Total and Permanent Disability (TPD) & Super Claims – Australia-wide

Total and Permanent Disablement (TPD) insurance is often provided by your superannuation fund. The purpose of TPD insurance is to provide a lump sum benefit if you become totally and permanently disabled and can no longer work. TPD cover is not limited to workplace injuries, so you can claim whether this is due to an accident, injury or medical condition.

To qualify, you must be medically certified as unable or unlikely to work again in any capacity, and in any occupation based on your previous education, training and experience.

If a TPD insurance payment is approved by the insurer, you will generally be eligible to withdraw your preserved superannuation benefit also.

We will generally require the following information to lodge a claim:

• details of your medical condition and treating doctors,
• details of your last employer, including date last worked and occupational history,
• details of any other claims, such as Workers Compensation or other insurance policies,
• any medical reports or information you have,
• any authority forms required by the fund and insurer,
• certified identification, such as driver license, passport or birth certificate to validate your identity.

Whilst the claims experience can vary considerably based on several factors, including which superannuation fund you are with, there is a general process which is followed. Our experienced staff will guide you through the process to ensure it is as smooth as possible.

1. Notify and confirm cover: In the first instance, Claimo will contact your superannuation fund(s) to confirm if you hold TPD cover. We will request relevant policy information to assist in determining if you may be eligible for a TPD benefit.
2. Gather relevant documents and information: We will assist you to complete any forms required by the fund’s insurer. We will let you know what additional information you can provide to assist in making the claim process as quick and straightforward as possible.
3. Submit the claim: Claimo will prepare your claim file and submit this to your fund. The fund will make a formal claim against the insurance policy with its insurer.
4. Insurer’s assessment process: The insurer will assess the initial information provided. If they require any additional information, they will advise Claimo within 20 working days. Typically the insurer will request additional medical reports and information direct from your providers. If you are required to obtain any information, we will let you know.
5. Insurer and super fund make a decision: The insurer will provide the fund with its decision. The fund trustee must also make its own decision on your claim. The superannuation fund will notify Claimo of its decision.
6. Payment (if approved): If your claim is approved, you will typically have several options, although this will depend on your fund. This can include having the whole amount paid into your bank account, keeping some or all of the benefit in your superannuation fund or setting up an income stream with your fund. We will notify you of what options are available from your fund if your claim is approved.

It’s possible your TPD benefit payment may result in financial or tax implications so you may also want to consider getting independent advice.

If the insurer and fund decline your claim, they will provide a written decision to Claimo. We will notify you of the reason for the decision and discuss the available options with you.

On occasion, the insurer may decide to defer your claim for a period if it believes more time is needed to determine the full extent of your disability and whether it’s permanent. For example, they may do this if you need to have surgery, or your doctor feels your condition is likely to improve over time with continued treatment. A timeframe will be set and the insurer will review your claim again at the end of this period.

The timeframe can vary, however the insurer must aim to make a decision within six months from when the claim forms are submitted.

Some factors which can influence the time frame or contribute to delays are:

• turnaround time for information requests (from you, your medical providers, employer, other insurers)
• if your injury or illness happened several years ago
• if your treatment is ongoing
• if you’ve returned to work in some capacity

You can assist us in making your claim process as quick as possible by ensuring you provide any additional information we need. You must notify us of any changes to your personal or medical circumstances such as medical treatment, medical providers and any return to work.

Generally, legal fees vary based on the complexity of the case and the amount of work involved in each case. Claimo charges a set fee for successful claims regardless of how the process goes. This means you know up front how much you will pay if your claim is successful.

A typical TPD claim does not require complex legal advice or assessment. Claimo’s team has the requisite industry experience to review employment, medical and financial information against relevant policy definitions to assist in managing your claim.

Claimo operates on a no win, no fee basis. If no claim payout is obtained, no fee is payable. If your claim is successful and paid out at the initial claim stage a fee of $10,000 + GST per successful claim applies. If your claim is declined and escalated to internal or external dispute resolution (for example, due to a dispute, further assessment, or internal review) and is then paid out, a fee of $15,000 + GST applies.

If a claim is approved, we recommend you seek financial and/or taxation advice to understand the implications for you, including how you’ll be taxed. It’s important to understand your options and how a TPD payment may affect other potential benefits such as Centrelink payments.