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Thinking of making a TPD claim? Learn the 5 key steps to take

If you're lodging a TPD claim, it's likely you've got a lot on your plate. This guide can make things a little easier for you.

How to make a TPD claim Learn more
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Suffering a serious injury or illness is stressful enough – don't let the total and permanent disability (TPD) claims process add extra pressure. This guide will help you understand when and how you can lodge a TPD insurance claim, so you know exactly what to expect and you can ensure the claims process is as smooth as possible.

What is a TPD claim?

TPD insurance provides a lump-sum payment if you ever suffer a serious injury or illness and are no longer able to work. The claims process can be lengthy, because insurance companies want to be certain that a disability is total and permanent, before providing the lump sum.

Am I eligible to make a TPD claim?

There are a few basic conditions you'll have to meet before you become eligible to make a TPD insurance claim. The specific criteria varies between different insurance companies and individual policies.

It's worth checking with your insurance company to find out what requirements you have to meet, before making a claim. We've listed a few common variations in the table below:

Requirement Variations between insurers
Your disability is total and permanent
  • You're unlikely to return to any type of work
  • You're unlikely to return to your previous role
  • You have lost a limb or suffered a serious injury
You've met the waiting period
  • Some conditions don't have a waiting period
  • You've been off work for at least 3 months
  • You've been off work for at least 6 months
You can prove work history
  • You were employed full-time for at least a year before the claim
  • You were in full-time employment when the claim was made
  • You were working a set number of hours before the claim was made
You've lost some independence
  • You can show you're unable to perform two to three daily living activities, such as using the bathroom or washing yourself
You're complying with ongoing medical care
  • You must maintain regular appointments, advice and care of a medical specialist
  • You must be under regular care of a medical practitioner
  • You must be undergoing, or have undergone, rehabilitation

How do I make a TPD claim?

The exact claims process varies between insurance companies and different super funds. However, in general, this is usually how it works:

Step 1Contact your insurer or super fund. Tell the company about your intention to make a claim and find out what evidence you'll need to provide.

The exact process varies, but a member of the claims team will be able to walk you through next steps. You may be assigned a case manager at this point.

Step 2Submit your claim. Fill out any forms provided and include evidence of your condition. Medical reports and employer information, along with relevant statements, should be included.

Once you've passed this onto your case manager, they'll keep you up to date throughout the process, and let you know whether you need to provide anything else.

Step 3Your claim is assessed. The insurer will decide whether you are eligible for a claim. In some cases, the insurer may request further evidence, such as a second opinion, or further medical exams.
Step 4An initial decision is made. After assessing the information, the insurance provider will accept, defer or decline your claim.
Step 5Respond. You may be given an opportunity to provide more supporting information if the claim is initially rejected. You can also lodge an appeal if you don't agree with the decision.
  • Accepted: The benefit will be paid and your insurer will be in touch to finalise payment details.
  • Deferred: Further assessment is required so your payment will be delayed.
  • Declined: You have not satisfied the conditions of the policy and will not receive payment.

Did you know? If you have TPD insurance with more than one super fund, you might be able to claim multiple benefits. Contact your funds directly to find out how they handle multiple benefits.

Claiming TPD bundled with life insurance

If you have bundled a total and permanent disablity policy with a life insurance policy, a TPD payout will reduce your overall life insurance cover. For example, say you were to take out $1.5 million worth of life insurance cover and combine it with $500,000 TPD insurance.

If you suffer an accident and become disabled, you will receive $500,000 for a successful claim, and your TPD cover would then end. However, this will now mean that your life insurance cover amount will be reduced by this amount, which in this case brings it to $1 million.

How long does a TPD claim usually take?

A straightforward TPD claim shouldn't take more than 2-3 months to be completed, while more complex cases may take around 6 months. Unfortunately, difficult and contentious cases can take years to settle.

If your claim is taking too long, you may want to consider lodging an internal complaint to the insurer or superannuation fund, or to the Australian Financial Complaints Authority (AFCA). You may also want to consider hiring a lawyer who specialises in TPD claims.

What's the difference between "any" and "own" occupation?

Your likelihood of being able to make a TPD claim may largely depend on whether you have insurance for any occupation or own occupation.

TypeWhat it means
AnyYou'll receive a benefit if your injury or illness stops you from working in any occupation. This is typically the cheaper option, but it's harder to make a successful claim.
OwnYou'll receive a benefit if you're unable to work in your own occupation. This is more expensive, but can be easier to prove when it comes to claim time.

Do TPD benefits get taxed?

This is a little tricky, and we explain it better here, but in a nutshell:

  • If TPD insurance is through your super: The benefit isn't taxed when it's initially credited to your super account. However, if you withdraw the money from your super early – which means before the age of 60 for most people – it is subject to tax.
  • The effective tax rate on withdrawal can vary between less than 1% to over 18%. In fact, a person with multiple TPD claims may have a different tax rate on each one.

  • If TPD insurance is through an insurer: The benefit is not taxed. Your premiums were subject to tax, so you don't pay tax on the payout. Easy.

How to get a TPD claim approved

The best way to get a TPD claim approved is by providing as much information as possible and cooperating with your insurance company.

You may have to comply with post-injury or post-illness medical requirements. For example, your insurance company may require ongoing rehab or specialist appointments.

Remember, you have a duty of disclosure when lodging a TPD claim. That means you have to tell the company any information that's relevant to the outcome of your claim.

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Fully underwritten with Trauma and TPD options. NobleOak offer up to $15 million maximum cover level.

Can I claim TPD for partial disability?

Although TPD insurance refers to total and permanent disability, some insurance companies will provide a payout for partial disabilities.

This means you'll have cover for any income lost if you can only work at a reduced capacity because of sickness or injury.

Benefits may be paid out under the following options:

  • Hours-based. You'll receive benefits if you can't work as many hours. To qualify, you'll need to earn less than you did before your disability and be under medical care.
  • Duties-based. You'll receive benefits if you're unable to perform all the duties essential to your previous job and are making less money as a result.

Some policies will also provide partial payment if you suffer certain disabilities. This may include loss of limbs or loss of sight.

Could my TPD claim be disputed?

In some cases, your TPD insurance claim may be disputed. This means your insurance company might not pay your claim. There are a few reasons why this might happen:

  • Varied definitions. There is no standard definition of TPD. Your insurance company might not agree that you are totally and permanently disabled.
  • Ongoing requirements. Some TPD insurance policies will only pay out if you follow ongoing specialist advice or even a rehabilitation program.
  • Waiting periods. Some policies enforce waiting periods before a payment is made. This means you might not be able to access your benefit immediately.
  • Exclusions. TPD insurance doesn't cover everything. If you're totally and permanently disabled due to a pre-existing medical condition, you might not receive the benefit.

What could I do if my TPD claim is denied?

It's possible that your TPD claim might be denied. If that happens, there are still measures you can take to get your case reassessed.

  • Understand why you were denied. If your claim is rejected, your insurance company has to tell you why. Understanding the company's reasoning is the first step to forming a strong counter-argument.
  • Put together your case. Gather evidence that proves your insurer was wrong to reject your case and supply any supporting evidence. Perhaps your insurer declined your claim because it believed the illness was pre-existing, but a doctor disagrees.
  • File a dispute with the insurer. Your insurer will have an internal dispute resolution process (IDR). Send your case to your insurer's resolution department and it will be reviewed by a team which did not initially handle your case.
  • Wait. Insurers have 45 days and super funds have 90 days to make their final decision, although they do have to communicate with you at reasonable intervals during that time.

If things still don't work out:

  • Talk to AFCA. Lodge a complaint with the Australian Financial Complaints Authority (AFCA).
  • Take legal action. There are law firms that specialise in having TPD claims approved.

Jake Gardiner

What are some common things to watch out for when making a TPD claim?

  • Multiple funds. It's critical to first check whether you have multiple funds or policies. You can do this by checking your ATO account or calling the ATO.
  • Waiting periods. Every super fund's policy is different. Some of them have a mandatory waiting period of 3 to 6 months before you can lodge a TPD claim.
  • Payments. Should you lodge a claim and it is successful, you may not necessarily be paid a lump sum of your total TPD benefit. Something to be mindful of is that some super funds prefer to pay the claimant in yearly installments. This allows them to reassess your circumstances to ensure you're still eligible to receive those funds over a number of years.

Are there some common traps that people fall into, or things people forget when making a TPD claim?

  • Fine print. Always make sure you read the fine print when choosing your super fund and policy because there are some things that may not be obvious when you sign up. For example, there are some exclusions that may apply to your policy, such as pre-existing medical. These can have an impact on your ability to claim.
  • Qualifying for TPD. Depending on your policy, your occupation type may determine the level of impairment you must demonstrate to qualify for a TPD payment.
  • Permanent injury. Your inability to work needs to be permanent. You cannot claim TPD if you will only be unable to work for a short period of time. Workers' compensation may be a good option for those people who are temporarily unable to work.
  • Early access to super fund. TPD can only be claimed where you have ceased work for medical reasons. You cannot make a claim for unemployment as a result of non-health-related factors, such as redundancy. Recently many people have been confused between accessing their super early (an initiative by the Government in response to redundancies due to the Covid-19 pandemic) vs a TPD claim through their super.

Any tips on making a TPD claim?

  • Check your paperwork to know who your fund is. You must be a member of the fund and have insurance cover at the date you ceased work.
  • Always discuss your injury with your GP soon after it has occurred. Without documentation from a GP, it will be difficult to establish that you are TPD.
  • It's crucial to confirm the date you last worked. This is imperative in determining whether you're eligible for a TPD claim, as you must be covered for TPD as of this date. Additionally, the amount you are insured for is usually calculated based on the date you last worked.
  • Seek out free advice from a lawyer. They will be able to tell you whether you're eligible for a claim and advise of any documentation you will need to support your claim.

Compare TPD insurance quotes

1 - 4 of 23
Name Product Maximum Cover Minimum Cover Maximum Entry Age Expiry Age Stand alone or Add on policy hide
NobleOak TPD Insurance
$5,000,000
No minimum
59
75
Add on
Get fully underwritten Total and Permanent Disability Insurance that can be customised to fit your occupational situation and financial circumstances.
Real TPD Insurance
$1,000,000
$50,000
59
65
Add on
Get a quote for up to $1 million in TPD cover.
Medibank TPD Insurance
$1,250,000
$100,000
60
65
Add on
RAC TPD Insurance (Only available in Western Australia)
$5,000,000
No minimum
59
75
Add on
When you purchase RAC TPD Insurance, WA residents receive complimentary RAC membership which includes access to discounts on fuel, savings on shopping, entertainment and more. T&Cs at rac.com.au.
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TPD claim story: 'I could only receive half of what I was promised'

"I wish I had known sooner - Julia, 57"

Julia is a former ambulance officer from Queensland. She had TPD insurance through her super fund, and made a claim in 2016 as she was suffering from fibromyalgia.

In the two years leading up to the claim, Julia had also been suffering from PTSD. When she finally lodged the TPD claim for her fibromyalgia, she was expecting to receive $450,000.

However, after undergoing an 18-month claims process, Julia was surprised to learn she would only be receiving $300,000 in disability cover.

"They told me I could only receive $240,000 because of my age, which is almost half of what was promised," Julia told Finder. "Then they said they would backdate the payment to 2015, so I would receive 300,000."

Finder contacted Julia's super fund and confirmed that the value of the potential TPD benefit policy does reduce as you get older, but the payment will be backdated to the date of the claim.

"Make sure you check if your cover diminishes as you get older," Julia added. "Age reduces cover and it's something I wish I had known sooner."

It's not the only advice Julia has for anyone else going through a TPD claim – she also urged other policyholders to be well-prepared for any insurance-mandated medical assessments.

"Be aware of the independent medical assessments, especially those provided by the insurance company," she said. "Demand taking in a support person who can witness and verify what he or she said."

Frequently asked questions about TPD claims

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30 Responses

  1. Default Gravatar
    NarelleAugust 5, 2019

    I receive TAC loss of earnings from a car accident 2 years ago but circumstances have changed financially & I never expected my recovery to be this long & there is no hope of me returning to my role in my previous positions because of ongoing back problems from the accident. Am I eligible for TPD or early super funds?

    • Avatarfinder Customer Care
      JeniAugust 6, 2019Staff

      Hi Narelle,

      Thank you for getting in touch with Finder.

      In situations where you are permanently incapacitated, you can apply to your super fund for early release of super. Often referred to as a “disability super benefit”, this amount can be paid as a lump sum or an income stream.

      To qualify for early access, you’ll need to prove to your fund that you have a permanent physical or mental medical condition that will most likely prevent you from ever working again in a job for which you are suitably qualified. This must be certified by at least two medical practitioners in order for you to receive concessional tax treatment.

      If you qualify for this payment, keep in mind that you almost certainly also qualify for a Total and Permanent Disability (TPD) insurance payment. If you hold TPD cover through your super fund, this may offer the financial support you need.

      You can make a TPD claim if you satisfy the conditions set in the policy by the insurance company or super fund that holds your cover. This usually involves showing that you’re no longer able to work. Insurers will typically look at the following criteria when assessing TPD claims. Please note that criteria will vary from insurer to insurer.

      I hope this helps.

      Thank you and have a wonderful day!

      Cheers,
      Jeni

  2. Default Gravatar
    LesleyJanuary 10, 2018

    What should I do when someone I know well is claiming tpd through the court system, due to a accident at work. However he was injured but not TPD therefore his claim is fraudulent.

    • Avatarfinder Customer Care
      HaroldJanuary 10, 2018Staff

      Hi Lesley,

      Thank you for your inquiry.

      If you have any concerns or issues with a claim you will need to contact your insurer and go through its dispute resolution process. If after this process you’re still not satisfied, you can contact the Financial Ombudsman Service.

      I hope this information has helped.

      Cheers,
      Harold

  3. Default Gravatar
    MikeSeptember 14, 2017

    Just wondering how long it generally takes to receive a TPD payment once it has been approved and an amount agreed upon?

    My partners TPD claim has just been approved and we’re waiting for the payment to assist with some medical bills.

    Thank you

    • Avatarfinder Customer Care
      MaySeptember 14, 2017Staff

      Hi Mike,

      Thank you for your inquiry.

      Basically, the timeframe would take longer like months. I would suggest that you speak to your super fund to inquire and confirm.

      Cheers,
      May

  4. Default Gravatar
    AngelaJune 9, 2017

    I doubt whether to go ahead or not with my TPD claim. I have a mental condition and haven’t worked for 7 years. I have a proof indicating the severity of my illness. My doubt is about recovery, even though my mental illness just seems to get worse with age. I don’t know if I have any chance to recover.

    I would like to find out if I have a chance to have this claim accepted. If it does, do I get paid lump sum and 5 years later I have recovered enough to work one day a week (I am 49)?

    I would really appreciate your advise.

    Thank you.

    • Default Gravatar
      JonathanJune 10, 2017

      Hi Angela!

      Thanks for the comment.

      Usually, the insurer has pre-defined criteria in their TPD benefits claim, including the mechanism of how you’ll get paid if approved. It is important that you go back to your policy, their Product Disclosure Statement webpage or talk to their specialist whether you meet this criteria and your chances of approval.

      Some insurers may honor partial disability (part-time workers due to their health conditions) and has their own math to know how much they’ll approve on your claim based on the lost income. This also requires that you get in touch with them for discussion.

      Should you not be satisfied about their claims review, you can go through with their internal dispute process. If you’re still dissatisfied with the outcome, you may avail of Financial Ombudsman Service.

      Hope this clarifies.

      Cheers,
      Jonathan

  5. Default Gravatar
    koutabexMay 8, 2017

    if i have had a successful tpd claim am i able to obtain my file and a copy of the supporting documents used to lodge the claim? is there some sort of freedom of information act or can i request my file from the super company?

    id like to obtain my file for my records & to verify a few things my solicitor is saying relating to the claim.

    also wondering if my file from the super company which i have successfully claimed through could somehow support a claim with a different super company?

    • Avatarfinder Customer Care
      ZubairMay 9, 2017Staff

      Hi Koutabex,

      Thank you for your inquiry.

      You may receive some documentation from your insurer after a successful claim.

      Cheers,
      Zubair

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