If you can’t work because of injury or illness, you might be able to make a TPD Insurance Claim.
TPD stands for Total and Permanent Disability.
It’s very important to understand that disability in this context refers only to an inability to perform your work. A common misconception is that to qualify for TPD benefits, you have to be disabled in the sense that you cannot mobilise or that you need constant and ongoing domestic care. That is not the case at all.
The other important thing to remember is that disability can mean both a physical injury or illness, as well as a psychological condition.
Some common examples of disability include chronic back pain, blindness or post traumatic stress disorder.
Its also important to realise that two people can have the same condition but, depending on the circumstances, one of them may qualify for TPD benefits while the other might not. For example, if a physical worker, who has no experience in any other type of work, develops chronic and permanent back pain that is so severe that they are unable to do any physical work, they may qualify for TPD benefits, but an office worker with the same condition may not necessarily be able to get over the threshold. In other words, whether a particular condition qualifies as “Disability” depends on all the circumstances of the case.
Most employees have TPD cover through their superannuation fund.
Many people don’t realise this, but when you join a super fund (regardless of whether you chose the fund or whether you join the employer’s default fund) the fund will purchase a TPD insurance policy on your behalf. Basically, the fund purchases the same policy for all of its members.
This insurance policy includes TPD cover.
It is possible to opt out from this insurance, but if you have not taken that step, then it is likely that you have TPD cover at least through your super fund.
You can verify this by contacting your super fund and requesting an up-to-date statement. This will include things like your current super balance, but it will also include details about any insurance cover available to you.
In addition, it is also possible to purchase TPD cover outside of super. For example, you can buy TPD cover by contacting a private insurance company that offers this. In addition, some people have TPD cover through their employer. This is because some large employers arrange for group insurances for all of their employees.
The point to remember is that, if something happens and you can’t return to work, it is important to investigate whether you would potentially have TPD cover either through your super fund or through some other arrangement.
First of all, each policy is different. There is no “standard” amount.
Having said this, generally speaking TPD cover arranged through the Super fund will probably be for a lower amount than if you buy TPD yourself.
In addition, some industry funds tend to have lower amounts. For example, we commonly represent injured clients in the meat industry and the available TPD coverage is around $80,000 to $100,000.
However, it’s also important to bear in mind that the amount of cover changes as you age. A 25-year-old worker will have a higher amount than a 40-year-old worker. Basically, there is a small adjustment to your cover on an annual basis.
You don’t necessarily need a lawyer, and in fact we have had situations where we considered a case to be so straightforward and obvious that we encouraged our clients to do the claim themselves. Having said that, there are a few reasons why you may wish to consider engaging a competent lawyer to represent you from day one.
Firstly, sometimes there is a dispute with the insurance company about how the insurance policy should be interpreted. For example, we represented a client who lost approximately 90% of their vision. The insurance policy said that TPD benefits will be paid if you lose your vision. But the insurance company wanted to argue that what they meant was that you have to be completely blind. You may think this is a trivial dispute but in fact there was a very significant amount of money at stake and the insurance company delayed payment by almost 9 years before our client came to us and we were able to help them.
This example is not unique. Often the insurance companies will use outdated definitions for certain medical conditions, and these outdated definitions generally favor them and not you.
Secondly, there can be a dispute about the severity of your symptoms. Your treating GP might think that you are unable to return to work, but the insurance company can send you to their doctor who will write a report that is favorable to the insurance company. In these types of situations, we may be able to assist in getting the right expert evidence, to get you over the line.
These are just 2 examples, but there are many other types of disputes.
If you would like to discuss a potential TPD claim, please contact us and we will be happy to arrange for a no obligation consultation.
We act for clients on a no-win no-fee basis in all of these claims.
Please also keep in mind that in TPD claims, we act for client’s nationwide given that the law is the same in relation to these claims no matter where you live in Australia.
Many firms try to rush you to sign up with them without carefully considering your options. We encourage you to first learn about your personal injury claim. You should ask yourself:
Our book is available to you free of charge. You don’t have to be a client to receive this book. Head to the order page and we will be happy to send you a copy straight away.
In TPD claims, we act on a No Win No Fee basis. Our fees are also fixed. This means you know from the start how much you pay if your claim is successful. See our dedicated page which explains our cost structure in TPD claims, together with a video.