Total and permanent disability

Total Permanent Disability (TPD) is a type of Insurance cover, in which an individual is no longer able to work due to injuries. Total permanent disability, also called permanent total disability, applies to cases in which the individual may be unable to work again due to severe injuries.

However, each insurer has a different definition of what it means to be totally and permanently disabled and this is why it is important to understand the policy wording.

Case study: Mrs T was a passenger in a motor vehicle that was involved in a head-on collision. Amongst other injuries, she sustained a burst fracture of her spine resulting in paraplegia. Consequently, Mrs T was unable to continue to work as she now was reliant on care and assistance due to her limited mobility.

Many will be unaware that they may already have TPD cover as a result of automatic cover held within your superannuation and / or other insurances that they hold.

An example of this is when you commence work with a new employer and join the employers default superannuation fund where an automatic Insurance cover can be applied.

You should check your superannuation statement to check what cover you may have.

To lodge a TPD claim, you will need to contact your insurer or superfund and request the appropriate claims documents. The insurer may also ask for medical evidence relating to your injury/illness.

Most insurers will require two medical professionals to sign off that you are unable to work in any occupation (this will be in the policy wording). For some conditions you may need to meet the required waiting period.

Claiming on a TPD benefit means you are not working for at least 3 months. What this means is you must meet a minimum of 3 month waiting period before lodging your claim with the insurer. Please note that some policies may also have a 6 month waiting period.

It is in your best interest to disclose all illness as the insurer may request all medical records. By providing all the medical evidence this will help us to assess the claim. Please note some policies may have an exclusion for pre-existing conditions. Wording around pre-existing exclusions may be included in the policy document / Product disclosure document.

This will depend on the arrangement made with the insurer at application time. You may also hold more than one policy as you may have different superfunds. Some clients hold more than one superfund. You can check this with the ATO.

TPD payment made through the superannuation will incur tax payments This may also affect any Centrelink payments you may be eligible for. It may be in your best interest to seek financial advice when receiving a lump sum payment to help mitigate the tax and any Centrelink benefits.

We can also assist you with experts within this area that will help review the tax liability and look at ways to assist in reducing the tax you pay.

If your claim is declined, you have the right to dispute this with the insurer or you can reach out to the superannuation complaints tribunal or the financial service ombudsman. It is best to seek legal advice as soon as possible.

TPD claims can be complex and become overwhelming when trying to navigate through this process yourself. Seeking legal advice will remove the level of stress when dealing with the superfund or insurer.

With TPD, there can be a lot of grey areas and by having a lawyer to support you with the claim, we can prepare all the evidence required to move the claim along as quickly and smoothly as possible.

If you are feeling uncertain on what your rights are when looking to claim on TPD please contact our team at Accident Claims Lawyers. Our dedicated team will be more than happy to help you.