These FAQs and answers provide an overview of TPD insurance in Australia. Individuals seeking TPD benefits should refer to their insurance policies for specific policy definitions and guidelines.
What is ‘Total and Permanent Disability’?
A ‘total and permanent disability’ refers to a severe and permanent disability, caused by an injury or illness, that significantly impacts an individual’s ability to work or perform activities of daily living (‘ADL’). It is a classification used in insurance and compensation schemes to assess the extent of a person’s disability.
The specific definition of TPD is unique to the superannuation fund and its applicable policy wording and definitions.
How is a TPD claim determined?
TPD benefits claims are typically assessed using the criteria included in the disability claims policy schedule/s.
Attending Doctor’s Statements are required to determine the level of disability and the impact on an individual’s daily life and ability to work.
Who qualifies for TPD benefits in Australia?
To be entitled to make a claim for TPD, individuals must have TPD insurance covered by their superannuation fund or independent policy. You can check your entitlement and coverage by:
- Calling your superannuation fund;
- Accessing your superannuation account online; or
- Accessing a past superannuation statement.
To qualify for a Disability Superannuation Benefit under the Income Tax Assessment Act 1997, an individual must have two legally qualified medical practitioners certify that it is unlikely they can ever be gainfully employed in a capacity for which they are reasonably qualified because of education, experience or training. In addition, the reports are required to be completed within 12 months and be post the date of event.
What is the process for applying for Total Permanent Disability (TPD) in Australia?
To apply for TPD, you must first check whether you are covered for TPD insurance by your superannuation fund.
If you think that you may be eligible to make a claim for TPD, you should contact your superannuation fund, notify them that you would like to apply for your TPD benefit and request your superannuation fund’s specific application forms. These forms will be unique to your superannuation fund.
Once you have received your application forms, you should read them carefully, and ensure that you provide all the information necessary to enable your superannuation fund, and its insurer, to make its decision. The process involves completing an application form and providing necessary medical documentation which will include two (2) attending doctor’s statements, and any other documentation provided by the insurer.
Upon receipt of your completed application forms, your superannuation fund will refer your application to its insurer. The insurer will review your application, and then either recommend payment of your benefit or decline to pay your benefit.
There is often no strict deadline for the insurer to make its decision, however, it will do so within a reasonable amount of time. If the insurer requires further information to make its decision, they will contact you and explain what they require.
Should the insurer recommend the release of your TPD benefit, your superannuation fund will typically inform you of its final decision, in writing, in 21 days. Your TPD benefit will be paid into your superannuation account in the first instance. Your superannuation fund will provide you with the appropriate paperwork necessary to have your benefit released. You will need to decide what to do with your benefit, and there are generally 3 options:
- You request a full or partial withdrawal (a full withdrawal would include your entire superannuation balance); or
- You leave the entire benefit amount in your superannuation fund; or
- You rollover your TPD benefit and superannuation into another fund.
There are various tax implications depending on what you choose to do with your benefits, such that you should seek professional financial advice as to how best to manage your benefits.
Once you have decided how best to manage your benefit, you will return the completed forms to the superannuation fund. Should all the paperwork be correctly completed, the superannuation fund will typically release your benefit in 10 business days.
Is Total Permanent Disability (TPD) assessment the same across all Australian States and Territories?
Each superannuation fund has its own unique TPD definition and criteria. However, the fundamental principles remain the same across all Australian States and Territories.
Are there different criteria for TPD assessment based on the insurance policy or scheme in Australia?
Yes, each superannuation fund has its own unique policy definition and eligibility criteria for TPD. It is important that you refer to your particular policy and wording to understand the criteria and requirements.
What benefits or compensation are available to individuals deemed as having Total Permanent Disability (TPD) in Australia?
Answer: Individuals suffering a TPD may be eligible for lump sum compensation and other benefits (such as income protection).
Is there a time limit for applying for Total Permanent Disability (TPD) after an injury in Australia?
The time limit for applying for TPD after an injury varies based on the specific insurance policy and wording. It is important that you refer to your particular policy and wording to understand the criteria and requirements.
Can I appeal a decision regarding Total Permanent Disability (TPD)?
Yes, you have the right to appeal a TPD assessment decision. Initially, it may be most appropriate to obtain further medical evidence and request an internal review. In your request for review/appeal, you should provide further submissions which clearly outline why you consider the insurer’s decision is incorrect, and a formal request for review.
Other than an internal review, there are two formal avenues for review:
The first avenue for review is lodging a complaint with the Australian Financial Complaints Authority (‘AFCA’). The role of AFCA is to provide fair and independent resolution of financial complaints. Sometimes, AFCA will provide the parties to the complaint with a preliminary assessment before making a binding decision. A preliminary assessment is only binding on the parties if all parties agree to settle the complaint on the basis of the preliminary assessment. If any of the parties involved reject the preliminary assessment, an AFCA Decision Maker will proceed to make a binding determination. When an AFCA Decision Maker makes a determination, the Decision Maker assumes the position of the superannuation provider. Determinations by AFCA can only be appealed through the courts.
An AFCA determination is a final decision. Any determinations made by AFCA on a financial firm are binding if you accept the determination. In the case of superannuation complaints, are binding on both parties, regardless of whether the outcome is accepted. Each party to a Superannuation Complaint has a right to appeal to the Federal Court on a question of law within 28 days after the day when a copy of the Determination has been given to the party.
The second avenue for review is to commence proceedings in Court. In commence proceedings, you will need to instruct a solicitor. You have 6 years from the date of the superannuation fund’s decision to issue proceedings in court.
Can I receive both TPD benefits and other forms of compensation or benefits in Australia?
Yes, you may be eligible to receive TPD benefits as well as other forms of compensation or benefits, depending on the circumstances and the applicable insurance policy. It is important that you refer to your particular policy and wording to understand the criteria and requirements.
If you have TPD coverage by more than one superannuation fund, you are also entitled to make TPD claims against both policies.
Is my TPD benefit taxable?
Yes, your TPD benefit is subject to tax and will have a taxable and non-taxable component. Your superannuation fund will advise you of your non-taxable component, should your claim be approved. You should obtain professional financial advice before making any decisions relating to your benefit.
Can my TPD benefit be affected if I return to work in some capacity?
This is a common question for many people who have received or are in receipt of, TPD benefits. Generally, if you make a successful TPD claim, you are not prevented from returning to work at a later point. However, different TPD policies will provide cover for different things and you should read through your policy carefully.
How does TPD assessment affect future medical treatment and rehabilitation for the individual?
Answer: A TPD assessment typically focuses on evaluating the permanent Disability caused by an injury or illness. The assessment does not directly affect future medical treatment and rehabilitation. Individuals deemed to have TPD will continue to receive necessary medical treatment and rehabilitation as prescribed by healthcare professionals to manage their condition and improve their quality of life.
Is there assistance available for completing the TPD application and assessment process in Australia?
It is important to understand what your TPD coverage is. Policies of insurance vary from one to another in terms of the level of coverage and the eligibility criteria. Some TPD policies cover you only in the event that you are incapacitated for the occupation for which you have specific education, experience and training, while others require that you are incapacitated for any occupation regardless of your training and experience.
If you feel that you need a specialist personal injury lawyer to fight for your future financial security, please do not hesitate to speak with one of our experienced personal injury lawyers today. No win / no fee options apply.
This Service Includes
- Perform the initial no-obligation insurance claims assessment;
- Obtain your detailed instructions and review any medical reports and clinical notes;
- Obtain and review the specific policy schedule and product guide relevant to your policy;
- Correspond with the insurer to notify and lodge your initial claims application and supporting documents;
- Obtain all relevant medical evidence to support your claim;
- Correspondence and submissions to the insurer;
- Review the decision and make an application for internal review where the claim is declined;
- Lodge an application with the Australian Financial Complaints Authority in the event that the internal review is unsuccessful; and
- Issue and conduct Court proceedings.
What role does my medical team play in my TPD claim?
In order to apply for the release of your TPD benefit, you will be required to obtain two (2) Attending Doctors Statements, that certify that you are totally and permanently disabled. The specific wording on the statements will vary depending on your superannuation fund. Their assessments are fundamental in determining the level of Disability and assisting the superannuation fund and its insurer in making informed decisions.
Can I apply for TPD if the disability occurred due to a work-related incident or accident?
Yes, an individual can apply for TPD even if the disability was a work-related injury.
Does TPD Cover vary for work injuries, motor vehicle accidents, and other injuries in Australia?
TPD cover is its own specific avenue to compensation regardless of how and where you were injured.
If you would like to discuss your individual circumstances with our professional staff, reach out online or by phone (02) 4050 0330.
