Total and Permanent Disability) Insurance.
TPD Insurance can be held through your superannuation or as a separate policy outside of your super fund.
You can check whether you have TPD insurance by reviewing your annual statement or contacting your superannuation fund directly.
If you hold TPD insurance with more than one fund, we may be able to make multiple TPD claims.
Step 2: We read your policy
We need to consider the following: –
- Whether your insurance is still valid/was valid at the time of your injury/illness.
- Whether you meet the waiting period requirements.
- Whether you meet the work history requirements.
- Your age; and
- Any exclusion or eligibility clause in your TPD policy.
DATES ARE IMPORTANT
- The date you are diagnosed with an illness, and
- The date the doctor confirms you are permanently impaired is important.
These dates determine who the relevant insurer is and the extent of your insurance cover. Also, if relevant, these dates determine if an exclusion contained in the policy applies to you.
We will ask you for this information when we see you.
Step 3: We explain your entitlements and contact your insurer
We request the TPD claim documents from your insurer.
Insurance companies can be quite uncooperative when claim forms and information are requested. Letters from insurance companies responding to our requests are often written in a manner that is confusing and complex, and sometimes suggestive that the claimant doesn’t have TPD cover. If a claimant didn’t have a lawyer, they could be very put off by this and probably do nothing further.
Step 4: We gather evidence to prepare your claim documents
Usually, the following needs to be provided:
- An initial TPD Claim Form.
- Medical Attendant Statement – completed by your treating practitioner.
- Medical evidence – any report, records, or medical documents you have relating to your injury, illness, and the treatment you have received.
- Employer Statement -completed by your employer along with copies of your pay/leave history.
- Your resume/work history.
- Financial documents –payslips, taxation documents and Centrelink documents.
It is very important to have an experienced lawyer at this stage. If you make this claim yourself, you may include or exclude information that may result in your claim being rejected.
Step 5: Your claim is assessed and approved
The Insurer will assess your claim documents. During this time, the Insurer may ask for further information and will make a decision to approve your claim or refer it to the trustee of the super fund for review.
You will need to decide how much money you would like to withdraw, and you will be required to sign withdrawal documents.
It is very important to obtain formal financial advice about whether or not you should withdraw some or all of the money, or to leave all of the money in your super fund, or to roll it into another super fund.
What if your claim is rejected?
If your claim is denied/rejected by both the Insurer and the Trustee, you will be provided with the reasons for the rejection.
Once you know why the insurer rejected your claim, you may have the following options:
- Lodge an internal complaint to both the Insurer and your Superannuation Fund;
- Submit a complaint to the Financial Ombudsman Service;
- Refer the decision to the Australian Financial Complaints Authority (AFCA); or
- Begin Court proceedings to ask a Judge to overturn the Superannuation Fund’s decision.
It’s Important to have a Lawyer in your Corner.
Total and Permanent Disability claims can be complex and overwhelming. There is a lot of evidence to be gathered and information to be provided in the process of making a claim.
A lawyer assists with the process and in understanding the details of the contract of insurance between you and the insurance company (Superfund). Your lawyer can give you advice about the interpretation of the insurance terms. Terms can be complex.
Superannuation Funds and their Insurers often make the process difficult, so having a lawyer who is experienced with TPD claims, will assist you in understanding what you are required to provide in order to have your claim accepted. A lawyer can also advise about your rights/options if your TPD claim is rejected.
When you lodge a TPD claim, what you put in the application is very important and may determine whether the application is initially accepted. It is critical to have a lawyer early on in the process.
TPD Super Claims are no win no fee lawyers and have experienced lawyers who work exclusively in this area of law.
We offer personalised service and would love to help you.
We are no win no fee and your first appointment is no charge.
Call us on 47 725 155.
TPD Super Claims – We are no win no fee lawyers.
We are compassionate, experienced and committed to the efficient progression of your claim. Make an appointment to see one of our experienced injury claim lawyers sooner rather than later, to ensure your rights are protected.
