TPD stands for total and permanent disability. It’s something no one wants to think about and never imagines could happen to them. You may claim TPD if you are injured in an accident and cannot return to work. It’s a serious situation to be in, but you should have to fight insurance companies for the compensation you require. Most Australians have insurance through their superannuation fund, but are unaware of this perk. Let’s jump into some of the details of a TPD claim, and walk through the step-by-step process of filing.
How to qualify for TPD
When you are unable to meet the basic requirements of your job or any other job that you were previously qualified for, you could file for TPD. The cause for this hardship could be a physical disability, an illness or a lack of mental capacity.
If you were not working at the time of the accident, you could also file for TPD if you cannot perform basic functions of self-care and need assistance. Activities like dressing, eating, showing or walking could all qualify for TPD.
To qualify for TPD, you’ll need to present proof of injury and certification from your health professional that states your injury level. You will need to get a notice from your doctor on returning to work.
Different policies have their own rules and expectations for filing a claim. The best way to know if you qualify and how to lodge a claim is by calling your life insurance provider or your super fund contact and getting information from the source.
However, unlike other types of claims, no fault is involved. Meaning, the insurance companies are not looking if anyone is at fault for the accident. You will receive coverage depending on your insurance policy.
For example, if you were diagnosed with borderline personality and bipolar disorder, you would not file for workers’ compensation or any other type of at-fault compensation claim. In short, if you are unable to work your job or any other type of position, then you qualify for coverage.
Why you would file a TPD claim
If you are considering whether you need to file a claim, think about your ability to financially carry on your day-to-day activities on what you have saved already. You’ll have to cover your:
- Rent or mortgage payments.
- Debts owed.
- Savings for retirement.
- Medical and rehabilitation expenses from the moment you got into the accident and into the future.
Consider how much you have in your savings and super fund, and what you’ll need to cover the differences. Your insurance provider and your compensation lawyer can help you calculate this gap and create a plan for meeting your needs.
After you’ve talked to your doctor, your insurer will consider the evidence and award you a TPD benefit. Let’s take a look at the step-by-step TPD cover claims process.
What injuries would qualify you for insurance?
Any number of injuries and illnesses could qualify you for income protection TPD coverage. However, if you’re injured and unsure if your bodily state would qualify, here are some examples you could for evaluation based on the type of impairment.
Physical injuries:
- Loss of hearing or speech.
- Spinal fusions or paralysis.
- Loss of a limb.
- Paraplegia
Mental injuries:
- Anxiety.
- Schizophrenia.
- Post-traumatic stress disorder (PTSD).
- Depression.
Illnesses:
- Alzheimer’s disease.
- Parkinson’s disease.
- Multiple Sclerosis.
- Chronic Lung Disease.
The TPD claim process: Step-by-step
It’s important to consider the different steps you’ll need to follow to file a successful TPD claim, so you don’t miss anything and you can get the coverage you need without delays.
It can take up to six months for an insurer to look over your claim and approve you for coverage. It could take up to a year for insurance companies to evaluate your case and come to a decision. Once the insurance has arrived at a conclusion, superannuation professionals must look over the TPD policy insurance recommendations and come to their own determination which could take between one and two additional months.
That’s medical, housing, food and other bills piling up and cutting into your savings. These steps can help you get started on a claim right away.
Step 1: Reach out to your superannuation and personal injury insurance provider
The first step to lodging a TPD claim is identifying your insurance coverage entities. Whether that’s through your super fund or the insurance you’ve purchased independently, you’ll need to find these connections right away.
Here, you’ll find coverage details and how much compensation you can expect from insurance. Keep in mind that you may have multiple insurance avenues to explore if there were job changes or opened several lines of coverage. This is pretty common and could qualify you for more coverage. The outcome of one claim does not affect the other, and you can file a claim for each policy.
Step 2: Ensure that your policies were valid at the time of the injury
Check to make sure your insurance was valid at the time of the injury and is still valid now. Because the insurance can only cover you for the duration you were covered, not retroactively. In situations of a long illness or chronic pain that has worsened over time, this could be a grey area. For questions on when you should consider the start of your condition, it’s important to work with a total permanent disability lawyer throughout the process.
Step 3: Understand what it is your insurance covers
If you have valid insurance, you should consider what your insurance covers exactly. It may protect you if you’re unable to return to work or any line of work. This is an important distinction if you’re filing for work protection that has resulted in a severe condition like paralysis.
Step 4: Apply for coverage
A TPD insurance claim requires that you submit an application to the necessary office and include all medical bills, recommendations, details of the injury and all other relevant documentation. You’ll need to substantiate the claim with evidence such as workers’ compensation and medical records to be fully considered — the application alone will not help you earn a TPD payout.
If you’re working alone, this process may drag on with a back and forth from your insurer asking for more information. In this step especially, you should work with personal injury lawyers to help you file the necessary documentation. It’s not uncommon for an applicant to give up on filing because of the frustrating process; this doesn’t have to be you with the help of an informed TPD lawyer.
Step 5: Write up and include a letter on why you need coverage
Getting approved quickly for coverage should include a well-written, thorough, thought out and detailed letter.
You’ll need to write a formal letter explaining your condition to insurers and why you need TPD insurance cover. After looking over your life insurance policy, this letter should outline why you meet each criterion. A well-written application signifies that you’ve reached out to medical professionals and TPD lawyers to formulate a legitimate claim. Insurance company personnel receive thousands of phoney applications every year, indicated by a poorly written letter that does not meet the requirements.
Step 6: Be proactive about your claim
Being proactive about your claim means following up with your insurer to check that you included everything they needed for their evaluation. Because insurance organisations have to sift through many applications every year, it’s important not to assume that they will tell you if you’ve missed anything before denying your claim.
Step 7: Don’t stop trying if your claim gets rejected
There is a rejection process you can follow if your claim gets denied. Just because your claim gets rejected the first time doesn’t mean that’s the end of the line for your coverage. Reach out to a lawyer to dispute the rejection and help you prepare for the next application.
Why would a TPD claim be rejected?
There are many ways your claim could be rejected. Some reasons are very much within your power to correct and get coverage sooner rather than never. More specifically, here are a few reasons your claim may have been rejected:
- Filing outside of the age recommendations.
- Failing to meet the work history requirements for a workers’ compensation TPD claim.
- Lodging your claim outside of the statutes of limitations.
- Realising too late that your insurance is no longer active.
- Applying before your injuries are fully realised (a minimum waiting period).
- Turning in evidence that is questionable or not relevant to your current condition.
- Missing criteria for compensation.
If you filed your claim before reaching the waiting period, talk with your doctor about when you will fully realise your injuries.
For example, you may have gotten into a car accident, and the initial shock of the accident has not fully set into your body. Yet, your doctor predicts you will no longer be able to perform your job once the injury is fully realised. In this scenario, it is tempting to start the claims process for TPD right away, but your injuries may take an unexpected turn in the interim. For this reason, you’ll need to wait to file.
Alternatively, you may receive advice to hold off filing a claim and miss the deadline. This extenuating circumstance could still qualify you for coverage with the help of a law professional to reverse the decision.
Successfully file with a lawyer at GMP Law
Getting help as soon as possible on your claim can save you a lot of headaches and frustration in the long run. Having to deal with insurance, superannuation, applications, paperwork and your injury is an overwhelming expectation put on a lot of people in recovery. Instead, you can not only likely expedite the process but get it right the first time with the help of GMP Law TPD law professionals.
You can focus on your recovery knowing that your lawyer is working in the background collecting medical information, forms, and applications and writing your letter to insurance for you. We know how long you’ll need to wait, how long you have until the deadline, the evidence you’ll need and so much more. Our law professionals write hundreds of TPD letters a year, and we are confident we can help you in your claim for coverage.
Reach out to a Gerard Malouf & Partners law professional today for a no-obligation consultation today to get started.
