As most people are aware, in order to achieve a successful TPD claim, you must satisfy the TPD definition contained in the Insurer’s Policy applicable as at the Date of Disablement.
However, unbeknown to many people, there are multiple TPD definitions contained in the Policy that may or may not be applicable to your situation, depending on many factors including job classification.
Understanding TPD Definitions: ETE vs ADL
The most common TPD definition is commonly known as ‘Education, Training and Experience’ (ETE).
This definition broadly means that you have sustained an injury or illness that prevents you from returning to your pre-injury occupation or any other occupation based on your existing education, skills and training.
This is generally the most straightforward definition contained within the Policy.
The other definition that may apply is known as ‘Activities of Daily Living’ (ADL).
This definition means you are unable to independently perform at least two daily living activities, such as feeding, toileting or transferring from one chair to another unaided.
How Job Classifications Determine Your TPD Category
Your job classification may determine which TPD definition is applicable, regardless of whether you satisfy the ETE definition.
Within the Insurance Policy there is an Occupation Guide. The Occupation Guide is unique to your Policy and often varies between Insurer’s.
Depending on your occupation at the time of your injury, your occupation may be classified as ‘special risk’ and subsequently fall under ADL category in the Occupation Guide for satisfying the TPD definition.
Typically, occupations of a very physical and high-risk nature, such as underground mining work are rated ADL within the Occupation Guide.
However, this is not always the case and is important to be aware of when applying for TPD insurance.
Real Case Study: Same Person, Different Outcomes
We recently acted for a client who held two Superannuation memberships with different Superannuation Funds.
Both memberships offered TPD insurance, however his occupation placed him in different categories within each Insurer’s Occupation Guide. His job description as at his date of injury placed him in ETE definition under one Policy and ADL for the other Policy.
Our client’s TPD claim was accepted by one Fund’s Trustee under the ETE definition.
The other Fund’s Trustee rejected the TPD claim on the basis he did not satisfy the applicable TPD definition, being ADL.
Our client was not aware of this when he took out the Policy many years prior, and had been paying insurance premiums for TPD cover that would make any potential TPD claim extremely difficult to succeed.
Similarly, you may be classified as a ‘non-manual’ office worker and provided a certain level of TPD insurance that you may not have qualified for if you were a ‘manual worker’. If, at the time of the claim, you were working in a manual role, this may place you in the ADL category, making it very difficult to satisfy the applicable TPD definition.
What To Do
The takeaway here is two-fold:
- When applying for TPD cover, you must check the ‘rating’ of your occupation against the relevant Insurance Policy to be aware of your occupation classification and relevant TPD definitions applicable;
- Should your occupation or duties change you must check with your Superannuation Fund if this change impacts your existing TPD cover and subsequent requirements if you were to make a claim.
Being aware of your occupation classification and subsequent relevant applicable TPD definitions provides you with the best chance of success should you be required to submit a TPD claim.
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