What is Total and Permanent Disability?
TPD stands for Total and Permanent Disability. This type of insurance provides cover if a mental or physical disability or ill health prevents you from performing your usual occupation or another role that is reasonably suited to your skills and education. TPD claims are generally paid monthly or in a lump sum and can be used to cover medical costs and the general cost of living.
Total and Permanent Disability insurance benefits are provided by many insurance and superannuation funds across Australia. It is also referred to as a disability insurance benefit.
How are Total and Permanent Disability Claims governed in NSW?
Similarly to all states in Australia, NSW 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 own-occupation cover, if you choose to make a claim 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 relevant education, training, and experience in.
What are the most common types of TPD Claims?
There are several common TPD claim types made in NSW. These include:
- Musculoskeletal disorders
- 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 NSW. If you developed cancer and weren’t predicted to make a full recovery, then this could also be claimed in NSW. 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.
Are you eligible to make a TPD claim?
If you believe you are entitled to a Total and Permanent Disability insurance claim, you will need to meet certain criteria. Each insurer in NSW will define TPD differently, and so it entirely depends on their exact policy. Normally in NSW, 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 period of time. You must also prove that you were working before your claim and demonstrate that your finances have been directly impacted by your Total and Permanent Disability.
Five common criteria required from insurance providers include:
- Proof of a total and permanent disability
- The completion of the specified waiting period
- Proof of your recent work history
- Proof that you’ve lost some independence as a result of your disability or illness
- Proof that you’re following the ongoing medical care recommended by your doctor or medical practitioner
It’s important to remember that each insurance provider will have a slightly different definition of what each criterion means and how it is met. Refer to your policy certificate or schedule for the definition used by your policy provider.
What evidence do you need to provide when making a claim?
To make a TPD claim, you will generally need to provide evidence that proves that you meet the criteria set by your insurer. This evidence can include:
- Medical evidence (medical reports, x-rays etc) provided by a doctor or other medical practitioner outlining the type of illness, injury or disability you are experiencing
- An outline of your education and experience
- Any documentation that can show why you can’t perform any other job that may be considered suitable
- Any relevant workers compensation files
If you’re unsure of what evidence you need to gather and how you can go about it, our specialist TPD lawyers can provide you with assistance.
How much will you receive when you make a Total and Permanent Disability claim?
The size of the benefit that you receive from a successful TPD claim will vary depending on several factors. The type of insurance coverage that you have will be one of the greatest influences, with maximum compensation amounts varying depending on the policy you’ve chosen. Some policies may not cover you for some conditions, so it’s important to refer to your insurance policy for further clarification.
Unlike some other forms of insurance, TPD benefits can typically be claimed in addition to Workers Compensation and Centrelink payments.
Could your 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 NSW 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 NSW with our claim calculator, but 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). Contact us to discuss your options.
Frequently asked questions
Can you work after a TPD payout?
In some circumstances, whether it’s the result of a new rehabilitation technique or a more effective medication, you may eventually be able to return to work after receiving a TPD payout. In most cases, you won’t need to repay your TPD payout if this were to happen. If you were to submit a fraudulent claim and then return to work, your insurance provider may seek repayment.
How long should a TPD claim take?
TPD claims are typically processed and approved within six months of a claim being submitted. The timeframe of a TPD claim may vary depending on your insurer and any factors that may extend the approval process.
Does a TPD claim affect Centrelink?
In most cases, a TPD claim won’t affect Centrelink payments. As a TPD payout is considered to be a form of income, it should, however, be reported to Centrelink. It’s always best to consult the Centrelink website and the organisation’s customer service staff for the latest information and procedures.