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Total and permanent disability (TPD) insurance claims 

Everything you need to know about making a TPD claim

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Fact checked

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 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.

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.

Can you 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.

Can you claim TPD for mental illness?

It can be difficult to prove that you'll never be able to return to work due to mental illness. However, insurance companies will take certain factors into consideration and may pay out in some circumstances.

Insurers may look at the type of treatment prescribed, as well as how often you're having the treatment. Insurers can also defer the payment if you can't prove your condition is permanent or severe enough to warrant a claim. Deferral can last until all treatment options have been tried.

Could your 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 if your 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.

TPD claim stories

"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

How long does a claim take to process?

A tpd claim can take anywhere from two to six months. It depends on the complexity of the claim and the terms of your policy.

Can I claim TPD and Income protection at the same time?

Yes, you can generally claim a tpd benefit while receiving income protection. There are some instances where this may not be possible but that is generally in the conditions set out by the insurer. In order to check what you are eligible to claim you should contact your provider directly.

Should I get a lawyer to help with a TPD claim?

Some people decide to hire a solicitor to help them navigate the claims process. While this can help if you don't want to deal with the insurer or if the claim is complex, you might want to consider if it's totally necessary. Lawyers can be expensive and can charge upfront and ongoing fees for representation. If your claim is straight forward, you may be saving yourself money by dealing with the insurer yourself. However, if your claim has been disputed or is taking an exceptionally long time you might consider getting some legal advice.

Do TPD payouts affect Centrelink?

Generally TPD payouts won't impact your centrelink payments, particularly if that insurance is held within super. However a TPD payout is a form of income and you should always report any changes in circumstances to centrelink and seek advice from them directly.

Can you claim multiple policies?

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.

What is a duty of disclosure? Do I have to do this?

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 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.

Compare TPD insurance quotes

Name Product Maximum Cover Minimum Cover Maximum Entry Age Expiry Age Stand Alone or Add on hide
NobleOak TPD Insurance
$5,000,000
Not Stated
64
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.
Guardian TPD Insurance
$1,000,000
$50,000
59
Not Stated
Add on
Get a quote for up to $1 million in TPD cover.
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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
Provides a lump sum payment if you become totally and permanently disabled and are unable to return to work.
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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

  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.

      Cheers,
      Zubair

  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.

      Cheers,
      Zubair

  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.

      finder.com.au 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,
      Zubair

    • 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.

      finder.com.au 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.

      Cheers,
      Zubair

  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 finder.com.au, 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,
      Zubair

  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. finder.com.au 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,
      Richard

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