If you have been impacted by an illness or injury and are unable to return to work, you may be eligible to make a claim for total and permanent disability benefits otherwise known as a TPD claim.
In this article, we will address some fundamental aspects of TPD claims, from what these are to the claim process.
What is a TPD Claim?
TPD stands for total permanent disability.
If you have sustained a permanent injury or illness then you may be eligible to make a TPD claim.
TPD insurance generally pays a lump sum if you become totally and permanently disabled because of illness or injury. This type of insurance can provide a financial safety net to help support you and your family if a permanent injury or illness prevents you from returning to work.
Eligibility for TPD Claims
The eligibility conditions for TPD claims can vary from policy to policy. Generally, however, you will need to establish that you are unable to return to work as a result of your condition or injury in order to bring a TPD claim.
It is important to note that an application for TPD benefit generally involves the completion of a thorough application that clearly shows how you meet the applicable policy definition. At Walker Law Group, we can assist you to investigate and lodge your TPD claim on a no-win-no-fee basis.
TPD Claim Process
When filing a TPD claim, the following steps are important:
- Step 1: Identity and assess your TPD insurance policies. This can include checking that the policies are valid.
- Step 2: Review the approval criteria and applicable definitions.
- Step 3: Submit your application. This generally involves the completion of a thorough application that clearly shows how you meet the applicable policy definition and sometimes supporting submission in respect of why your claim should be approved.
- Step 4: Follow up with the insurer on the assessment of the claim.
After you complete the above-mentioned steps, you should wait for the final decision. If you receive a denial, you can appeal the decision.
TPD Claim Challenges
It is not uncommon for an insurer to deny a TPD claim. The denial can be affected by a variety of factors and reasons, but in our experience, the most common reasons include:
- Failure to follow the required procedures, including missing documents.
- Lack of supporting evidence, such as insufficient medical documentation.
- Applying before the minimum waiting period has lapsed.
- Pre-existing conditions also can interfere with the claim decision and result in denial.
TPD Claim Time Frame
TPD claims are usually assessed within 6 to 12-months.
The first part of the timeframe is the initial waiting period. It starts from the day you stopped working due to a disability. Initial waiting periods are generally between 3 and 6 months, depending on your policy and you must wait for this period to lapse before you can apply for a TPD claim.
After the initial waiting period, you can file a claim. Thereafter, the initial assessment will generally be completed within 6-months of the date that all relevant information is supplied to the insurer. When the insurer makes the decision, it can take another two or more months for the superannuation fund trustee to finalise their decision in relation to the claim.
Please keep in mind that assessment timeframes can vary significantly from case to case. Contact expert lawyers to find out the approximate timeline for your case.
What Affects the Timeline of TPD Claim?
There are various factors affecting the overall timeline of your TPD claim. In our experience, the main factors include:
- Type of injury or disability. For instance, physical disability claims are generally approved relatively faster, providing the claimant has reached maximum medical improvement, compared to mental illness claims.
- The severity of injury or disability and whether further surgery is complicated can also impact the timeline of your TPD claim. This is because the insurer may not be able to determine whether a person is TPD as a person's condition may change and it may improve with treatment.
- The available medical evidence. Detailed and supportive medical reports will generally improve the assessment timeframes for TPD claims.
Frequently Asked Questions
Finally, it is time to answer the frequently asked questions.
How Long Does it Take to Receive a TPD Claim?
Receiving a TPD claim in Australia takes up to 12 months. This timeframe considers the initial waiting period, which is usually between 3 and 6 months from the date you stopped working as a result of your injury or disability. Thereafter, the insurer should complete the initial assessment within 6-months of receiving all the relevant documents. Thereafter, the claim will usually be referred to the Trustee for further determination which will usually take up to 2 months.
How Do Insurance Companies Try to Slow Down the Process?
It is no secret that insurance companies are also making a profit and the assessment of claims can sometimes be protracted with ongoing delays. At Walker Law Group our experienced team can assist you by following up with the insurer to ensure that your claim is assessed as quickly as possible.
How can a TPD Lawyer Help?
At Walker Law Group, our team can help you to navigate the legal procedures, gather all the necessary documentation and evidence, and ensure lodgment of a claim that gives you the best chance of successfully obtaining an approval.
If you have already filed a claim and it has been rejected, contact a legal professional to receive advice on the prospects of having the denial overturned.
Can you make multiple TPD claims at once?
Yes - if you have more than one TPD policy you may be eligible to make multiple claims. In our experience, this situation is not uncommon as a person may have multiple superannuation funds, each with their own insurance policies, as a result of changing jobs over the years. In these circumstances, we recommend seeking legal advice to ensure that there is no conflict between multiple policies prior to lodging your claims.
Win the TPD Claim with Professional Lawyers
At the Walker Law Group, we specialise exclusively in personal injury law and offer expert legal services. Our track record of success and hundreds of satisfied customers showcase our ability to win TPD cases efficiently.
Contact us today to find out how we can help you win.
