Total and Permanent Disability (TPD) insurance is the coverage provided by many super funds that entitles one to a lump sum payment if injury or illness (mental or physical) has prevented them returning to work in their regular capacity. Importantly, injuries and illnesses extend to anything that prevents your return to work.
To be eligible to make a claim, you must show that you are permanently unfit to undertake your usual employment or any other employment which you are qualified based on your level of experience, education and training. This means that when making a decision, an insurer will take into account all of the experiences a person has in their life – their schooling, any specialist trades or licences and the types of work they have undertaken. To be eligible, you must also satisfy the conditions set out in your insurance policy or super fund.
To submit a claim, several steps need to be taken. Firstly, let’s consider the steps taken in receiving a TPD benefit from your super fund.
Contact your super fund
You will need to contact your super fund and request the necessary claim documentation. This documentation consists of a
- Initial claim form;
- 2 x Medical Attendant Statements;
- 2 x Certificate of Releases;
- Employer Statement; and
- Any authorities that the Super Fund require you to sign. These authorities are usually to allow the super fund and Insurer to request further information from your treating doctors
Submitting your claim
You will need have all of the above completed before you can submit your claim. However, if you are having trouble, your case manager will provide you with assistance throughout the claim process and help ensure that all of the necessary documentation is received.
The following additional documentation is usually needed to be provided:
- A form of ID such as your birth certificate, driver’s licence or passport;
- Any existing medical reports;
- Any medical evidence to support your claim; and
- Your Centrelink, CTP or Workcover file if you are on any of these schemes.
To avoid delay, it’s advisable to have all of the above submitted from the outset.
Your insurer assesses your claim
Your insurance provider will assess the documentation that you submitted. In some cases, they may request further evidence, such as doctor reports, or a medical examination undertaken by an independent specialist.
Acceptance, Procedural Fairness or Declined of your claim
After assessing all the information provided, your insurance provider will make the following determination:
- Accepted. Your insurer has accepted your claim and will contact you with your claim payment options and advise of the tax payable on withdrawal.
- Procedural Fairness. Your insurer has deferred your claim as they believe that you may not meet the TPD definition. The Insurer will give you 28 days to submit further evidence. This is where you should contact WKB TPD Lawyers for a free review to determine your prospects. After you submit further evidence, your Insurer then may either accept or decline your TPD claim.
- Declined. Your insurer has denied your claim because you have not satisfied the conditions of the policy.
Most TPD claims should take around 6 months before a decision is made. It’s very important that your both your super fund and your insurer have all the information to be able to make this decision. A lawyer can make sure you have all the requisite documents, claim forms and medical evidence so that your super fund will make a decision within the timeframe.
At WKB, we understand that the process to receiving your benefit can be lengthy, however, we want you to know your rights and to be eligible to claim and more importantly, receive the full range of benefits and compensation for your individual circumstances. If you’d like to learn more about how we can help you with your TPD claim, contact one of our friendly TPD experts for a free consultation on 1800 865 225