Frequently asked questions - Berrill & Watson

Frequently asked questions

TPD Claims - Frequently Asked Questions

At Berrill and Watson we are often asked all sorts of questions about superannuation and insurance claims. So, we have called on our years of experience to answer some of the most frequently asked questions we get about TPD and superannuation and insurance claims. If you question isn’t answered below, please email or call us and ask us and we will provide you with a detailed response.

What is TPD?

Total and Permanent Disability (TPD) is usually and insurance lump sum. It might be part of your superannuation of a separate insurance policy or both.

What does TPD mean?

TPD or Total and Permanent Disablement usually means that you have stopped work because of an injury or sickness for more than 6 months and you are unlikely to ever go back to work in any suitable work given your education, training or experience (suitable occupation TPD). Some TPD policies add a retraining clause ie you must also be unfit to go back to work in a job you could be retrained to do. Some TPD policies are more generous- you only need to be permanently unfit fit to do your normal job (own occupation TPD)

What does suited to by education, training or experience mean?

This term is common used as part of the definition of Total and Permanent Disability (TPD). As part of an assessment of your TPD claim, the insurer will consider all of the work that you have done in the past and all of the skills and education that you have and then consider whether (taking account of all these things) you can return to work when the impact of your injury or illness is considered.

Does my super fund have insurance?

Almost all super funds have insurance for their members. Sometimes the cover can be stopped by different events (such as a change of jobs, contributions stopping or a person stopping work), however, even in these circumstances, successful TPD claims can often be made.

How long does it take to claim a TPD benefit?

The amount of time that it takes to claim a TPD benefit varies and depends on the circumstances of the claim and the information that is available relating to the claim. Typically, claims take longer if:

  1. All of the relevant information is not given correctly, and completely when you lodge your claim;
  2. It is necessary to request PBS or Medicare history;
  3. Information or documents need to be obtained from the ATO; and/or
  4. A claimant is unsure about their past medical or employment history or they are unsure which fund hold their super monies.
As expert superannuation TPD lawyers, we are skilled at getting claims assessed quickly and can give quick advice on what funds and insurers absolutely do and do not need to assess your claim.

Are there any medical conditions I can’t claim for?

No. You can usually claim for any medical condition. Many people think they can’t claim for depression or other mental illnesses, but that is not usually correct. If the medical condition has caused you to stop work, you should seek some advice as soon as possible.

What is the TPD claim process?

There are a number of steps involved in making a successful TPD claim. First you must get the claim forms. Some funds may refuse to give you the documents by telling that you are not sick enough to make a claim or they may say you can’t have claim forms until the waiting period (6 months) has passed. If this happens you should seek legal advice because if you have been paying insurance premiums, you should be provided the claim forms at the very least. A TPD claim will usually require the completion of:

  • A claim form by you, usually called a Member’s Statement
  • A form for your doctor, usually called a Medical Attendant’s Statement
  • A form for your employer, usually called an Employer Statement.
The forms must be completed carefully and accurately by the claimant and their doctor and employer. At this stage it is vital to get all of the details right to avoid any unnecessary delays or a rejection. Expert advice is recommended to avoid delay or rejection. Once the claim forms are lodged, the fund and insurer will assess your claim. They will usually ask for more documents from you or that you see a doctors that they choose. If you have doubts about the fund/insurer’s choice of doctors or whether or not they need the documents which they have requested from you or a third party, it is worthwhile getting some legal advice.

How much is a TPD payout?

The amount of money that you will get from a TPD payout differs from policy to policy. Usually the TPD cover held in a fund is aged based and is calculated at the date you stop work. This means that the cover changes as a person gets older. Also, people can increase or fix the insurance cover which they hold in a super fund. We offer free super checks to anyone who would like us find out how much TPD cover that they have in their super fund.

Can I have more than one TPD claim?

Yes. Most people have more than one super fund. If you have insurance cover in more than one super fund, you can often claim a TPD benefit from each super fund.

Can I still claim a TPD benefit if I stopped work a long time ago?

Yes. It may be more difficult to claim, because of availability of doctors who treated you back then, or sometimes because the fund may have changed name, but the claim may still be valid.

Do I need a lawyer for TPD claim?

Some people do their claim themselves and are successful without a lawyer. However, we have seen many instances where people have made simple mistakes which has caused their claim to be rejected. Remember insurers and super funds have lawyers in-house who provide claims assessors with guidance on “claims strategy”. One of the big problems in claims can be delays caused by insurers who say it is too early to assess the claim, or who drip feed requests for documents. We know the process better than anyone and can explain it to you. We won’t let the super funds or insurers stuff you around or delay your claim unreasonably.

What does it cost for a TPD claim with a law firm?

People are often concerned about what the costs of lawyers would be. We do all claims on a no win, no fee basis. We charge a fixed fee so you know up front, before the claim starts exactly what the cost will be. There won’t be any surprises. We will, wherever possible, beat any quote of any other law firm.