Suffering an injury or receiving a diagnosis of a serious illness that stops you from working in your regular job may qualify you for entitlements within your Superannuation fund.

Do I have TPD cover?

Superannuation funds usually include, by default, a form of insurance known as Total and Permanent Disability (TPD) Insurance. Where illness or injury results in an inability to work, this insurance may deliver a lump sum payment over and above your superannuation account balance, even if that illness or injury is totally unrelated to work.

You may also have TPD Insurance attached to a stand-alone policy.

Your current Superannuation statements may show that you do not hold any insurance cover (TPD) but you may still be covered.

Our experience has shown that clients who have sustained an injury or suffered an illness, whether work-related or not, often attempt to return to work on more than one occasion following their injury or diagnosis. Therefore, when they do cease work permanently, their Superannuation statements may show they do not have TPD insurance. However, your ‘date of disablement’ is generally the date you ceased working your normal duties/hours. Subsequent attempts at returning to work are often considered ‘failed attempts’.

Provided you held TPD insurance cover on the date of injury/diagnosis and/or when you ceased working your normal hours/duties, you may be entitled to make a TPD claim.

It is possible to have more than one active Superannuation Fund at the same time.

Provided you held TPD insurance at the time of your injury/illness with each of these funds, you are entitled to make multiple TPD claims.

TPD definition

In order to achieve a successful TPD claim, you must satisfy the Fund’s definition of Total Permanent Disablement contained within their Insurer’s Policy. The TPD definition contains a number of elements that need to be satisfied and the TPD definition can vary slightly from fund to fund.

Generally, the TPD definition requires that:

• You have stopped working due to injury or illness;
• You have been unbale to engage in employment for six consecutive months;
• You are under the ongoing care of a medical practitioner; and,
• You are “unlikely” to ever return to your own occupation or any other occupation for which you are suited by education, training or experience.

Of course, remembering that the injury or illness does not have to be work related.

If you were not working at the time of your injury or illness, an alternative TPD definition applies. This definition is known as ‘Activities of Daily Living’. This is a very difficult definition to satisfy and requires you to show that you are unable to perform at least two out of five activities of daily living such as: feed yourself, toilet yourself, get out of a chair without assistance or walk any distance unaided.

What is the TPD claim process?

The first step is to confirm that you held TPD insurance with your superannuation fund at the time of your injury/illness and/or date you last worked.

After instigating your claim, the Fund will provide the necessary claim documents. These documents will typically include two medical statements to be completed by your treating practitioners.

In addition to completing the required claim forms, it is imperative to prepare a detailed submission to accompany the claim forms as the claim forms are quite brief and often do not provide the full picture.

At Ryan Carlisle Thomas, we gather all medical evidence in support of your TPD claim. This may include medical records and supporting medical reports. Often, we have existing medical evidence on our system if you are a previous or current Workcover/TAC client.

Our TPD submission will detail the client’s education, work history, full duties of their occupation, injury, subsequent treatment and ongoing symptoms. Most importantly, we break down the TPD definition, ensuring we satisfy each component. We believe this will give you the best chance of a successful claim.

Based on the provided information, the insurer will then make their assessment, generally within six months, and deliver a decision on your claim. The decision is typically binary, either accepting the claim or rejecting it.

If the claim is accepted, the insurer will pay out the insured benefit. Your account balance will also become available to you to withdraw. If you are under the age of 60, any withdrawals will be taxed at a concessional rate.

If the claim is rejected, you may be able to challenge the decision depending on the basis of the rejection.

It is important to note that time limits do apply if your claim has been rejected and you wish to dispute the decision. We strongly recommend seeking legal advice.

Are there time limits for making a TPD claim?

It is important to note that there are no time limits when submitting a superannuation TPD insurance claim. Therefore, regardless of when your injuries/illness forced you to stop working, if you were covered, you may have a claim.

Ryan Carlisle Thomas recently settled a case where our client ceased working 16 years prior due to a cancer diagnosis. Despite the closure of her account, the fund eventually agreed that our client was entitled to a TPD insurance payment as at the time she ceased work she was covered for TPD. As a result, a lump sum payment of $350,000 was made to our client.

Can I claim TPD while on worker’s compensation claim or TAC payments?

Yes, you are able to pursue a TPD claim if you have an ongoing Workcover or TAC claim.

TPD claims do not affect worker’s compensation or TAC claims because a TPD benefit is a lump sum insured benefit and not considered income.

Likewise, if you are receiving a Centrelink or a Disability pension, a TPD benefit will not affect your pension.

Many of our existing and former Workcover and TAC clients have achieved successful TPD claims.

Need help from a TPD lawyer?

There is a misconception that TPD claims are straightforward.

However, to give your TPD claim the best possible chance of success, it is imperative to provide a detailed submission, addressing the relevant TPD definition, along with providing all supporting evidence. We believe providing only the standard claim forms do not present the strongest claim.

Ryan Carlisle Thomas has a dedicated superannuation department, and their expert team understand the effects that illness or injury have on individuals and their families and bring a wealth of compassion and professionalism to all claims.

All of our work is performed on a No Win, No Fee OR Expenses* basis, meaning that there are no fees up front nor any legal costs or disbursements should the claim be unsuccessful.

For further information, visit the https://rctlaw.com.au/legal-services/superannuation-tpd-insurance/ phone (03) 9238 7878 or email supertpdadmin@rctlaw.com.au