Claiming total and permanent disablement

It could have happened in one accident or slowly gotten worse, but your doctor has informed you that you are unable to go back to your job or, in some cases, unable to work any position you would normally qualify for. If you’ve suffered a serious injury or fallen terminally ill, you could be eligible for total and permanent disablement (TPD) compensation through your superannuation fund.

Personal injury law can be complicated when it comes to proving disability and winning the necessary level of compensation — many victims of TPD are unaware that they have insurance that will cover them. A TPD lawyer may be able to help you navigate through the nuances of the process and win the payout you deserve. 

What is total and permanent disablement?

TPD is a phrase, used in the insurance industry and law, when someone has a terminal illness or injury and is unable to return to work or take another role in an occupation for which they are suited by education, training or experience. A patient who qualifies for TPD must have been unable to perform their duty in the workplace for a minimum period of six months. Insurance cover is usually found in your superannuation. It’s important to check the language in your coverage as it could require a certain amount of proof and forms in order for your payment to be realised. 

An insurance benefit payment is meant to cover current and future medical costs, provide a source of income as you restore your quality of life and clear any debts you may have accrued. 

If your injury or illness has not been identified as permanently debilitating then you could qualify for temporary total disability (TTD) instead. This occurs when a medical professional does not believe that your injury will endure for the rest of your life, as long as you follow a series of medically recommended steps such as attending physical therapy, seeing a psychologist or receiving medical treatments. Compensation for TTD is about 1% of the sum insured.

Additionally, there is permanent partial disability (PPD) where a patient’s disability is partial but total, meaning they can perform their job but not at full capacity. This can occur if they have lost a finger, or hearing in one of their ears. Coverage generally starts at 5% of the sum insured and could cover 100% of the sum depending on the level of impairment. 

Making an insurance claim

To lodge a successful TPD claim, you must follow specific steps. If your super policy covers TPD it will require a particular filing process. 

Here are common steps you should be aware of when filing a claim:

1. You begin by speaking with your super contact for information and the specifics of your policy.
2. Next, you fill out an application for TPD benefit; this will likely require medical records and proof of identification.
3. Then, you submit your application to a coordinator who will determine your eligibility and payment amount. 
4. The application coordinator will pass the application to the insurer who makes the final assessment based on your medical history, the information you provided about your injury and your work history, and schedule you for a medical exam.
5. You will receive a decision of accepted, declined or deferred because your injuries have not been fully realised yet. 

The process involved can be lengthy and it is recommended that you seek legal advice from compensation lawyers who are familiar with TPD insurance benefit cover claims. 

It is not uncommon for a compensation claim to be rejected initially — especially if you are filing on your own. This should not discourage you from trying again or working with a TPD lawyer from Gerard Malouf & Partners. We will offer no-obligation advice and follow our no-win, no-fee policy. A lawyer will understand your policy well and take the necessary steps to file properly so you have a greater chance of getting approved and receiving TPD compensation. 

Eligibility to file a claim

Your eligibility to make a claim will depend on the requirements laid out for you in your insurance policy. Generally, though, if you have been out of work for at least three months and you have no expectation to return to work that you’re qualified for, you are likely eligible. While the requirements vary from insurer to insurer, there are some common criteria for making a claim such as:

• Your disability is total and permanent: Before filing for TPD, you will have to show you are suffering a minimum level of disability through medical records and doctor recommendations.
• Your super fund covers TPD: If you are unsure if your super covers TPD, you should reach out to a member of your super fund. 
• The waiting period: After you have incurred an injury or received a diagnosis some funds require a waiting period for all injuries and symptoms to stabilise to the full extent of the damage. This will help determine your level of disability. 
• Employment history: If you are injured and unable to return to work, some policies require proof of employment prior to the accident. The insurer will need to see a minimum total number of weekly work hours or a form confirming the total length of employment. 

The sooner you can get approved, the faster you can cover the debts you have incurred. A mistake on an application can set you back several months, or even a year, because of the time it takes to review applications. 

The typical payout for a TPD claim?

TPD is a lump sum payment that typically ranges between $60,000 and $300,000. Your insurance benefit will be outlined on your superannuation membership statement. It’s important to note that you can make multiple claims if you have multiple TPD insurance policies, so you can achieve the maximum amount of compensation you need and are entitled to. 

TPD payouts are linked into your superannuation account so it has no impact on your Centrelink or other benefits. However, if you make a withdrawal from the super fund, this could have repercussions on your entitlements. This being the case, it does help to speak with an entitlement professional before withdrawing any amount from your super.  

Finally, there is no tax on your TPD payout until you take the money out in part or whole, when it will be called a “superannuation lump sum withdrawal tax.” 

If you or a loved one is going through total and permanent disability and you are curious about what your super covers, please contact a Gerard Malouf & Partners professional right away for expert legal advice. We are the leading law firm in TPD claims and specialise in maximising the lump sum benefit results for your personal injuries.