If you find yourself in a situation where you are no longer able to engage in gainful employment due to a permanent disability, making a TPD claim against your superannuation policy can provide vital financial support. However, it is important to understand the criteria and requirements involved in making a successful TPD claim.
TPD insurance is a form of life insurance which pays a specified lump sum to the policy holder in the event that the insurer person suffers “total and permanent disablement” in accordance with the definition contained in the applicable insurance policy. This policy is in place to provide you with cover in the event that you are unable to return to work as a result of an injury or medical condition (psychological or physical).
Meeting the Definition of Total and Permanent Disability
The first and most crucial criterion is to meet the definition of total and permanent disability as outlined in your superannuation policy.
Generally, this definition refers to a situation where you are unlikely to ever engage in gainful employment for which you are reasonably qualified by education, training, or experience. The specific definition can vary between policies, so it’s important to carefully review the terms and conditions of your policy.
Education, Training and Experience
To be eligible for your TPD benefit, most definitions require you to be unlikely to ever engage in your own occupation or any other occupation for which you are suited based on your education, training, or experience.
Superannuation funds should take a realistic and common-sense approach when evaluating this aspect of your claim. They need to consider your previous education, training, and experience and determine if it is probable for you to obtain actual paid employment.
When assessing your ability to engage in your own occupation or any other occupation suitable based on your education, training, or experience, funds must consider whether you can obtain, undertake, and sustain a “real world” job. A “real world” job must be an actual existing job and cannot be hypothetical or contrived.
Roles created by sympathetic employers or compelled employment by a WorkCover insurer do not constitute real world jobs.
The superannuation fund should also consider whether a job that accommodates frequent unplanned breaks or light duties due to pain would be available on the open labour market.
Satisfying the Waiting Period
Most superannuation policies have a waiting period before you can make a TPD claim. This waiting period is typically a continuous period of disability, usually ranging from three to six months.
You must demonstrate that your injury or disability has lasted beyond the waiting period to be eligible to make a claim for your TPD benefit.
Many funds include a clause in their TPD definition stating that you must be unable to be gainfully employed in your usual occupation or any other occupation for which you are reasonably suited by education, training, and experience.
When considering if you can be reasonably retrained, the superannuation fund should assess what alternative occupations you could reasonably be trained for, taking into account your education, training, experience, and the limitations imposed by your injury or illness.
This is why the superannuation fund will often request accurate and detailed information about your work history, including job descriptions, employment contracts, and any vocational training you have received.
Under The Care of a Medical Practitioner
An increasing number of policies require you to be under the care of a medical practitioner in order to be eligible to make a claim for your TPD benefit. It is important that you carefully review the terms and conditions of your policy.
Additionally, compliance with the advice and treatment provided by the doctor is often necessary.
If accessing medical care or exhausting relevant treatment options becomes challenging, seeking legal advice is recommended.
Providing Sufficient Medical Evidence
To support your TPD claim, you will need to provide comprehensive medical evidence from qualified medical professionals. This evidence should clearly demonstrate the nature and extent of your disability, including medical reports, specialist opinions, diagnostic test results, and treatment records.
It is crucial to gather all relevant medical documentation to strengthen your claim.
Navigating the criteria for making a TPD claim against your superannuation policy can be complex. Understanding the fund’s definition of total permanent disability, the duration of your inability to work, the consideration of education and experience, activities of daily living, “real world” employment, active employment requirements, reasonable retraining possibilities, and the need for medical care are all essential aspects to be aware of.
Any delay in bringing a TPD claim and preparing the supporting evidence can lead to significant difficulties as the quality of evidence available to support a claim will diminish over time.
Seeking professional guidance from legal experts experienced in TPD claims can provide valuable assistance throughout the process.
Why Choose Stacks Goudkamp For your TPD claim?
We understand that this can be a stressful time, and we want to assure you that we are here to support you throughout the claims process. At Stacks Goudkamp, we want to alleviate that burden and provide you with the support you need.
We understand that every client is unique, and we take the time to listen to your story and understand your individual circumstances. Our personalised approach allows us to tailor our strategy maximising the chances of a successful outcome in your TPD claim.
Contact Karina Goodall at Stacks Goudkamp on 1800 25 1800 to discuss your entitlements today.
Written by Karina Goodall
Karina Goodall is a Practice Group Leader and Director at Stacks Goudkamp specialising in motor vehicle accident claims and superannuation and TPD claims.