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What do the definitions on my TPD Policy mean?

What is TPD and what can I claim?

The definition of Total and Permanent Disability (TPD) differs from claim to claim. However, the term “totally and permanent disability” will usually mean that you have sustained an injury or illness that prevents you from working in your usually occupation.

If you are TPD you may be eligible to claim compensation (money) under your TPD policy.

TPD policies are usually an entitlement under your superannuation policy, however, you may have a separate TPD policy, or your employer may be making contributions into a company TPD insurance policy.

TPD policies and insurance policies generally are complex and difficult to understand. To make things more complicated, each insurance policy has a different set of terms and definitions. What may be the TPD definition under one policy may be entirely different on another policy.

Why is this important to understand the terms of a TPD policy?

It is important to know what the terms in your TPD policy mean as they determine whether you are eligible for TPD compensation.

We have created a list of the most commonly used terms found in TPD policies to make it easier for you to understand your rights and entitlements.

Understanding TPD Terms and Definitions

Unlikely Ever:

Example: “An insured person is Totally and Permanently Disabled if, in our opinion, the illness or injury means that the Insured Person is unlikely to ever work in or attend their usual professional occupation…”

The best way to understand this definition is to look at your capacity to return to work. If there is a chance that you will return to work, even if that chance is less than 50/50 you will not be able to claim TPD benefits.

To be unlikely ever sets a very high threshold. It means that there is almost certain that you will never return to gainful employment as a result of your illness or injury.

To combat this definition, you need to look at the real likelihood of re-entering employment in the future and also address the prospects of being able to undertake the actual employment.

For example, if you may be able to return to work in the future but will require periods of time of work to recover when your symptoms are aggravated you would probably still satisfy unlikely ever and be able to claim your TPD benefit.

Unable Ever:

Example:“Total Disability and Totally Disabled means that as a direct result of suffering an illness or injury an Insured person is unable to ever perform at least one income-producing duty of their regular occupation…”

You are incapable of returning to employment. To combat a term like this it is best to have you’re treating practitioner or an expert report that you are “incapable to ever return to gainful employment”

“Unable ever” does not mean the employment in its entirety so when challenging a decision based on this term, you will need to establish that you cannot undertake certain aspects of the employment.

Retraining:

Example:“In determining our opinion on Total Permanent Disability we will have regard to factors including but not limited to; any retraining or re-skilling that could reasonably be expected to be undertaken by the Insured Member.”

Most TPD definitions have a term that states if you are able to be retrained in any form of employment you will not satisfy the definition for TPD and be eligible for benefits. The Courts have determined that retraining must be reasonable.

If the TPD insurer finds that you can be retrained you may be able to challenge this decision by proving that you are not suited for the training proposed and even if retrained would be precluded from employment due to the nature and extent of your injury or illness.

To challenge the insurers decision based on reasonableness you will need to consider the cost of retraining, the time it will take to be adequately trained, your age and the benefit of retraining, and the connection between previous employment and proposed employment. It may also be necessary to get an opinion from an occupational therapist.

It is important to keep in mind that a short course or training to obtain a licence or labouring ticket is not unreasonable, so long as once obtained you are fit and able to undertake the work.

As can be seen from these definitions, TPD claims are complex. In order to make the claims process smoother and less stressful we advise seeking the assistance of a lawyer to help you complete your claim form, obtain the right medical evidence the first time, and if necessary, request a review decision or take your claim to Court.

About Matthew Garling

Matthew Garling, Founder of Garling & Co is a NSW Law Society Accredited Specialist in Personal Injury Law. He specialises in compensation law and has acted on behalf of thousands of injured people in work accidents, motor vehicle accidents and negligence cases over the last 20 years.

Zee
14:20 15 Jan 22
I would like to thank the entire team at Garling and Co for being in my corner throughout the worst years I've experienced in my life.I chose Garling and Co in the end after being seriously injured... at work and needing representation, something I should have done years prior.I met with over 12 other legal firms in Sydney. Large,medium, small and all in between. Some were friends, some family, some were sharks, many were pressuring, many promised the world, Matthew was not like that.Matthew was the benchmark as he was one of the first I spoke with and ultimately he stood out in the end as I felt he was the most genuine.From the outset to the conclusion, I found Matthew to be very polite, easy to communicate with and extremely down to earth.He explained everything simply, he had answers for any questions along the way. He told me it how it was, not just what I wanted to hear.Matthew is a genuine nice guy that runs a very efficient and professional law firm. I made the correct choice engaging him in my claims and would not hesitate in recommending him.Renee was also terrific in handling my TPD claim which was literally finalised faster then international postage.Allison, Rebecca and Kelli were all great, always.Thanks again Garling and Co.read more
mark S.
06:30 23 Dec 21
I found from my very first meeting With Matthew that he was upfront honest and to the point . He thoroughly investigated my claim and we agreed too proceed.The staff at Garling and Co are wonderful... and helpful and I was kept informed and upto date from day one till the end .They made me feel confident and secure and I know I had the best team possible for my best outcome .I can’t thank Matthew and the team for their wonderful serviceread more
Daniel F.
08:48 10 Nov 21
My wife suffered psychological injury.Never having similar experience she had to get legal advice.Workers compensation law is complex and she needed someone to help her navigate her way through.... There are many compensation lawyers but not all with enough experience and strong reputation . We have finally decided to go with Matthew and his team based on the independent website reviews .Looking back now we have made the right choice .There is lot of hurdles and having trustworthy lawyer with great communication skills on your side can make huge difference .My wife can now try to move on with the compensation she deserved.Thanks to Matthew ,Allison ,Emma,Rebecca and rest of the team. Thank you again.Daniel and Veerayaread more
K B.
07:35 28 Oct 21
When you work for an employer for a number of decades and suffer a debilitating injury, you expect compassion, support and belief that you are genuine. When you don’t get that and then also have to... deal with Workers Compensation Insurers it slowly breaks you.That's when you need amazing support like Matthew Garling and his team. From my first meeting with Matthew I was confident I was referred to the right guy. I couldn’t be more pleased with my outcome. Matthew is the Guru of workers compensation, he is professional, easy to work with, nothings a bother and most importantly he gets great results. Do not think twice about using Garling and Co Lawyers.Thank you Matthew, Renee, Allison and Kelli for your invaluable support.read more
Moussa I.
14:23 20 Sep 21
Great attitude! they return my call every time I callI'm very confident I will reach something good with garling &co
Dulce L.
08:48 23 Aug 21
Garling & Co have been exceptional. Matthew was always professional attentive clear and concise, I felt up most confidence in his management dealing with my matter always had my best interest. i... highly recommend Garling & Co Lawyersread more
Melissa H
11:53 10 Aug 21
I am grateful to have had Matthew represent me on my motor vehicle compensation claim.After meeting with two lawyers previous to deciding on Garling and co, I was left unsure and confused as to... where I stood regarding my claim. Matthew and Allison were incredibly helpful, put my mind at ease, and took the worry and stress out of an already difficult situation.Through the settlement process they would always keep me informed and made time to answer all of my questions. I am really pleased with the outcome of the settlement.Thank you to the team at Garling and Coread more
Violeta C.
07:30 05 Aug 21
My experience with Garling & Co was great. Matthew was always professional, attentive and communicated in a clear manner. I felt confident in his management of my matter & always had my best interest... in mind.I have no reservation in recommending Matthew & the Garling & Co team.read more
Sonia C.
03:04 05 Aug 21
Ann F.
04:11 04 Aug 21
Professional and helpful
READ ALL TESTIMONIALS

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Zee
14:20 15 Jan 22
I would like to thank the entire team at Garling and Co for being in my corner throughout the worst years I've experienced in my life.I chose Garling and Co in the end after being seriously injured... at work and needing representation, something I should have done years prior.I met with over 12 other legal firms in Sydney. Large,medium, small and all in between. Some were friends, some family, some were sharks, many were pressuring, many promised the world, Matthew was not like that.Matthew was the benchmark as he was one of the first I spoke with and ultimately he stood out in the end as I felt he was the most genuine.From the outset to the conclusion, I found Matthew to be very polite, easy to communicate with and extremely down to earth.He explained everything simply, he had answers for any questions along the way. He told me it how it was, not just what I wanted to hear.Matthew is a genuine nice guy that runs a very efficient and professional law firm. I made the correct choice engaging him in my claims and would not hesitate in recommending him.Renee was also terrific in handling my TPD claim which was literally finalised faster then international postage.Allison, Rebecca and Kelli were all great, always.Thanks again Garling and Co.read more
mark S.
06:30 23 Dec 21
I found from my very first meeting With Matthew that he was upfront honest and to the point . He thoroughly investigated my claim and we agreed too proceed.The staff at Garling and Co are wonderful... and helpful and I was kept informed and upto date from day one till the end .They made me feel confident and secure and I know I had the best team possible for my best outcome .I can’t thank Matthew and the team for their wonderful serviceread more
Daniel F.
08:48 10 Nov 21
My wife suffered psychological injury.Never having similar experience she had to get legal advice.Workers compensation law is complex and she needed someone to help her navigate her way through.... There are many compensation lawyers but not all with enough experience and strong reputation . We have finally decided to go with Matthew and his team based on the independent website reviews .Looking back now we have made the right choice .There is lot of hurdles and having trustworthy lawyer with great communication skills on your side can make huge difference .My wife can now try to move on with the compensation she deserved.Thanks to Matthew ,Allison ,Emma,Rebecca and rest of the team. Thank you again.Daniel and Veerayaread more
K B.
07:35 28 Oct 21
When you work for an employer for a number of decades and suffer a debilitating injury, you expect compassion, support and belief that you are genuine. When you don’t get that and then also have to... deal with Workers Compensation Insurers it slowly breaks you.That's when you need amazing support like Matthew Garling and his team. From my first meeting with Matthew I was confident I was referred to the right guy. I couldn’t be more pleased with my outcome. Matthew is the Guru of workers compensation, he is professional, easy to work with, nothings a bother and most importantly he gets great results. Do not think twice about using Garling and Co Lawyers.Thank you Matthew, Renee, Allison and Kelli for your invaluable support.read more
Moussa I.
14:23 20 Sep 21
Great attitude! they return my call every time I callI'm very confident I will reach something good with garling &co
Dulce L.
08:48 23 Aug 21
Garling & Co have been exceptional. Matthew was always professional attentive clear and concise, I felt up most confidence in his management dealing with my matter always had my best interest. i... highly recommend Garling & Co Lawyersread more
Melissa H
11:53 10 Aug 21
I am grateful to have had Matthew represent me on my motor vehicle compensation claim.After meeting with two lawyers previous to deciding on Garling and co, I was left unsure and confused as to... where I stood regarding my claim. Matthew and Allison were incredibly helpful, put my mind at ease, and took the worry and stress out of an already difficult situation.Through the settlement process they would always keep me informed and made time to answer all of my questions. I am really pleased with the outcome of the settlement.Thank you to the team at Garling and Coread more
Violeta C.
07:30 05 Aug 21
My experience with Garling & Co was great. Matthew was always professional, attentive and communicated in a clear manner. I felt confident in his management of my matter & always had my best interest... in mind.I have no reservation in recommending Matthew & the Garling & Co team.read more
Sonia C.
03:04 05 Aug 21
Ann F.
04:11 04 Aug 21
Professional and helpful
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