Key Takeaways
- When PTSD stops you from working permanently, you may be able to claim on your TPD Insurance.
- Ensure that you have gathered enough medical evidence to support your claim.
- A denied TPD claim is not always final—you can still appeal your insurer’s decision.
- Claiming TPD for PTSD can be a complex process depending on your condition. Consulting a TPD claims expert can help you navigate the process and save you time so you can focus on treatment.
Can you Claim TPD Insurance for Post Traumatic Stress Disorder (PTSD)?
Yes, you may file TPD claims if you are suffering from PTSD that permanently disables you from getting back to work. PTSD is a serious mental health condition that can greatly affect one’s ability to work and perform home duties.
If you are the breadwinner, the financial stress from your inability to earn an income can fuel your mental health instability—sending you further into a downward spiral of mental health disability.
Eligibility and requirements for claiming PTSD
It is important to understand that eligibility requirements vary depending on your insurer and the severity of your condition.
Below is a list of some requirements that insurers often look at when assessing your eligibility for a claim.
Valid TPD Policy
Typically, you must have a valid and updated TPD insurance policy at the time of being unable to work. Generally, your insurance provider requires that your premium payments be up to date.
Definition of disability
To be eligible for a claim, your PTSD condition must meet the definition of disability on your TPD policy. In Australia, there are three TPD definitions, they can be:
- Own occupation – means you are unable to work in the same job function you recently had.
- Any occupation – means you are unable to work in a job that is reasonably suited to your education, training, or experience.
- Activities of daily living – means you are unable to perform at least one of the basic home duties, such as eating, bathing, or dressing.
Diagnosis
The diagnosis of your disability from PTSD must come from a qualified medical professional. Medical evidence, such as a medical attendant’s statement and/or medical results, must support your permanent disability claim.
Impact on work
Your TPD claims application must be able to show how your mental health condition disables you from performing your job functions. Statements from your colleagues about your work conditions can help support your claim application.
Supporting Evidence
In some cases, your insurance provider may need additional evidence that will signify your permanent disability from PTSD.
Claiming TPD for PTSD Process
Claiming TPD for PTSD requires a careful understanding of the process and being organised with the documents. Dealing with the process while suffering from PTSD can be challenging. Curo Financial Services provides expert TPD claim advice for PTSD.
If you wish to lodge a claim individually, below is our team’s process that you can follow.
Step 1: Obtain TPD claim forms and a list of requirements
Contact your superannuation fund or insurance provider (if the TPD policy is held under your name) to inform them of your intent to lodge a claim.
Prepare the basic information, such as your name, policy number, date of diagnosis, and the reason for your claim for initial screening. The insurer will then send you the TPD claim pack and the list of documents you need to submit.
A clear understanding of the requirements and documents will help you to provide a well-prepared claim application.
Step 2: Check your eligibility for a TPD claim
Before proceeding to the next step, it is important to check that you are eligible for a claim. Generally, there are two main factors that you need to consider:
- Check if your TPD insurance policy is valid and active at the time you become disabled. Typically, insurers require that your policy’s premium payments be up to date. However, some insurers may have complex criteria to determine whether your policy is active and valid. In this case, consulting a professional TPD claims adviser will be beneficial.
- Next, check if your condition is eligible under the disability definition in your policy. The Product Disclosure Statement (PDS) will help you understand your TPD coverage. You can contact your insurer or your broker to obtain the PDS.
Step 3: Gather medical evidence and documents
Obtain all relevant medical evidence and documents to prove your disability and your claim. This step requires you to be organised and persistent in following up with your doctors.
The documents and evidence required may include:
- Medical reports and certificates from your treating doctors
- Statements from your employer, colleagues, or family members
- Proof of income and expenses
- Workers’ compensation files or other insurance claims
- Any other relevant information that supports your claim
You should keep copies of everything you send and track the dates and communication with your insurer.
Step 4: Submit your TPD insurance claim
When it is time to submit your TPD insurance claim, remember to:
- Know where to send your claim
- Review and make sure you have all the files ready
- Create a copy of all the documents
- Take note of the date of submission
Step 5: Follow up with your insurer
After you submit your TPD claim, you will need to wait for the insurer’s assessment and decision. This can take anywhere from 2 to 12 months, depending on the complexity of your case and the insurer’s timeline.
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 your claim’s status and ask for updates regularly.
Step 6: Be persistent even if your claim gets denied
Rejected TPD claims are not always final, and often, insurers may only require an additional piece of evidence to turn around your case. Generally, you can appeal your insurer’s decision by asking for clarification about their decision.
However, if you feel that the insurer is delaying your claim or has a misinterpretation, you have these options that you can explore:
