When you get injured or an illness it’s hard to know what benefits you could be entitled too. Total and Permanent Disability insurance benefits are coverage provided by many insurance funds across Australia for a range of reasons. This blog will discuss the most common TPD claims made and what to do if you think you have a claim.
If you need any further information on Total and Permanent Disability and whether you have a claim, please click here and follow the prompts to find your State.
Total and Permanent Disability is supervised and governed by insurance providers. Most people have this insurance provided to them by their superannuation provider on an opt-in basis. Laws surrounding Total and Permanent disability payouts have become increasingly strict, not least by the law changes in 2019 which meant that insurance would be offered to superannuation members on an ‘opt-in’ choice, rather than the current ‘opt-out’ basis. These rules would be in effect if the member is under the age of 25 or has an account balance below $6,000. Also, as superannuation is not governed by state or federal law, but instead by the individual provider, each payout is determined on a case by case basis. Your insurance provider has every right to disagree with your claim attempt.
The rules used to decide if an individual is eligible to make a TPD claim are varied. Certain criteria must be met, including proving that your disability is total and permanent. However, even this varies according to your insurance provider. If your provider allows, you can make a claim for a partial Total and Permanent Disability, but the payout amount would be determined based on the severity of your case and disability levels. There are also other criteria that should be met, such as a waiting period. Normally, most claims have to be made following at least six months without work so that you can prove that this disability has a direct impact on your working life. Claims assessors will be looking to see that this disability has affected your ability to work and the easiest way to prove this is to make your claim after a certain time period. You must also prove that you were working prior to your claim and demonstrate that your finances have been directly impacted by your Total and Permanent Disability. Other criteria, such as proving that you have lost complete independence and require ongoing medical care, may also need to be met. You need to provide as much information as possible when submitting your claim to have the best chances of success possible.
As previously mentioned, some insurance companies do allow partial Total and Permanent Disability claims, but this depends on the provider and their individual policies. Some insurance providers will pay out a claim in full, whereas some will pay on an ongoing basis with conditions attached. For example, requiring you to go to physical therapy as part of your ongoing recovery process.
There are several common TPD claim types. These can include Musculoskeletal disorders, cancer and mental health issues. Musculoskeletal Disorders (MSDs) are injuries and disorders that affect the human body’s movement or musculoskeletal system. Some examples include injuries such as carpal tunnel syndrome, mechanical back syndrome and herniated discs. If you were injured at work and it resulted in a Total and Permanent Disability, you could make a claim through your insurance provider. If you developed cancer and weren’t predicted to make a full recovery, then this could also be claimed. Other claim types include mental health claims for conditions such as depression, bipolar disorder and PTSD. The most important thing to consider when making a claim is the ability to prove that you are not going to make a full recovery from the condition you are suffering from.
If you believe you are entitled to a Total and Permanent Disability insurance payout, you have to meet certain criteria. Each insurer will define TPD differently so this criteria will depend entirely on their exact policy you have.
To be clear, if you are expected to make some kind of recovery, then you are not going to qualify for any cover. This is because, under the definitions, you are not permanently disabled. If you have a mild condition, you may also not be able to make a claim. For example, if you lost a finger at work, instead of making a full claim (as one could assume you would still be able to work), you may be able claim for a portion of the cover.
If you think you have a claim for Total and Permanent Disability and you want to make a claim, What’s My Claim Worth is here to help. Simply click here for more information and to start the process. What’s My Claim Worth works with lawyers across the country who work on a no-win, no-fee basis.
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