The Activities of Daily Living (ADL) definition in a TPD policy measures whether you can independently perform basic self-care tasks like bathing, dressing and feeding yourself.
To qualify for a TPD payout under this definition, you typically need to be unable to perform at least two of these essential activities without assistance, and your inability to do so must be permanent.
This definition is important because many superannuation funds use it as a stricter test for TPD claims, especially if you weren't working when you became disabled, or stopped working more than 12 months before your disability occurred. Understanding the criteria for ADL is crucial because it's significantly harder to meet than occupation-based definitions.
This article explains what the ADL definition covers, when it applies to your claim, what evidence you need to prove your case and the practical steps you can take to improve your chances of a successful claim.
Understanding the ADL Definition in TPD Policies
What activities are included in the ADL definition?
The ADL definition focuses on basic self-care tasks essential for independent living. While specific activities vary between policies, most TPD policies include these core activities:
- Bathing: washing your entire body in a shower or bath without assistance
- Dressing: putting on and removing appropriate clothing, including fasteners and footwear
- Feeding: getting food from the plate to your mouth, including picking up utensils and swallowing safely
- Toileting: using the toilet and maintaining hygiene
- Mobility: getting in and out of bed, moving between chairs and walking short distances
- Continence: managing bowel and bladder function (only for certain policies)
Most policies require you to be "continually and totally unable" to perform these activities independently, not just find them difficult or painful.
How is inability to perform ADLs measured?
Insurance companies assess your functional capacity through medical examinations and reports, with the most important test being whether you can perform the activity independently (without another person's assistance and with reasonable safety).
Simply experiencing pain while performing an activity doesn't automatically mean you're unable to perform it under the definition of ADL.
Your Rights and Entitlements
What you're entitled to:
- Fair assessment: your insurer must assess your claim based on the actual ADL definition in your policy, not a stricter interpretation. They must also take all medical evidence you provide into consideration.
- Independent medical review: if you disagree with your insurer's medical assessment, you have the right to provide your own medical evidence from treating specialists and occupational therapists.
- Internal review and appeal: in the event your claim is denied, you can request an internal review by the insurer, then escalate to the Australian Financial Complaints Authority (AFCA) if still dissatisfied.
What you must do:
- Notify your fund promptly: contact your superannuation fund within 3 months of realising you meet the TPD definition so you can protect your claim rights.
- Provide complete medical evidence: submit comprehensive medical reports, functional assessments and any other evidence requested within the timeframes specified (usually 6 months from notification).
- Attend assessments: cooperate fully with any independent medical examinations arranged by the insurer. Keep in mind that you can request for your own doctor is present.
Key deadlines:
- Initial notification: within 3 months of disability (recommended, though not always mandatory)
- Full claim documentation: usually within 6 months of initial notification
- Internal review request: within 90 days of claim denial for some providers
- AFCA complaint: within 2 years of the insurer's final decision
Common Scenarios and Questions
I was retired when I had a stroke. Can I still claim TPD?
Quick answer: yes, and your claim will likely be assessed under the ADL definition rather than occupation-based criteria because you weren't working when the stroke occurred.
What to do:
- Check your super fund's Product Disclosure Statement to confirm which TPD definition applies to non-working members
- Focus your medical evidence on functional limitations (what you can't do independently) rather than work capacity
- Document assistance you need from family or carers for daily tasks
Important note: ADL definitions are more restrictive than occupation-based definitions, so ensure your medical evidence clearly demonstrates you cannot perform at least two self-care activities independently.
I can dress myself but it takes 45 minutes and causes severe pain. Does this qualify?
Quick answer: unfortunately, probably not under most ADL definitions, which focus on whether you can perform the task independently instead of how long it takes or whether it’s uncomfortable.
What to do:
- Get an occupational therapist assessment that objectively measures your functional capacity
- Document any assistance you actually require, regardless of if it’s from family members
- If you need adaptive equipment or modifications to complete the task, this may support your case in some instances
Important note: evidence showing you can perform activities despite pain may not be sufficient, unless the pain prevents independent performance or creates safety risks.
My policy has both "any occupation" and ADL definitions. Which one applies?
Quick answer: this depends on your work status when you became disabled and the specific terms of your policy.
What to do:
- Review your policy's PDS carefully because some funds have multiple TPD definitions that apply in different circumstances
- If you were working when disabled, the "any occupation" definition typically applies first
- If you stopped working more than 12 months before becoming disabled, many policies switch to the ADL definition
Important note: some policies allow you to claim under the definition most favourable to you if you meet multiple criteria. You should seek legal advice to help you understand which definition gives you the best chance of success.
I can perform each ADL with help from my partner. Does this count as being unable?
Quick answer: yes. If you require another person's physical assistance to complete an ADL task, you're considered unable to perform it independently.
What to do:
- Keep detailed logs of what assistance is required and how often
- Have your partner or carer provide a statutory declaration describing the help they provide
- Get confirmation from your doctor that this assistance is medically necessary, not just convenient
Important note: the test is about whether or not you can perform the activity independently. Regularly needing another person's assistance meets the definition of inability.
Step-by-Step Process for ADL-Based TPD Claims
- Confirm your policy's ADL definition. Request your fund's current Product Disclosure Statement and review the exact TPD definition that applies to you. Take note of which activities are listed and how many you must be unable to perform.
- Gather comprehensive medical evidence. See your GP and relevant specialists (neurologist, rheumatologist, etc.) to get detailed reports. Request an occupational therapy functional capacity assessment specifically focused on ADL performance.
- Document your daily limitations. Keep a diary for at least 2-4 weeks showing what assistance you need, as well as when you get it and from whom. Take photos or videos (with appropriate privacy considerations) showing your difficulties with specific tasks.
- Notify your super fund. Contact your fund in writing, stating: "I am lodging a claim for Total and Permanent Disability under the Activities of Daily Living definition." Keep copies of all correspondence.
- Complete claim forms thoroughly. Fill out all sections of every claim form completely and with as much detail as possible. For ADL-specific questions, be very detailed about what you cannot do independently, not what you can do with difficulty.
- Attend assessments cooperatively. If your insurer arranges an independent medical examination, it’s important to attend, but you can consider having your own doctor present. You can provide additional reports if you disagree with the assessment.
- Follow up regularly. Contact your fund every 2-3 weeks for updates. Insurers typically have 90 days to make a decision once they have all the required information.
- Seek review if denied. If you are denied, request an internal review within 90 days. You should try and provide additional evidence addressing the specific reasons for denial.
Documents you'll need:
- Medical reports from all treating doctors. These should specifically address your ability to perform each ADL listed in your policy definition, not just your diagnosis or work capacity.
- Occupational therapy functional assessment. This is critical for ADL claims. The assessment should objectively measure your ability to perform each specific activity independently and safely.
- Care provider statements. Statutory declarations from family members and/or carers detailing the daily assistance you require, including how often you need assistance and the nature of the help.
- Video or photographic evidence. Visual evidence of your attempts to perform ADLs can be powerful. Ensure appropriate privacy considerations.
- Hospital and rehabilitation records. These are used to establish the severity and permanence of your condition, which is particularly important for showing that the disability is "total and permanent."
Legal Framework
Primary legislation: the Insurance Contracts Act 1984 (Cth) governs how TPD insurance policies must operate. It establishes that insurers must assess claims fairly and cannot rely on overly restrictive interpretations of policy definitions.
What this means for you:
- Your policy's ADL definition must be clearly disclosed in the Product Disclosure Statement before you join the fund or make significant decisions about your insurance.
- If the policy’s wording is ambiguous about the ADL criteria, courts will generally interpret it in your favour.
- The Superannuation Industry (Supervision) Act 1993 (Cth) requires that super fund trustees always act in members' best interests, including when assessing TPD claims.
Red Flags and Warning Signs
When to act immediately:
- Your claim is denied without proper functional assessment. If your insurer denies your claim based solely on your doctor's reports and without arranging an occupational therapy assessment of your ADL performance, this is a red flag.
- Your insurer misquotes your policy definition. If correspondence from your insurer describes the ADL criteria differently from what's in your actual policy document, they may be applying the wrong standard.
- The deadline for internal review or an AFCA complaint is approaching. You have limited time (usually 90 days for internal review, 2 years for AFCA) to escalate denied claims. Missing these deadlines can prevent you from challenging an unfair decision.
- Your insurer arranges a single, brief assessment. A proper ADL assessment should be comprehensive, not just a 30-minute examination. Brief assessments often miss the full extent of your limitations.
Common mistakes to avoid:
- Understating your limitations. Never downplay difficulties out of pride or stoicism. Be completely honest about what you cannot do independently and safely.
- Focusing on pain rather than inability. While pain is important, ADL claims require evidence that you cannot perform tasks independently, not just that tasks are painful or uncomfortable
- Using adaptive equipment without documenting the reason. If you use assistive devices, ensure your doctors explain that these are medically necessary for you to perform basic tasks, not just conveniences.
- Delaying your claim because you hope to improve. The permanence requirement means your condition is unlikely to improve with treatment. Delaying your claim doesn't help if your disability is truly permanent.
When to Seek Legal Advice
In cases such as these, it is always recommended to get legal advice as quickly as possible, especially if:
- Your super fund has told you your claim will be assessed under the ADL definition (this is the most restrictive TPD test)
- You've received a denial letter and don't understand why your medical evidence wasn't accepted
- The insurer's independent medical examination reached a different conclusion than that of your treating doctors
- You stopped working more than 12 months before becoming disabled and are unsure which TPD definition applies
- Your policy contains multiple TPD definitions and you're uncertain which to claim under
- You're approaching time limits for internal review (usually 90 days) or AFCA complaints (2 years)
Seeking early advice is vital so you can:
- Understand your full rights and entitlements under your specific policy wording before lodging your claim
- Get the right medical evidence from the start. ADL claims require different evidence than occupation-based claims
- Avoid common mistakes that lead to claim denials, such as inadequate functional assessments or incomplete documentation
- Get expert guidance before time limits expire, as missed deadlines can permanently prevent you from challenging unfair decisions
Key Takeaways
Remember these essential points:
- The definition of ADL requires you to be unable to perform at least two basic self-care tasks independently. It's about functional independence not work capacity.
- "Unable to perform independently" means you need another person's assistance or cannot perform the task safely. Difficulty or pain alone usually isn't enough.
- The ADL definition is harder to satisfy than occupation-based TPD definitions, with lower acceptance rates and more frequent disputes.
- Medical evidence must focus on functional capacity assessments, not just diagnoses. Occupational therapy reports specifically measuring ADL performance are critical.
- Most policies generally require you to be unable to perform 2 out of 5-6 listed activities, though the specific activities and threshold vary by policy.
- Always keep detailed records of the daily assistance you require, get comprehensive medical assessments and seek legal advice early, especially if your claim is denied or you're unsure about the process.
Get Help Now
If you've been injured or diagnosed with a severe disability and believe you cannot perform basic daily living activities independently, and you're uncertain about your rights or the best next steps, getting early legal advice helps you understand your options, hold your insurer accountable and get the financial support you're entitled to.
Contact Smith's Lawyers today for a free, no-obligation consultation with lawyers experienced in ADL definitions and TPD tests under our No Win, No Fee, No Catch® promise.
You don't pay unless your claim succeeds, so call us on 1800 960 482 or use the form below to have our team contact you at a convenient time, and we'll assess your situation and guide you through the claims process.
