How to Claim TPD from Superannuation
Total and Permanent Disability (‘TPD’) insurance can provide financial support if you are unable to work due to illness or injury. This guide outlines the typical steps involved in claiming a TPD benefit through your superannuation fund, along with the necessary documents and usual claim process.
Understanding TPD Insurance and Your Superannuation
Generally, TPD coverage is on an automatic, or opt-out basis, and is a specific type of personal insurance. TPD insurance provides a lump-sum payment if you become permanently disabled and are unable to return to work. The specific definition of TPD will depend on your superannuation fund and the wording in its Policy Disclosure Statement, but it generally falls under two main categories:
- Own Occupation: You are unable to work in your specific job or profession.
- Any Occupation: You are unable to work in any job that you would be suitable for on the basis of your education, training, or experience.
Before lodging a claim, check your superannuation fund’s Policy Disclosure Statement to understand the eligibility criteria and the type of cover that you have.
Step 1: Confirm Your Eligibility
To make a claim for a TPD benefit, you must meet the specific eligibility requirements of your superannuation policy. Eligibility requirements may vary between superannuation funds, but generally, the three criteria will be something like:
- solely because of your illness or injury you have not been able to work in any job for at least 3 months in a row since you became ill or injured, and
- you are being treated by, and following the advice of, a medical practitioner for your illness or injury, and
- at the end of the three months in a row, your injury or illness means that you are incapable of ever working in any job that you are reasonably suited to based on your previous education, training or experience, or any job that you may reasonably become suited to with further education, training or experience within a reasonable period.
Your super fund may have additional criteria, so it’s essential to review your policy documents, or contact your superannuation fund directly.
Step 2: Gather the Required Documents
Having the right documents ready can speed up the claims process. Each superannuation fund will have certain requirements with respect to the paperwork to be completed, but the forms will usually include:
- Medical reports from your treating doctors outlining your condition and its impact on your ability to work. Your superannuation fund will have specific forms for your treating doctors to complete and are often called ‘Attending Doctors’ Statements’.
- A TPD claim form from your super fund.
- An Employer statement confirming your work history, employment duties, and inability to perform your job.
- Certified Identification documents such as a passport, driver license, or birth certificate.
*In some cases, the super fund may request additional medical assessments or financial information.
Step 3: Submit Your TPD Claim
Once you have gathered all necessary information and medical evidence, you are now ready to submit your claim to your super fund. This can usually be done online, or via post. Be sure to follow the fund’s guidelines and keep copies of all documents for your records.
Once the superannuation fund receives the paperwork it will begin assessing your claim, and this may take several months. Some funds or their nominated insurers will also require you to undergo an independent medical assessment before making a decision, or make requisitions (ask for) further medical evidence.
Step 4: Await the Super Fund’s Decision
Your super fund will assess your claim based on medical evidence, policy definitions, and eligibility criteria. The processing time varies, but it typically takes about three (3) to six (6) months. If your claim is successful, you will receive a lump-sum payout that will initially be deposited into your superannuation fund balance, for distribution in whole or in part, in accordance with your instructions.
If your claim is denied, your superannuation fund must provide reasons for the denying your claim. You can challenge the decision through an internal review, lodge a complaint with the Australian Financial Complaints Authority (AFCA) and request and external review.
Tips for a Successful TPD Claim
- Seek professional advice: A lawyer can guide you through the claims process and greatly improve your chances of success.
- Double-check whether you may have multiple superannuation fund or TPD / insurance policies, as all may be triggered simultaneously (i.e. multiple benefits paid on top of the other)
- Provide complete documentation: The more evidence you supply, the stronger your case will be.
- Follow up regularly: Stay in touch with your super fund to ensure your claim is progressing smoothly.
Claiming TPD through your superannuation fund/s can be a complex process, but understanding the steps and preparing the necessary documentation will help you navigate your claim/s.
If you or a loved one are unable to work due to an injury or illness, we would be pleased to meet with you to discuss your options on a no-win, no-fee basis. Please contact our friendly team on (02) 4050 0330 to make an appointment with one of our specialist personal injury lawyers.
DISCLAIMER
This article reflects the current law at the time of publication. It is intended for informational purposes only and does not constitute legal advice. The actual decisions in each case are summarised for general understanding. For specific legal guidance in relation to your situation, please consult with a qualified legal professional.
