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Total and Permanent Disability (TPD) insurance claims

Making a TPD claim in Australia - step by step.

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If you're making a claim for total permanent disability (TPD) insurance then it's crucial you understand what makes you eligible. The process from submitting a claim to actually receiving a benefit payment has a few key steps.

Three things you need to consider before making a TPD claim:

  1. Make sure you understand the reasons why a TPD claim could be disputed.
  2. Check if you're eligible to make a claim.
  3. Follow the appropriate steps to claim, depending on whether your TPD is included inside your super fund or a standalone policy.

Why are TPD claims disputed?

Am I eligible? See below

When can I make a claim?

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.

Note that criteria will vary from insurer to insurer, so be sure to check with your insurer..

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How does criteria vary between insurers?

The following chart highlights the various criteria that different insurers may have before accepting your claim.

CriteriaCommon variations between insurers*
The extent of your disability
  1. You're unlikely to return to any type of work.
  2. You're unlikely to return to your previous role.
  3. You have lost a limb or suffered a serious injury.
Own vs any occupation
  • Own occupation. The definition of "current occupation" will vary. For example, if a piano player suffers a hand injury and can no longer perform professionally but can still teach piano, some insurers might classify teaching as the same occupation while others may consider it to be different.
  • Any occupation.The definition of "any occupation" also varies. Medical advances, such as prosthetics and similar advances in the workplace, can make an insurer less likely to classify someone as unable to work in any job.
Waiting periods
  1. Three-month continuous absence from work
  2. Six-month continuous absence from work
  3. No waiting periods for some conditions such as major head trauma
Minimum work history
  1. Show 12 months of employment before a claim can be made
  2. Full-time employment
  3. Not full time but with minimum hours
Loss of independence
  1. You have to show that you are unable to perform two to three daily living activities.
  2. Evidence in the form of a diary may sometimes be required.
Ongoing medical care
  1. Regular appointments, advice and care of a medical specialist
  2. Regular care of a medical practitioner
  3. Rehabilitation

*This is not an exhaustive list of variations. Always check the product disclosure statement (PDS) of your policy for exact eligibility requirements. Source: Australian Securities and Investment Commission

How do I make a TPD claim? Key steps

The appropriate steps will depend on whether you bought your cover inside a superfund or outside of it.

How do I make a TPD claim inside of my super fund?

Some superannuation funds offer a default level of TPD cover for members. You can check if there is TPD cover in your super fund by contacting your fund representative and requesting a copy of your online statements.

Steps to follow

  1. Contact your super fund. You will need to contact your super fund and provide the necessary claim documentation. You might also need to provide the following additional documentation:
    • Identification, such as a birth certificate, driver's licence or passport
    • Existing medical reports
    • Medical evidence to support claim
  2. Submit your claim. You need to sign your claim statement and attach all necessary documentation, which you will then give to your case manager. Your case manager will provide assistance throughout the claim process and help ensure that all of the necessary documentation is received.
  3. Your case manager organises the claim. Your case manager will assess your claim to determine whether you are eligible to receive a TPD benefit. The case manager will usually contact your employer to receive a written statement as to why you ceased work.
  4. Your insurer assesses your claim. Your insurance provider will then assess the documentation that you submitted. In some cases, the insurer may request further evidence, such as the following:
    • Doctor reports
    • Further medical examination from an independent specialist
    • Further information from your employer
    • Further information from you
  5. Your insurer accepts or rejects your claim. After assessing all the information provided, the insurance provider will make the following determination:
    • Accepted. Your insurer accepts your claim and contacts you with claim payment options.
    • Declined. Your insurer denies your claim because you have not satisfied the conditions of the policy.
    • Deferred. Your insurer defers your claim in order to do a further assessment on the full extent of your disability and its permanency.

If your insurer defers or declines your claim, it will be referred to the fund trustee who will review the decision made by the insurance provider on your behalf.

How do I make a claim outside of my super fund?

Claiming standalone TPD insurance is similar to claiming TPD held inside of your superannuation, although there are some differences between the two processes. Each claim process may differ depending on the type of claim and the insurance provider, although you will generally need to take the following steps:

Steps to making a TPD claim

  1. Contact your insurer's claims team. You can get the necessary forms from the claims team. Your financial adviser may assist you in filling out the documents if necessary.
  2. Prepare necessary documentation. You will need to provide the following documentation:
    1. Completed claim forms
    2. A statement completed by a certified medical practitioner verifying your illness/injury
    3. Bank details so your insurer can deposit any benefits into your account
    4. Details of previous health claims
  3. Submit claims documentation. You need to complete the claim documentation and submit it to the insurance provider.

How do TPD claims work for multiple super funds?

Many people have TPD insurance that has accumulated in multiple funds that have been opened by different employers. In some circumstances, you may be able to claim multiple benefits at the same time. However, it is important that you carefully check the conditions of each fund before submitting multiple claims at the same time.

Is there a time limit on super fund claims?

There is no time limit on when you can make a claim for a TPD benefit payment held within a super fund. That said, there are time limits on when you can appeal a refusal of a TPD claim. Legislation states that the Superannuation Complaints Tribunal can only review a complaint that has been made within two years after the trustees have made a decision regarding a claim.Back to top

Mental illness, claim denials and complex terms

How do I make a claim for depression and other mental illnesses?

It can be difficult to prove that you are unable to return to work on account of mental illness. The episodic nature of mental illnesses can make it difficult for a diagnosis to be formed.

Considerations for a TPD claim related to depression and mental health

  • Your insurer will look at the type of treatment prescribed by a health professional and the regularity of your treatment. This consideration is of particular importance for claims that are late in submission.
  • Your insurer may defer the benefit payment for a mental health claim if the insurer believes that the permanency and severity of your condition is not determined. This deferral can last until all treatment options have been tried.
  • Your insurer will assess if you are able to perform your duties at another place of employment or if you could continue work by adjusting your duties.

What if my claim gets denied?

In the event that your insurer denies your claim, you can ask for a review by following these steps:

Start with the insurer

  1. Understand why you were denied. Is the insurer claiming your cover was expired? Are they claiming your disability was caused by a pre-existing condition that was excluded from your policy? Understanding why insurer reached their conclusion will help you put together a more effective counter-argument.
  2. Put together your case. Re-read your policy in detail to make sure you're not misunderstanding any key points. Then type a letter stating why you think the decision was wrong and gather any additional supporting evidence you may have missed when you originally submitted the claim. For example, maybe you were able to dig up medical evidence proving your disability was not caused by an excluded pre-existing condition.
  3. File a dispute with the insurer. All financial providers who have signed their relevant code of practice are required to have an internal dispute resolution process (IDR). Send your case in writing to your insurer's resolution department and they will review your case independently from the claims department that originally reviewed your case.
  4. Wait. Insurers have 45 days from start to finish (90 days for funds within super) 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

You still have options at this point:

  1. Take it to the regulatory authorities. If your claim comes back denied again, or the insurer hasn't made a decision within 45 days (90 for super), you can take the complaint to the appropriate regulatory authority. For both normal insurers and super policies you'll chat to the Australian Financial Complaints Authority (AFCA). Note: In the past for super, that would have been the Superannuation Complaints Tribunal (SCT).
  2. Take legal action. If the relevant regulatory authority doesn't rule in your favour, there is nothing stopping you from hiring a lawyer and taking your case through the external justice system.

Why do life insurance claims (including TPD) get disputed?

Type of claim disputePercentage of total claim disputes
General denial5%
Limitation period2%
Reason not provided for denial1%
Waiting period1%
Approved claim with late or no payment1%
Income protection ceased1%
Sickness vs injury0%
Customer service0%

Duty of Disclosure

When looking for TPD cover, you have to disclose any relevant information requested by the insurance provider to allow them to assess your situation. This is known as a duty of disclosure. Duty of disclosure is legally binding and you must disclose any relevant, known information to avoid the legal consequences of not informing the underwriter about information that may affect the policy. If you fail to provide this information and your policy is less than three years old, the insurer can terminate the contract. If the insurer finds that you haven't disclosed the relevant information, they may reduce the sum insured in accordance to the premium that would have been payable had the correct information been disclosed at the time of application.

Claims for partial disability

Some insurance providers will provide a partial disability benefit. This means you will have cover for any income lost if you can only work at a reduced capacity because of sickness or injury. An approved medical practitioner must certify your partial disability.

Benefits may be paid out under the following options:

  • Hours based. You will receive benefits if you cannot work the same number of hours as you could before the disability. To qualify, you will need to earn less than you did before your disability and be under medical care.
  • Duties based. You will receive benefits if you are unable to perform all the duties essential to your previous job and are making less income as a result.

This benefit is determined using the following formula:

(Pre-disability income - post-disability income) / (pre-disability income x monthly benefit) Some policies will provide partial payment if you suffer certain disabilities. This may include the permanent loss of the use of the following:

  • Loss of one arm
  • Loss of one leg
  • Loss of sight in one eye

Compare TPD insurance quotes from these direct brands

Name Product Maximum Cover Minimum Sum Insured Maximum Entry Age Expiry Age Stand Alone or Add on hide
NobleOak TPD Insurance
Not Stated
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Get fully underwritten Total and Permanent Disability Insurance that can be customised to fit your occupational situation and financial circumstances.
Real TPD Insurance
Add on
Get a quote for up to $1 million in TPD cover.
Guardian TPD Insurance
Not Stated
Add on
Get a quote for up to $1 million in TPD cover.

Compare up to 4 providers

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Coverage is the amount of money that you will be paid in the event of a claim. An insurance consultant can help you determine an appropriate amount. Calculator
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Get quotes is a comparison service and not an insurer. For clarification on whether you are eligible to receive a claim, please refer to your product disclosure statement or contact your insurer. If you are having issues with a claim or feel your insurer has treated you unfairly, 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 Australian Financial Complaints Authority (ACFA). Note: In the past you would have had to contact the Financial Ombudsman Service.

REPORT 498: Life insurance claims: An industry review

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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!


  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.


  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.


  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.


  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.


  6. Default Gravatar
    koutabexMay 8, 2017

    can you make a claim directly to the underwriting insurance company or does it have to be through the super company?

    • Avatarfinder Customer Care
      ZubairMay 9, 2017Staff

      Hi Koutabex,

      Thank you for your inquiry.

      Generally, you will notify about your claim to the super fund and they will rise it to the insurer. For further clarification on this matter please get in touch directly with your insurer.


  7. Default Gravatar
    koutabexMay 8, 2017

    is a tpd claim affected in anyway if the super company changed hands between the date last worked and the date you lodge a claim?

    • Avatarfinder Customer Care
      ZubairMay 9, 2017Staff

      Hi Koutabex,

      It depends on the conditions of the super fund so it’s a good idea to get in touch directly with your super fund for the clarification on this matter.


  8. Default Gravatar
    koutabexMay 8, 2017

    I’ve been told there was a legislation change in 2013 and after this automatic TPD cover was applied to my account where prior to this i did not have TPD insurance.
    The date i last worked was in 2012 – before the legislation change. is there anything i can do about this or is it just too bad i wasn’t covered?

    • Avatarfinder Customer Care
      ZubairMay 8, 2017Staff

      Hi Koutabex,

      Thank you for your question. is a comparison and information service and we are not permitted to provide our users with personalised financial advice or product recommendations.

      Note: Most superfund that offers TPD cover will usually have a requirement where you are working at the time of cover instated. For clarification on whether you are eligible to receive a claim, please refer to your product disclosure statement or contact your insurer.

      All the best,

    • Default Gravatar
      EmmaMay 8, 2017

      Thanks for your reply.

      Can I ask in general terms when the legislation changed in 2013 and TPD insurance automatically got applied was there anything put in place or any part of the legislation that addressed change from no TPD insurance or is there any sort of special considerations given to those who prior to the 2013 legislation change did not have TPD insurance and now hold it? Or is there any alternate ways to lodge a claim if this situation should arise. Generally speaking.

    • Avatarfinder Customer Care
      ZubairMay 9, 2017Staff

      Hi Emma,

      Thank you for your inquiry. is a comparison and information service and we are not permitted to provide our users with personalised financial advice. However, You can get help from Insurance Law Service.


  9. Default Gravatar
    CraigFebruary 27, 2017

    Can I claim my TPD, I was abused as a child which now has caused severe mental illness, I also have a issues with my spine I have spondylitis etc

    • Avatarfinder Customer Care
      ZubairFebruary 28, 2017Staff

      Hi Craig,

      Thank you for your question.

      You have contacted, we are a comparison and information service and not an insurer. To find out whether or not you can claim for any conditions on your policy, it is a good idea to get in touch with your insurer or your super fund (if you’re TPD is included in your super).

      Note: TPD included in your superannuation will only cover disabilities if your disability leaves you unable to work in any type of job again.

      All the best,

  10. Default Gravatar
    lanaDecember 29, 2016

    My Tpd claim thru my super has been approved my insurer can I draw on the insurance part of the claim only without having to take out all my super as the insurance part is non preserved

    • Avatarfinder Customer Care
      RichardJanuary 4, 2017Staff

      Hi Iana,

      Thanks for getting in touch. is a comparison service and we are not permitted to provide our users with personalised financial advice. As claims processes vary between insurers, you should contact your fund for the specifics.

      All the best,

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