How Can I Make a TPD Claim in New South Wales?

By 15 August 2019Personal Injury

In case you’ve never come across it before, TPD stands for ‘total and permanent disability’.

TPD can be caused by injury, illness or disease, and can be anticipated by an insurance policy which is either stand-alone through an insurance company or, more commonly these days, included as part of your superannuation policy.

Unlike personal injury claims where the circumstances of the case will determine the amount of compensation, a TPD insurance contract sets out the entitlements a claimant will receive before a claim is made, such as an annual income if you can no longer work.

What are the important elements of a TPD insurance policy?

TPD policies can vary in their terms but the essential things to take notice of include:

  • how the policy defines TPD;
  • the time frame in which you would need to make a claim;
  • the detail of entitlements should TPD leave you unable to work either at all or in your current occupation.

In relation to the definition of TPD, this will usually depend on which of the two types of TPD policies you take: either an ‘Own Occupation’ policy or an ‘Any Occupation’ one.

Experts in TPD insurance will often advise an Own Occupation type policy is preferable, as this will entitle you to benefits should an injury or illness prevent you from continuing in your current job (such as a tradesman with a chronic back condition) but not prevent you from potentially working in a different sort of occupation if you’re able to.

Conversely the more general Any Occupation policy applies when you’re unable to work in your usual occupation for at least six months, and are unlikely to be able to work in any occupation for which one has suitable training, education and experience in the future.

How to make a TPD claim

As with any interaction between an insured person and an insurance company, the services of an experienced legal professional are highly advised when it comes to making a TPD claim.

This is because the terms of a TPD policy are usually very precise as to the elements needed to prove a claim. A lawyer experienced in TPD claims can make sure the medical evidence you submit to the insurer addresses the specific criteria needed to prove the claim, and also that you do so within the required time frame.

This medical evidence – often termed a ‘medico-legal report’ – should include reports from your GP and any treating specialists which support your claim of TPD.

What will the insurance company require?

In response, the insurance company with whom you have the TPD contract may require you to submit to its own medical expert, in order to verify the claims made in your own medico-legal report. It is entitled to do this.

Depending on the report of the insurance company’s medico-legal person back to the insurer, it will then either accept or deny your TPD claim. If the insurer denies your claim, you will need to decide whether to pursue an action through the court or, if your TPD policy is part of your superannuation, through the Superannuation Complaints Tribunal.

At this point it should be noted that a complaint to the Tribunal must be made within two years of the insurance company’s decision to deny your claim. Any court action against the insurer must be made within six years of the insurance company’s decision.

Obviously if the insurer accepts your TPD claim, you will be paid out the sum you’re insured for in the policy, in addition to your superannuation benefit.

In some cases, TPD benefits can total very large sums, so it’s natural an insurance company will thoroughly test your claim of total and permanent disability. And this is why experienced legal advice can be vital in securing a successful claim.

Harris Lieberman Solicitors has years of experience in advising clients on TPD policies and claims. If we can help you with any of the issues raised in this article, contact us today on (02) 6051 5100.