What is a TPD claim? What are the eligibility criteria?

TPD stands for Total and Permanent Disability. Some superannuation funds provide default Total and Permanent Disability (TPD) insurance for their members. You may also have TPD insurance retail policy that you applied for and purchased yourself. However, just because you have TPD insurance, it does not automatically mean that you are covered and that you can make a claim.

Firstly, to ensure that you are covered, you must satisfy the specific eligibility requirements and exclusion clauses contained in the fund’s TPD insurance policy. This often depends on your circumstances at the time the insurance policy was entered into by the fund. Usually factors such as, whether your employer had made regular super contributions, whether you were actively working, your age, pre-existing conditions, are considered.

Secondly, to be able to make a TPD claim, you will also have to meet the definition of “Total and Permanent Disablement” as specifically defined in their insurance policy. It is usually intended to cover for people who are unlikely ever to work because of permanent restrictions caused by their injury or illness.

In order for you to be successful in the claim the insurer, and where applicable the Trustee of the Fund, must be satisfied, based on the medical and other evidence available, that you meet the definition of Total and Permanent Disablement as it applies to you. Each definition will vary from policy to policy however the standard definitions that are usually seen are:

Total and Permanent Disablement

As a result of an injury or illness, the insured person has not worked for 3 or 6 consecutive months and, at the end of that period, is so disabled as to be unlikely to return to his/her usual occupation or any occupation that he/she is reasonably suited to perform based on education, training and experience.

Often there are other applicable definitions for people who were not working, perform full- time domestic duties, or have specific medical conditions.

Finally, the TPD benefit amount you may be entitled to will depend on your date of disablement, not how much your TPD insurance cover amount is today. This also means that, even if your superfund informs you that you do not have TPD insurance today, if you had TPD insurance at your date of disablement, you may still be able to make a TPD claim.

For expert legal advice and representation in relation to any TPD or Superannuation claim do not hesitate to contact Brydens Lawyers without delay on 1800 848 848 or at brydens.com.au. At Brydens Lawyers – #WEDO TPD and Superannuation claims.