Compulsory superannuation in Australia means that many people hold a Total & Permanent Disability (TPD) policy through their super fund. ASIC has found that 90 percent of TPD policies in Australia are held through super funds, however, they can also be part of a life insurance policy or taken out independently through an insurance company, a financial adviser or an insurance broker.
TPD insurance pays out a lump sum if you become permanently disabled through illness or injury (whether as a result of your employment or not) and are unable to work.
TPD policies can differ quite markedly in terms of the definitions used by the insurer to determine whether you are eligible to make a claim. Familiarising yourself with the Product Disclosure Statement is essential when it comes to TPD policies.
We’ll explain more about eligibility criteria below, but if you need advice about whether you’re able to claim under your policy, contact TPD specialists BPC Lawyers today.
Own Occupation vs Any Occupation
TPD policies generally provide coverage in one of two categories: ‘own occupation’ policies that cover you if you are unable to work in your usual job, and for which you have special skills; and ‘any occupation’ policies, which cover you if you are unable to ever work again in your former job or any other job suited to your education, training or experience.
If you are unable to do your old job but you are able to continue working in a different job, you may only be eligible to make a TPD claim if you have ‘any job’ coverage.
The wording in your policy is critical to determining whether you are entitled to receive the TPD payment. The wording is strictly interpreted by the insurer and you will need legal advice and assistance to ensure that your claim is not frustrated.
What if you’re also making a workers’ compensation claim?
If you become injured or ill through your work and are making a workers’ compensation claim as a result, you may also be eligible for the TPD benefit even though you are pursuing a motor vehicle accident claim or are receiving benefits from Centrelink.
Where your superannuation policy also provides for income protection payments, those payments may be refundable if you recover damages or workers compensation. You will need to carefully read the terms of the insurance policy or seek legal advice about your potential liability to reimburse payments that have been made.
The need for accurate information
The insurer will usually request a lot of information about your age, occupation, medical history, family medical history, lifestyle (smoking, alcohol consumption, etc) and whether you participate in any high-risk sports or hobbies, before agreeing to provide coverage. You have a duty to provide accurate information and if you do not fulfil your duty of disclosure the insurer may avoid the policy.
Generally speaking, there is no time limit to making a TPD claim. There are time limits however to challenge a decision in the event that a claim is denied.
The ability to prove that your entitlement to the benefit occurred whilst the policy was in place will be easier if the claim is made without unnecessary delay.
Speak with BPC Lawyers
Making a TPD claim can be a complex matter and claims can sometimes take quite a long time to resolve. Collating medical evidence, and dealing with insurers and superannuation trustees, can be stressful and testing of a person’s patience.
If you are in the position of needing to make a TPD claim and are unsure about eligibility, or how to go about it, contact BPC Lawyers today. We are specialists when it comes to TPD policies and has helped many clients make successful claims.