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Total & Permanent Disability Claims

The term “TPD” stands for total and permanent disablement.

Most superannuation funds come with TPD cover that will pay out lump sum compensation if you become totally and permanently disabled for work.

Generally speaking, if you sustain an injury or illness that prevents you from ever working in your usual occupation you will be able to claim the amount of money under your TPD policy.

How do I find out if I have TPD Insurance?

Look at your super fund account statement or call your super fund and ask: “Am I covered for TPD?”. If you are looking at your superfund online, it will usually have a TPD section that says “Insurance cover” under that heading will usually have three types of cover: Death, TPD, and Income Protection. If there is a figure next to TPD it means you have a TPD policy. If there is $0.00 or it says “not covered” it is more than likely that you have no TPD insurance, but always call your super fund to confirm.

I have a Policy, so can I make a Claim?

To be able to make a claim for TPD you will need to have active cover at the time of injury. This means if you join your superfund in August 2018 and have TPD insurance, but your injury occurred on May 2018 you will not be covered for TPD.

Some TPD funds also require you or your employer to be making the required contributions into your superannuation account. If you or your employer has not made the required contributions, you may be prevented from claiming the TPD benefit under your superannuation fund.

Some funds also require a minimum premium before your TPD benefit will be activated.

How do I make my Claim for TPD?

Once you have determined that you have an injury that prevents you from returning for work, and you have active TPD insurance at the time of injury you can make a claim.

To make a claim you should follow these steps:

  1. Call your Superfund/TPD Insurer and notify them that you wish to make a claim for TPD benefits under your policy
  2. Request the claim forms and the policy documents that were in place at the time of injury
  3. Once you receive your claim form and policy documents contact a lawyer to help you fill them out

TPD claim forms are very important. If you fill out your claim for incorrectly or do not obtain sufficient medical evidence to support your claim your claim may be declined. For this reason, we advise that you consult an Accredited Specialist In Personal Injury Law for assistance with your TPD claim.

Why do I need to Request the Policy Documents?

Your right to your TPD benefit depends entirely on the terms and conditions set out in the policy document that was in force at the time of your injury.

The policy document sets out relevant information about:

  1. Waiting periods: How long you have to wait after your injury before you benefit becomes payable. This is usually between 6-12 month
  2. Approval process:How the insurer assesses your claim and what you can expect to happen. For example, the policy document will set out requirement for medical assessments, review procedures, and time frames for assessing your claim. The insurer usually takes between 6-12 months to decide on a claim for TPD benefits
  3. TPD definitions: This is the most important part of the policy documents. It will tell you the criteria that you will need to satisfy to classify as “TPD” and to be eligible to claim your TPD benefit

Why are TPD Definitions so Important?

TPD definitions vary from policy to policy. It is important that your lawyer reviews the definition of total permanent disablement under your policy as this will determine whether you are eligible to claim the TPD Benefit.

Most policies contain definitions that require the insured member to be unfit for employment for a number of months and unlikely to ever be able to return to gainful employment.

See the below examples of TPD definitions:

Example 1

  1. Absent from employment for six consecutive months because of sickness or injury; and
  2. Is so disabled at the start of those six months and continuously since that time that the Insured member is unlikely to ever engage in any reasonably suitable occupation

Put simply, this definition means that you must not be able to work for the first six months following your injury and it does not appear that you will ever return to suitable employment in the future.

Example 2

  1. The insured member is unable to perform, in respect of the first two years of disability, at least one income producing duty of their regular occupation
  2. The important duties of any gainful occupation for which you are reasonably suited by way of education, training, or experience
  3. Are not working in any undertaking usually performed for wage of profit
  4. Are under the regular care, and following the advice and treatment of a Medical Practitioner

This example is far more complex, unfortunately definitions under TPD policies are beginning to become more complex and have more elements that need to be satisfied to try and minimise the amount of TPD benefits paid out.

Example two requires the policy holder to be unfit for at lease one aspect of their usual job in the first two years, and following that, in order to be eligible the condition must deteriorate to the extent that the policy holder can no longer perform “important duties” of their gainful employment.

The second example also brings in training/education component. Which means that if you can be retrained in any other type of employment and you would be able to undertake that employment you will not be TPD.

In effect to satisfy this definition you must not be able to work and never be able to work in any form of employment ever again.

What does that mean?

Often there are a number of vague terms in the definitions such as “important duties” or “one income producing duty” which are difficult to understand.

Where these terms aren’t defined it is up to interpretation which can make claiming a TPD benefit very difficult.

For this reason, it is advised to contact a lawyer who knows and understands TPD claims and the insurer framework.

How do I fill out my TPD Forms?

The TPD insurer will send you out forms to complete. You will need to complete the following:

  1. Application for TPD: You will need to include information about your injury or illness, details of your incapacity to work, your medical history, employment history, and financial history.
  2. Doctors Statement x 2: Your treatment general practitioner who you have seen for your injury/illness will need to complete a form detailing the nature and extent of your injury/illness. They will also need to provide their opinion as to whether you will ever work again. The other Doctors Statement will need to be completed by another doctor, you can use either a specialist, another general practitioner, or any other doctor you have consulted for you injury/illness
  3. Certified proof of identity: You will need to provide certified copies of your driver licence, passport, or birth certificate.
  4. Medical evidence: Your claim for TPD must be accompanied by medical evidence supporting your claim that you are totally and permanently disabled.

What Medical Evidence do I need to Provide?

The medical evidence that you will need to provide depends entirely on your injury or illness.

For example, if you are unable to work due to a workplace injury and you have made a workers’ compensation claim for whole person impairment, you can provide the medical evidence to the TPD insurer as it will prove that you have a whole person impairment and will address your ongoing incapacity and your inability to work.

If you have a longstanding illness you will need to provide evidence detailing the treatment received. It will also be beneficial to obtain a detailed report addressing your restrictions and provide detailed reasons as to why you can no longer undertake aspects of your gainful employment.

Will I be Medically Assessed?

The insurer will have you assessed if they think you may not satisfy the TPD definition.

In our experience, if the right medical evidence is provided with your application it will be difficult for the insurer to dispute your work capacity and they may approve your claim without the need for a medical assessment.

If the insurer decides to have you assessed they will likely have you assessed for the purposes of obtaining an employability assessment report or they will have you assessed by an occupational physician to see if you are able to undertake your employment as per the definition of TPD.

Will my Claim be Accepted?

In our experience, most claims are accepted first go if the right evidence is submitted with the claim form and TPD benefits are paid out within 12 -18 months of receipt of the application.

The remaining claims are either rejected by the insurer of the Superfund or delayed longer that 12-18 months as the insurer does not have enough medical evidence or because there has been another claim such as a workers’ compensation or motor vehicle accident claim that relates to the injury.

What do I do if my Claim is Rejected?

You can either request a reassessment of the declined claim or if you think the decision reached by the TPD insurer is incorrect and not made in good faith or formed unreasonably you can challenge the insurers decision in Court.

You should contact a Lawyer to assist with your claim as the insurer can be very difficult to deal with and often decline claim in the hope people do not challenge the decision.

Matthew Garling

Matthew Garling is an Accredited Specialist in Personal Injury Law approved by New South Wales Law Society. He is admitted to practice in the Supreme Court of NSW and the High Court of Australia. Matthew is also a member of...
Yanthi S.
01:51 18 May 22
I engaged with Garling and Co to assist me for my weekly payment dispute with the insurance. I was upset with Natasha, as she didn't prepare me to the worse outcome or kind of negotiation in the... hearing. I assumed that as a Lawyer she should experience with the process or the way to solve the case. Even though I asked her what should I do or what would be happened in the hearing a week before but she didn't mentioned anything, and told me not do anything. But in the hearing she and the Arbitrator only gave me less than 5 minute to make decision and pushed me to accept the disappointed outcome and what she said totally different with what she said earlier. I don't trust her at all, her words is not consistent.I would like to express my appreciation to Matthew Garling who had stepped in to handle my weekly payment issue with the insurance. He is very professional, knowledgeable, easy to talk to and very humble. My disappointment earlier has melted away by his kindness and caring to resolve my issue which has came out the great outcome. Now I am satisfied with his expertise therefore I would not hesitate to let him to handle the case I might have in the future.read more
Lynda S
00:34 04 May 22
For such complicated matters, it is extremely important to have a good team in your corner. The right team.Garling and co is just that and much more.They listen to you and care. They support you... during the entire process. You will have so many questions and they always return your calls and reply to your emails.Thank you so much to Renee, who explained everything to me and what to expect in details and really reassured me. The process felt less heavy and stressful because she was there. She was professional and so efficient. She took over my case from previous lawyer and I wish I could have met her first. She was available to answer the many questions I had along the way. There is also Kelli, she was the first person I got on the phone most of the time when I called and she is nice and very helpful, I had so many questions and doubts, I was stressed yet she had the patience to explain and seek answers to my questions.Natasha took over my case towards the end and she also was great in listening and supporting me and made sure to defend my best interests against the other side at all time.The Worker’s compensation process is very stressful, it can last for a long period. In my case it was three years and it is to the upmost importance to have people who treats you well, are professional and efficient.I am very satisfied with the outcome and I hope that this reviews helps the next person.Your assistance made the difference and I would have not been able to do it without your precious help.read more
Melinda B.
23:57 04 Apr 22
Workers compensation and the medical-legal process is a complicated and a difficult process.If you are looking for a highly professional compensation/personal injury lawyer, I would without... hesitation definitely recommend Matthew Garling who is a genuine, caring & dedicated lawyer.Matthew, Allison Luck and co. are extremely professional, clear and concise with all communication and an exceptional support during the whole process of my claim, I felt confident and secure that I had made the right decision having Matthew represent me, they worked tirelessly and where 100% committed to getting me the best possible outcome.My case was complicated and Matthew never gave up fighting for me, he didn’t just take the first option for a quick and easy resolution.He and his team got me the best possible outcome for my WPI and I will be forever grateful for their hard work and diligence. I now have peace of mind knowing I have lifetime medical assistance and payment till retirement age.read more
Jim M.
12:25 27 Mar 22
Garling and Co lawyers you have done again with Success for my TPD claim! Ms. Emma Perkins and her team have assisted my TPD claim with great success after the hard work, She is a very down-to-earth... person, professional, and highly knowledgeable with insurance claim law. She is very approachable and always willing to help and often reply my question of email after business hours. I will most delighted to recommend Garling and Co Lawyers. Ms. Emma Perkins and her team to any person who needs insurance claim law service like me. by Julieread more
Anthony N
22:13 17 Mar 22
I had Garling & Co Lawyers handle my workplace dispute, I could not be happier with the outcome, handled in such a professional way with excellent communication throughout the entire process.Natasha... and Kelli were very understanding in every aspect, requesting information via phone or email was never an issue, fast response times and helpful in every way. I HIGHLY RECOMMEND the team @ Garling & Co Lawyers. 👍read more
Yvonne M.
05:03 21 Jan 22
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
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Yanthi S.
01:51 18 May 22
I engaged with Garling and Co to assist me for my weekly payment dispute with the insurance. I was upset with Natasha, as she didn't prepare me to the worse outcome or kind of negotiation in the... hearing. I assumed that as a Lawyer she should experience with the process or the way to solve the case. Even though I asked her what should I do or what would be happened in the hearing a week before but she didn't mentioned anything, and told me not do anything. But in the hearing she and the Arbitrator only gave me less than 5 minute to make decision and pushed me to accept the disappointed outcome and what she said totally different with what she said earlier. I don't trust her at all, her words is not consistent.I would like to express my appreciation to Matthew Garling who had stepped in to handle my weekly payment issue with the insurance. He is very professional, knowledgeable, easy to talk to and very humble. My disappointment earlier has melted away by his kindness and caring to resolve my issue which has came out the great outcome. Now I am satisfied with his expertise therefore I would not hesitate to let him to handle the case I might have in the future.read more
Lynda S
00:34 04 May 22
For such complicated matters, it is extremely important to have a good team in your corner. The right team.Garling and co is just that and much more.They listen to you and care. They support you... during the entire process. You will have so many questions and they always return your calls and reply to your emails.Thank you so much to Renee, who explained everything to me and what to expect in details and really reassured me. The process felt less heavy and stressful because she was there. She was professional and so efficient. She took over my case from previous lawyer and I wish I could have met her first. She was available to answer the many questions I had along the way. There is also Kelli, she was the first person I got on the phone most of the time when I called and she is nice and very helpful, I had so many questions and doubts, I was stressed yet she had the patience to explain and seek answers to my questions.Natasha took over my case towards the end and she also was great in listening and supporting me and made sure to defend my best interests against the other side at all time.The Worker’s compensation process is very stressful, it can last for a long period. In my case it was three years and it is to the upmost importance to have people who treats you well, are professional and efficient.I am very satisfied with the outcome and I hope that this reviews helps the next person.Your assistance made the difference and I would have not been able to do it without your precious help.read more
Melinda B.
23:57 04 Apr 22
Workers compensation and the medical-legal process is a complicated and a difficult process.If you are looking for a highly professional compensation/personal injury lawyer, I would without... hesitation definitely recommend Matthew Garling who is a genuine, caring & dedicated lawyer.Matthew, Allison Luck and co. are extremely professional, clear and concise with all communication and an exceptional support during the whole process of my claim, I felt confident and secure that I had made the right decision having Matthew represent me, they worked tirelessly and where 100% committed to getting me the best possible outcome.My case was complicated and Matthew never gave up fighting for me, he didn’t just take the first option for a quick and easy resolution.He and his team got me the best possible outcome for my WPI and I will be forever grateful for their hard work and diligence. I now have peace of mind knowing I have lifetime medical assistance and payment till retirement age.read more
Jim M.
12:25 27 Mar 22
Garling and Co lawyers you have done again with Success for my TPD claim! Ms. Emma Perkins and her team have assisted my TPD claim with great success after the hard work, She is a very down-to-earth... person, professional, and highly knowledgeable with insurance claim law. She is very approachable and always willing to help and often reply my question of email after business hours. I will most delighted to recommend Garling and Co Lawyers. Ms. Emma Perkins and her team to any person who needs insurance claim law service like me. by Julieread more
Anthony N
22:13 17 Mar 22
I had Garling & Co Lawyers handle my workplace dispute, I could not be happier with the outcome, handled in such a professional way with excellent communication throughout the entire process.Natasha... and Kelli were very understanding in every aspect, requesting information via phone or email was never an issue, fast response times and helpful in every way. I HIGHLY RECOMMEND the team @ Garling & Co Lawyers. 👍read more
Yvonne M.
05:03 21 Jan 22
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
University of Technology, Sydney
Member of Law Society of New South Wales
Law Society of NSW Specialist Accreditation
University of Sydney
Legal Profession Admission Board of New South Wales
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