Accessing TPD super insurance

Why do TPD claims get denied?

Understanding why claims fail is one of the best ways to protect your own. In our experience, insurers most commonly reject or delay a total and permanent disability claim because of:

• a dispute over whether the medical evidence meets the policy's definition of disability
• incomplete or inconsistent paperwork
• a claim lodged after the policy's time limit
• a superannuation account that became inactive before the claim was lodged
• a claim submitted before the minimum waiting period had passed
• an eligibility dispute, including whether the member had standard cover or limited cover, which can affect the definition used to assess the claim
• your employment ending for reasons officially recorded as unrelated to your health, even where a medical condition was the real reason

If any of this sounds familiar, don't assume your claim is over. Our specialists regularly challenge these decisions on behalf of our clients.

What are the time limits for making a total and permanent disability claim?

You should generally submit a TPD claim as soon as you can, but you can also lodge a claim long after your injury or illness occurred depending on your policy.

Strict time limits can apply either before a decision is made, or once a decision is made. This depends on how your policy's definition is structured. It's important to get legal advice from an experienced TPD expert as soon as possible, ideally before you submit your claim, so you know where you stand.

Your date of disablement is usually based on when a doctor first certifies that you're unable to work, not simply when you stopped working. Because that date often can't be backdated later, it's important to get medical certification as early as possible, even if you're not yet ready to submit your claim.

What kind of compensation or benefits can you get from a total and permanent disability claim?

The amount of TPD compensation or benefits you get from a claim will vary depending on the policy terms negotiated by your super fund or employer.

Benefits are usually paid as a lump sum and can be worth tens or even hundreds of thousands of dollars, with many successful TPD claims resulting in payouts between $60,000 and $300,000. The payout amount can decrease or lapse as you age, so it's important to check the level of cover at the time you stopped working, even if that cover has since ended.

A TPD payout isn't taxed as income, but if you choose to withdraw part or all of it as a lump sum from your super, a withdrawal tax may apply depending on your age and preservation status. We can help you understand where to access accurate information and appropriate professional advice.

Making multiple claims

You can lodge multiple TPD claims if you have more than one eligible insurance policy. However, some insurers won't pay if you've already received or been entitled to claim another TPD benefit. Our superannuation specialists are experts at overcoming these provisions, but it's important to get advice before making any TPD insurance claim.

In addition to lodging a TPD claim, you may be eligible to make additional claims using other types of insurance, such as life insurance or workers' compensation insurance.

There may also be additional benefits you're not aware of through:

• your employer
• an enterprise agreement
• your employment contract
• your loans, such as a mortgage, car loan, or credit card
• your insurance purchased through a financial institution or advisor

Because there may be many different avenues for you to get compensation, our specialists will be able to identify your options and come up with the best possible strategy, especially if you're juggling more than one TPD superannuation claim at once.

You can read here about the different types of insurance benefits you can access when you're unable to work due to illness or injury.

How long does a total and permanent disability claim take?

The most important thing is to contact us as soon as you think you have a claim.

Our specialists understand the ins and outs of TPD insurance policies and can help you map out a broader plan for obtaining TPD compensation, including identifying avenues for compensation you may not be aware of.

As a general guide, insurers are expected to assess TPD claims within the timeframes set out in the Life Insurance Code of Practice, although more complex claims can take considerably longer.

Once the insurer has made its decision, the trustee of your superannuation fund must also carry out a separate assessment, which typically adds another one to two months.

Claims that involve disputed evidence or an appeal can take longer, which is exactly why getting a thorough, well-supported application in from the start matters so much.