TPD Claim Traps

Total and Permanent Disability (TPD) claimants in Australia often worry about the claims process and whether the insurance policy has a sneaky trick or loophole that favours the insurer and allows them to reject their claims. They also have concerns that the insurer may trick claimants into making mistakes in their TPD claims which lets the insurer off the hook.

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You are right to be concerned

In fact, TPD claimants are not imagining things. They are right to be concerned because many insurers see it as their duty to reject claims. The following tricks and traps will give you some idea of what to look out for when making a TPD claim for an insurance benefit from your superannuation fund or other insurers.

There are no surefire guarantees that your claim for TPD in your superannuation fund or retail insurance policy will be successful and bring you a lump sum payment, but there are ways to help avoid falling for any tricks and traps.

Common tricks and traps when claiming TPD insurance

We first need to define TPD and expunge the myth that total and permanent disability means you must have catastrophic disablement to make a successful claim. That is simply not the case, and insurers will try to trick you into feeling guilty and that you just are not disabled enough.

However, many claimants receive poor advice and leave their insurer’s office feeling that they are not injured badly enough.

Don’t fall for that old chestnut.

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Mixing up important dates

Insurers also often try to trick or trap claimants into mixing up dates. For instance, they may claim you were injured or became ill after you stopped working, therefore your claim is rejected because your injury or ill health wasn’t the reason for stopping work. They also try to reject claims by saying you accepted redundancy rather than claimed TPD; that you didn’t seek medical treatment when you stopped working, or that your condition was not yet diagnosed.

Superannuation funds have varying conditions within their policies. Allow us to review them before making a claim.

Again, don’t fall for it. Seek legal help.

Insurance doctors versus your treating doctor

Sometimes superannuation funds or medico-legal insurance doctors and your treating doctor may have different opinions about whether or not you can work again. The doctors employed by the superannuation fund or insurer often argue that a claimant can work, and treating doctors say the opposite.

The insurer usually takes the word of their medico-legal doctor that a claimant has seen once, and these doctors can easily get your details or circumstances wrong. A good lawyer can get the opinion of their own medico-legal experts and specialists so it’s not left up to a treating GP.

We also have access to GP’s who are experienced in TPD assessments.

Things you need to know to help make a successful TPD claim

When claiming TPD or making superannuation claims, you usually have to prove you are not able to work in the same occupation that you did before your disability caused you to stop working. If you have transferable skills, you must show that you could not use them in other employment. To claim TPD benefits, a major factor that determines the outcome of your claim is your level of disability that resulted from your accident/illness/incident. As a general rule, the TPD claims assessor will consider the following:

Can you return to the work you did before you were disabled?
Will you ever work in any kind of employment in the future?
Does your disability stem from the loss of a part of or a whole limb, your eyesight or other sense?

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Another thing to remember is that a Centrelink disability support pension is not affected by successful TPD claims from a superannuation fund. In other words, your TPD claim will NOT be impacted by your Centrelink benefits since the amount you win will be paid into your superannuation account initially. Superannuation funds are excluded from Centrelink means testing.

‘Any-occupation’ and ‘own occupation’ disability

The difference between ‘any occupation’ and ‘own occupation’ permanent disability injuries is not always covered in superannuation insurance policies. ‘Any occupation’ is any work that matches your basic training and experience. Meanwhile, ‘own occupation’ covers work-related injury occurring while in a specific role or organisation.

To qualify for TPD compensation, injured workers, generally speaking, must meet minimum work history requirements, which include:

Claimants must demonstrate via contracts or other signs of employment, that they have worked a minimum of 12 months.
The work can be part or full-time.
Claimants must prove the total number of hours they worked at the time of their injury.

TPD compensation claim factors

Whether it’s a TPD superannuation claim or common insurance, the factors involved in the level of disability you need to demonstrate will depend on your insurer’s policy. Other factors in TPD compensation claims include medical evidence or proof that any ongoing medical expenses and care needed are a result of the TPD injury or illness. This can be met by showing appointments for medical treatments or rehabilitation.

Lump sum TPD and your Super balance

A point to be aware of when you make a TPD claim: A TPD lump sum is calculated on top of your superannuation fund balance, which means your super is not affected by a TPD benefit or lump sum payout in superannuation insurance claims.

Can you work after a TPD payout?

You may be able to work after illness or injury in any job after a successful TPD insurance claim and lump sum payout. Your health and recovery may improve allowing you to return to some form of work. At TPD Helpline, our purpose is to help injured Australians claim their superannuation and win TPD benefits. We also aim to raise awareness about this little-known insurance benefit and the fact that there are time limits in which to claim possible entitlements. Contact us today.

Get in touch

Let us know know about your requirements

Phone

1300 679 222

Email

info@tpdhelpline.com.au

TPD Helpline Australia can be contacted on 1300 679 222. Our helpline reps are well versed in all things related to TPD claims, injury compensation claims, health conditions, illnesses and injuries whether sustained at work or not. If there is an issue we can’t answer over the phone, we have access to a mountain of resources so that we can call you back within the day to provide answers.

Due to time differences across states, we recommend leaving a voicemail if your call is not answered. We promise to return your call within the day taking note of time differences. Our phone helpline is manned Monday to Friday, 8.30am – 5.00pm (AEST). Our Facebook social media page is manned 7 days a week and we respond to direct messages quickly. In fact, most of our enquiries come via Facebook private chat.