If you have been injured or diagnosed with a severe illness that prevents you from working, you may be entitled to a total and permanent disability (TPD) insurance claim. TPD insurance is a type of cover that pays you a lump sum if you become permanently unable to work due to injury or illness.
Overview of the TPD claims process
However, making a TPD claim can be a complex and lengthy process that requires a lot of paperwork, evidence, and patience.
You may also encounter some challenges and obstacles along the way, such as dealing with uncooperative insurers, proving your disability, or negotiating a fair settlement.
That’s why we have created this 7-step guide to help you master the TPD claims process and get the compensation you deserve. In this article, you will learn:
- How to check your eligibility for a TPD claim
- How to gather the required documents and evidence
- How to submit your TPD claim form to your insurer or super fund
- How to wait for the assessment of your claim
- How to negotiate a settlement offer
- How to receive your lump sum payment
- How to be persistent even if your claim gets denied
By following these steps, you will have a better chance of making a successful TPD claim and securing your financial future. Ready to get started? Let’s dive in!
The 7-step TPD claim process
Making a TPD claim can be a daunting and stressful experience, especially if you are dealing with a serious injury or illness that affects your ability to work.
However, by following these 7 steps, you can increase your chances of getting your claim approved and receiving the compensation you need.
It is important to understand that the below steps are what one would typically follow when they are not being assisted by an adviser. By engaging our expert team to manage your claim, we will take the stress out of this process and manage it from beginning to end for you.
When you engage an adviser to manage your claim, the adviser will handle each of these steps for you, involving you only when it is required which will allow you to focus on what matters most, your health.
Step #1: Contact your insurer or super fund
The first step is to contact your superannuation fund or insurer and notify them of your intention to make a TPD claim.
You will need to provide some basic information, such as your name, policy number, date of injury or illness, and the reason for your claim.
The insurer will then send you a TPD claim pack and a list of documents that you need to submit with your claim. This list of documents you will need to provide will very likely be extensive and highly detailed.
To ensure the efficient handling of your claim, it is not only important to provide exactly what they are asking for but it can also be beneficial to understand exactly why they are requesting the information so that you can provide any necessary context for the assessment that is taking place.
Step #2: Confirm that your policy was valid at the time of becoming disabled
Super funds and insurers may well have specific criteria that dictates the way in which an insurer determines your eligibility for disability benefits.
This criteria typically revolves around your circumstances at the time of establishing the policy and also at the time of claiming on your policy.
Before you proceed with your claim, you need to make sure that your policy was active and valid at the time of your injury or illness.
This means that you were paying your premiums and that you met the eligibility criteria for the cover. If you have multiple superannuation funds or policies, you may be able to make more than one TPD claim.
Criteria may well include the type of work you were doing at the time of establishing the policy and at claim as well as the amount of hours you were working.
A specialist TPD claims adviser can help you navigate the policy terms and maximise the benefits you receive from a claim.
Step #3: Get clarity on your coverage
Different TPD policies have different definitions of what constitutes a total and permanent disability.
Some policies cover you for being unable to work in your own occupation, while others cover you for being unable to work in any occupation.
Some policies also have specific exclusions or limitations for certain conditions or circumstances.
You need to read your policy carefully and understand what it covers and what it doesn’t.
If you have any questions or doubts, you can contact your insurer or seek legal advice.
Step #4: Submit your TPD insurance claim
Once you have gathered all the required documents and evidence, you can fill out the TPD claim form and submit it to your insurer or super fund.
The documents and evidence may include:
- Medical reports and certificates from your treating doctors
- Statements from your employer, colleagues, or family members
- Proof of income and expenses
- Tax returns and payslips
- Workers compensation files or other insurance claims
- Any other relevant information that supports your claim
You should keep copies of everything you send and keep track of the dates and communication with the insurer.
Step #5: Craft a compelling coverage letter
A coverage letter is a document that explains why you are entitled to receive a TPD payout based on the terms and conditions of your policy.
It is not mandatory, but it can help strengthen your claim and persuade the insurer to approve it.
A coverage letter should include:
- A summary of your personal details, policy details, and claim details
- A description of your injury or illness and how it affects your ability to work
- A reference to the relevant clauses in your policy that support your claim
- A request for a prompt and fair assessment of your claim
A specialist TPD claims adviser can help you write a powerful coverage letter that highlights the key points of your claim.
Step #6: Stay active in your claim pursuit
After you submit your TPD claim, you will need to wait for the insurer to assess it and make a decision. This can take anywhere from 6 to 12 months, depending on the complexity of your case and the responsiveness of the insurer.
During this time, you should stay in touch with the insurer and provide any additional information or documents they may request. You should also monitor the progress of your claim and ask for updates regularly.
If you feel that the insurer is delaying or avoiding your claim, you can escalate the matter to their internal dispute resolution team or lodge a complaint with the Australian Financial Complaints Authority (AFCA).
Step #7: Be persistent even if your claim gets denied
Unfortunately, not all TPD claims are approved by insurers.
Sometimes, they may reject or dispute your claim based on various reasons, such as insufficient evidence, conflicting opinions, policy exclusions, or pre-existing conditions.
If this happens, don’t give up hope. You have the right to challenge the insurer’s decision and appeal their verdict.
You can do this by:
- Requesting a review of their decision and providing new or additional evidence
- Seeking an independent medical opinion or assessment
- Negotiating with the insurer for a better outcome
- Taking legal action against the insurer in court
Given the highly complicated nature of TPD insurance contracts, it is entirely possible that the insurance claims assessor you have dealt with may have misunderstood an aspect of your claim or the product itself.
The only way that one can know this is by understanding the claims process and product intimately which is unreasonable for any consumer to understand themselves.
As a result, a specialist TPD claims adviser can help you navigate this process and fight for your rights.
You can also read more about why TPD claims have been rejected in our blog post.
Factors affecting a successful TPD claim
A TPD claim can be complex and taxing, particularly if a serious ailment or injury impairs your work ability.
However, success can be influenced by:
- Disability Severity and Type: Qualification is likelier with a more severe, permanent disability. Medical evidence from at least two doctors is required.
- Policy Terms and Conditions: Understanding your policy’s definitions, exclusions, and limitations is crucial. Consult your insurer or legal advice if needed.
- Work History and Income: Eligibility may depend on minimum work history or income. Proof of employment, income, and expenses is necessary.
- Daily Task Performance Ability: Some policies assess your daily functioning. Statements from those who know your functioning level may be needed.
- Ongoing Medical Care Need: Costs of ongoing care like medication or surgery might affect your payout. Receipts and other documents can demonstrate these costs.
How Curo can help you with your TPD insurance claims process
If you are thinking of making a TPD claim, or if you have already made one and it has been rejected or delayed by the insurer, you may benefit from the professional help of Curo Financial Services.
Curo is a specialist in TPD insurance claims and has helped many Australians successfully claim on their TPD insurance policy.
Curo can help you with:
- Checking your eligibility and coverage for a TPD claim
- Identifying all of the benefits you may be eligible for
- Determining exactly why you are eligible for a benefit under the terms of the policy and concisely presenting this to the insurer
- Gathering and preparing all the necessary documents and evidence
- Guiding you through all of the necessary paperwork
- Compiling your story for the claims assessor so that your circumstances are not misunderstood.
- Following up and communicating with the insurer at regular intervals
- Negotiating a fair settlement offer and escalating issues where necessary
- Appealing a denied or disputed claim
- Taking legal action if necessary
Curo works on a no win no fee basis, which means you don’t pay anything unless they win your case. They also offer a free initial consultation, where they can assess your situation and advise you on the best course of action.
If you are ready to start your TPD claim, or if you have any questions about the process, don’t hesitate to reach out to Curo. They are the experts in TPD insurance claims and they can help you get the compensation you deserve.
Frequently asked questions
How long does a TPD claim take to process?
The time frame for a TPD claim can vary depending on the complexity of your case and the responsiveness of the insurer. Generally, it can take anywhere from 2 to 12 months for a TPD claim to be processed and paid out.
However, some cases may take longer if there are disputes or delays along the way. You can read more about how long do TPD claims take in our blog post.
What is the average payout for TPD?
The average payout for TPD depends on several factors, primarily around the means through which you acquired your cover.
Payouts provided by super funds are generally less than those received by those who established their insurance through a financial adviser such as ourselves.
The reason for this is that we provide our clients with advice on the amount of cover they require to adequately protect themselves whereas super funds are often unable to provide personal advice which tends to result in people being inappropriately covered.
Additionally, with many Australians only having ‘default’ insurance provided by their super fund, they are generally covered for lesser amounts.
How do you successfully claim TPD?
To successfully claim TPD, you need to meet the criteria set out in your policy and provide sufficient evidence to support your claim.
You also need to complete a thorough application that clearly shows why you qualify for a TPD payout.
You can follow our 7-step guide to help you master the TPD claims process.
Why do TPD claims get rejected?
TPD claims can get rejected for various reasons, such as insufficient evidence, conflicting opinions, policy exclusions, pre-existing conditions, etc.
If this happens, don’t give up hope. We are experts at turning around complex TPD claims. Our expertise allows us to understand the intricacies of your TPD policy and see exactly what the insurer is taking issue with.
If we believe it is a misunderstanding on their part, we are able to reposition our evidence to ensure that the insurer or super fund can see the angle we are coming from.
Due to our standing in the industry, we have numerous senior claims relationships at insurers which often allows us to deal directly with those that have significant technical expertise but also the ability to make a decision.