In TPD insurance policies, there’s an Activities of Daily Living (ADL) component which pays a benefit if illness or injury renders you permanently unable to perform basic self-care tasks, such as bathing, dressing, feeding, toileting and moving around, without help from another person.
It is the strictest way an insurer can assess a Total and Permanent Disability (TPD) claim.
Understanding the ADL definition in a TPD policy
TPD insurance pays a lump sum if you become permanently unable to work.
Most Australians are covered automatically through their superannuation, often without realising it.
The catch is that TPD policies have different definitions of disability. The definition laid out in your policy decides how sick or injured you have to be before the insurer pays out.
What are the activities of daily living?
Activities of daily living are basic tasks a person needs to do in order to look after themselves on a daily basis.
According to ASIC's MoneySmart, the ADL definition means you are "permanently unable to perform some basic self-care tasks, such as bathing, feeding, dressing, toileting and mobility, without assistance."
Policies generally assess five or six activities, most commonly:
- Bathing: washing yourself in a bath or shower
- Dressing: putting on and taking off clothing
- Feeding: getting food from a plate to your mouth and swallowing safely
- Toileting: using the toilet and managing personal hygiene
- Mobility: getting in and out of bed or a chair, and moving around
- Continence: controlling bladder and bowel function (included in many, but not all, policies)
To meet the ADL definition, you generally need to be unable to perform at least two of these activities by yourself.
Not every policy uses a self-care list. Some funds use a closely related test called “activities of daily working” or “everyday work activities”, built from work-related functions such as mobilising, communicating, seeing and hearing rather than self-care tasks. The principle is the same: you must be unable to perform a set number of listed activities, but the list is different. Check which version your policy uses.
How the ADL test differs from the occupation tests
TPD policies use one of three main definitions, and the differences between them can be significant. MoneySmart describes the ADL definition as the one with "the highest threshold to claim." For more on the first two, see our guide to own occupation versus any occupation cover.
Here is how the three compare:
The ADL definition is a fallback that generally applies to those who do not meet the occupation-based test, or whose cover was only ever offered on ADL terms. This is the reason someone can be too injured to hold down any job but still fail the ADL test because they can technically still dress and feed themselves.
How "unable to perform" is assessed
Insurers don’t just ask whether an activity is difficult for you to perform, they ask whether you can do it at all, safely, and without someone helping you.
Pain, slowness or having to take a break during the activity usually won’t satisfy the definition on its own; medical evidence must show a genuine inability, not just discomfort or difficulty.
Why the ADL definition matters so much
The ADL definition is where a large number of TPD claims fail, and the data on this issue is stark.
An ASIC media release on Report 633, "Holes in the safety net" (17 October 2019), found that 60% of claims assessed under the ADL definition are rejected. This is five times higher than the 12% average rejection rate for all other TPD claims.
ASIC also found that nearly half a million Australians are covered by these narrow ADL-only definitions, often people working in casual roles or high-risk occupations. Many of them are unaware that their cover involves the strictest possible test until they try to claim.
Common scenarios and questions
What does ADL actually stand for in my policy?
ADL stands for "Activities of Daily Living." They are basic self-care tasks used to measure whether you can look after yourself after an injury or illness. In a TPD context, it is a definition of disability, not a medical diagnosis. If your policy refers to an ADL definition, the insurer will assess your claim against a set list of tasks like bathing, dressing and feeding yourself.
I can't work anymore, so why might I still fail the ADL test?
Because the ADL test measures self-care, not work capacity. You can be permanently unable to perform any job and still able to perform daily tasks like eating and getting dressed. That is exactly why ADL claims are declined so often. If you’re in this situation, it is worth checking whether an occupation-based definition also applies to you.
My condition makes daily tasks painful but I can still do them, do I qualify?
Usually not based on pain alone. The majority of ADL definitions require that you cannot perform the activity without help, or are unable to do it safely alone, rather than that it causes you pain. This is one of the most common reasons genuine claims are rejected, making detailed medical and functional evidence critical in this situation.
My policy lists more than one TPD definition. Which one applies?
Your policy sets out which definition applies to you, and it can change based on your work status. Certain policies use an occupation-based test while you are actively employed, then change to the ADL definition after you spend a certain period of time out of the workforce. The exact wording matters here because you might be assessed under a definition you weren’t expecting.
I need my partner's help with some tasks, does that count?
It can, as long as the help is genuinely necessary rather than a convenience. Requiring another person to physically assist you with bathing, dressing or toileting supports an ADL claim. Insurers will look at whether the assistance is medically necessary and how consistently you need it.
Red flags and warning signs
Watch out for these signs that a TPD claim under an ADL definition is being undervalued or declined unjustly:
- The insurer relies solely on a desktop file review without arranging a proper medical assessment
- You are declined for being able to do one or two activities, without the insurer explaining the required threshold
- The insurer treats "difficult" as the same thing as "able"
- You are assessed under the ADL definition when an occupation-based definition may really apply
- The decline letter does not point to the specific policy wording it relied on
Common mistakes to avoid:
- Assuming the insurer's first decision is definitely final, as TPD decisions can be reviewed and disputed.
- Lodging a claim without gathering detailed evidence of how each daily task is affected by your illness or injury.
- Giving informal statements to the insurer about what you "can manage" without seeking advice first. Our TPD claims process guide sets out each stage.
When to get legal advice
It’s always a good idea to get legal advice before you lodge a claim, especially if:
- Your policy uses an ADL or "Activities of Daily Living" definition
- You have been told your claim was declined but cannot follow the reasoning
- More than one TPD definition appears in your policy and you are unsure which applies
- The insurer has asked for a statement or interview about your daily activities
Early advice is vital because insurers assess ADL claims strictly, and an unrepresented claimant often won’t know the evidence they need to prove they have an inability rather than a difficulty.
A lawyer can tell whether a more favourable definition applies, gather the right medical and functional evidence and put the claim in terms the policy actually requires. Insurers know a represented claimant can take a wrongful decline further, which changes how they’ll assess a claim.
Legal framework
TPD insurance held through superannuation is governed by federal law that applies across Australia.
- Superannuation Industry (Supervision) Act 1993 (Cth) sets the rules for when a benefit can be released on the ground of permanent incapacity. What this means for you: your super fund and its insurer must assess your claim against both the policy definition and the fund's release conditions. Its s 52(7)(d) covenant also requires the trustee to do everything reasonable to pursue an insurance claim on your behalf where it has a reasonable prospect of success.
- Insurance Contracts Act 1984 (Cth) — s 13 imposes a duty of utmost good faith, and since the 2013 amendments that duty is owed to you as a third-party beneficiary of the trustee's policy, not only to the trustee. What this means for you: the insurer must handle your claim honestly and fairly. It does not soften a strict ADL definition, but it does govern how the insurer goes about assessing you against it.
Key takeaways
- The ADL definition tests self-care, not work. It hinges on whether you can bathe, dress, feed and toilet yourself, not whether you can hold a job.
- It is the strictest TPD definition. ASIC MoneySmart describes it as having the highest threshold of the three standard definitions.
- Decline rates are high. ASIC's 2019 Report 633 found that 60% of ADL-assessed claims are declined, five times the rate of other TPD claims.
- Difficulty is not the test. Most policies require you to be unable to perform a task without help, not just find it painful or difficult.
- Check which definition applies before you claim. You may be assessed under a definition you did not expect, and a different one may be more favourable.
Get Help Now
If you have TPD cover through your super and think you may not be able to work again, Smith's Lawyers can review the definition that applies to your policy and tell you where you stand.
Call 1800 960 482 to request a free case review under our No Win, No Fee, No Catch® promise.
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