How are Total and Permanent Disability Claims governed in New South Wales?

Similarly to all states in Australia, New South Wales has strict rules for Total and Permanent Disability Claims. This is because it is up to the individual insurance provider to assess if you have a claim, and how much money is entitled to be paid out to you. 

When assessing your TPD Claim, insurance providers will look at various assessment criteria, such as the type of TPD insurance you are claiming from. When selecting your TPD insurance, you will be given the choice of any-occupation cover or own-occupation cover. These are the two distinct categories that you will have to choose from; any-occupation tends to be a cheaper cover because it is much harder to receive a claim from. For the own occupation cover, if you choose to make a claim then you will be paid out if you are no longer able to work in your chosen occupation. For any occupation cover, you will only be covered if you cannot return to the occupation that you have the education, training, and experience for. 

What are the most common types of TPD Claims?

There are several common TPD claim types that you can make in New South Wales. 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 in New South Wales. If you developed cancer and weren’t predicted to make a full recovery, then this could also be claimed in New South Wales. 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. 

How can I make a claim?

If you believe you are entitled to a Total and Permanent Disability insurance claim, then you have to meet certain criteria. Each insurer in New South Wales will define TPD differently, and so it entirely depends on their exact policy. Normally in New South Wales, 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.

Could my Total and Permanent Disability claim be disputed?

In some cases, your Total and Permanent Disability insurance claim may be disputed. This means your insurance company might not pay your claim. There are a few reasons why this might happen:

  • There is no standard definition of Total and Permanent Disability. This means your insurance company has every right to disagree with the idea that you might not be totally and permanently disabled.
  • If there are any ongoing requirements. Some payouts only happen if the victim follows ongoing specialist advice or a rehabilitation program.
  • Some policies enforce a waiting period before a payment is made, which means you won’t be able to access your claim benefit immediately. 
  • Total and Permanent Disability doesn’t cover everything. So if you have a prior condition, it could make you ineligible for this payout. 

How can What’s My Claim Worth help?

What’s My Claim Worth legal partners in New South Wales work on a No Win, No Fee basis. Meaning that you only pay legal fees if your case is successful and you receive your claim. 

If you do win, there are, of course, costs involved. What those will be, does depend on the costs of the TPD claim lawyer you work with and their solicitor’s fees and disbursements. This is an important conversation to have when you begin discussing your case. 

Why Choose What’s My Claim Worth?

What’s My Claim Worth not only allows you to calculate the value of your TPD claim in New South Wales with our claim calculator, we also work to connect you with our network of specialist TPD lawyers who can work with you to get you the best outcome — No Win, No Fee (excluding defendant costs if the claim is litigated).