Yes, you can claim Total and Permanent Disability (TPD) insurance for any disabilities which are the result of complications with pregnancy or childbirth in Queensland and across Australia. These claims come about when severe physical or mental health complications permanently prevent you from working in a suitable occupation.
Women who experience issues like severe perineal tears, post-partum cardiomyopathy and debilitating psychiatric conditions may be entitled to TPD compensation, which is typically held through superannuation. However, these claims are complicated and difficult, especially when it comes to proving that pregnancy-related conditions are truly permanent complications that will be resolved with time.
This guide explains which pregnancy and childbirth complications qualify for TPD, how to prove their permanence and the practical steps to take so you can protect your entitlement to compensation.
Understanding TPD Claims for Pregnancy and Childbirth Complications
What does "total and permanent disability" mean for pregnancy-related conditions?
Total and Permanent Disability is when you are prevented from working in your usual occupation or any occupation you're reasonably suited for due to a disability that is likely to continue indefinitely. The condition doesn't need to be completely permanent, but the exact permanence test depends on the wording of your particular policy.
For complications with pregnancy and childbirth, you will have to prove that your condition has caused lasting functional limitations that prevent work, not just temporary difficulties during recovery. Many insurers argue that pregnancy-related conditions are able to be resolved naturally, making strong medical evidence critical.
Your Rights and Entitlements
What you're entitled to:
- Lump sum compensation through your superannuation TPD insurance
- Access to claim assessment within 6 months of lodging a complete claim, with superannuation funds required to notify you of any delays
- Independent medical examination paid for by the insurer to assess your condition and functional capacity
- Internal review and external dispute resolution if your claim is initially denied, including access to the Australian Financial Complaints Authority (AFCA)
What you have to do:
- Lodge your claim while you still have TPD insurance coverage, or within the specific timeframes after coverage ceases, which is generally 6-12 months from when the disability occurs
- Provide comprehensive medical evidence from treating doctors and specialists which addresses diagnosis, treatment, functional limitations and injury permanence
- Respond promptly to insurer requests for additional information or independent medical examinations to avoid delays in assessment
- Notify your superannuation fund as soon as you suspect you may have a permanent disability, even if you're not ready to lodge a full claim
Key deadlines:
- Immediate: contact your superannuation fund to confirm you have TPD coverage, and seek legal advice
- 6-12 months from disability: most policies require notice of claim within this period, although it does vary by policy
- During active coverage: claims must generally be lodged while you still hold insurance or within specific timeframes after it ends
- 28 days: typical timeframe to request internal review if your claim is denied
- 6 months: standard assessment period for superannuation funds to decide claims
Common Scenarios and Questions
Can I claim TPD for severe perineal tears that won't heal properly?
Quick answer: yes, if you have a third- or fourth-degree perineal tear which results in permanent dysfunction that prevents you from working in any suitable occupation.
What to do:
- Get specialist assessments from gynaecologists and colorectal surgeons that document the extent of injury, any surgical repairs attempted and ongoing dysfunction stemming from the injury. These reports should detail conditions like chronic pain, faecal or urinary incontinence and sexual dysfunction.
- Document functional limitations to demonstrate how your condition prevents specific work activities, such as inability to sit or stand for extended periods, lift objects and/or take public-facing roles due to incontinence.
- Address the injury’s psychological impact with mental health assessments if chronic pain or loss of function has caused secondary depression or anxiety that affects your capacity to work.
Important note: it’s common for insurers to argue that surgical repair can resolve these types of injuries, so it’s vital to collect evidence of failed treatment attempts in the 12-24 months after your injury.
Does post-partum depression qualify as a permanent disability for TPD purposes?
Quick answer: it does, but only when the depression is severe, treatment-resistant and permanently impairs your ability to work in any suitable occupation.
What to do:
- Engage a psychiatrist (not just a psychologist) for comprehensive assessment, including diagnosis, treatment history, prognosis and objective psychological testing which shows permanent impairment.
- Document extensive treatment attempts, including multiple antidepressant medications, therapy modalities (CBT, DBT, etc.) and any hospitalisations, showing the condition persists despite optimal treatment.
- Provide functional capacity evidence demonstrating specific work limitations, such as inability to concentrate, make decisions, manage interpersonal interactions, cope with stress and maintain consistent attendance.
- Allow adequate time (typically 18-24 months) to establish that the condition hasn't responded to treatment and is unlikely to improve (stay mindful of policy time limits).
Important note: data shows that Queensland has concerning rates of perinatal mental health issues. This is a clear indication of the severity of these conditions when treatment-resistant.
What if my TPD claim was denied because the insurer says my condition isn't permanent?
Quick answer: if this happens, request an internal review immediately and gather stronger medical evidence which addresses the permanence of your issue, particularly from specialists who can confirm maximum medical improvement has been reached.
What to do:
- Lodge internal review within 28 days (or your policy's specified timeframe) of receiving the denial, requesting reconsideration with additional medical evidence.
- Obtain updated specialist reports which specifically address the insurer's concerns about permanence, including medical opinions that state you've reached maximum medical improvement with no prospect of returning to work.
- Present medical literature which shows that your specific condition usually results in permanent disability and counters assumptions that all pregnancy complications resolve on their own.
- Engage a TPD lawyer to review the denial reasons, strengthen your medical evidence and represent you through the review and appeals process.
Important note: many claims which are initially denied succeed on review when comprehensive medical evidence is presented, which is why early legal advice is so valuable for understanding what additional evidence is needed.
Step-by-Step Process for Claiming TPD
- Confirm your TPD insurance coverage immediately by contacting your superannuation fund to verify you hold TPD insurance, when the coverage began, what the policy definition of TPD is and what time limits apply for lodging claims.
- Seek comprehensive medical treatment and documentation by attending all recommended appointments, doing prescribed treatments and ensuring your doctors document your diagnosis, treatment history, functional limitations and prognosis in detailed reports.
- Request claim forms and policy documents from your superannuation fund, including the Product Disclosure Statement, insurance policy terms and the specific TPD claim form with all required sections properly filled out.
- Gather specialist medical evidence by obtaining detailed reports from relevant specialists (obstetrician, cardiologist, psychiatrist, pain specialist, etc.) that specifically address the TPD definition in your policy, confirm injury permanence and explain why you cannot work.
- Complete the claim form comprehensively by providing detailed personal information, your full employment history and a thorough description of your disability and its impact. Allow treating doctors to fill out the medical sections.
- Submit your claim with supporting documentation, including the completed claim form, all medical reports and records, hospital records from during your pregnancy and when you gave birth, treatment history and any functional capacity or vocational assessments you have taken.
- Respond promptly to fund requests by attending independent medical examinations arranged by the insurer, providing additional medical records if requested and keeping the claims manager updated on your condition and treatment.
- Monitor the assessment timeline, keeping in mind that funds aim to decide claims within 6 months (though complex cases may take 12-18 months, and the fund must notify you if they cannot meet this timeframe).
- Review the decision carefully and, if approved, understand how the payment will be made (whether to your super account or directly to you). If your claim is denied, immediately request reasons in writing and consider your review and appeal options.
- Exercise your appeal rights quickly by lodging an internal review within 28 days (if denied), escalating to the Australian Financial Complaints Authority (AFCA) (if internal review fails) and considering court proceedings for policy disputes with legal representation.
Documents you'll need:
- Complete medical records from your pregnancy and throughout current treatment, including GP notes, specialist consultations, hospital admission records, test results and imaging reports.
- Specialist medical reports from your obstetrician/gynaecologist, cardiologist, psychiatrist and/or other relevant specialists specifically addressing the TPD policy definition, your diagnosis and prognosis, functional limitations from the injury, the permanence of your disability and why you cannot work in any suitable occupation.
- Employment documentation, including employment history, position descriptions, income statements and correspondence with employers about your inability to return to work.
Red Flags and Warning Signs
When to act immediately:
- Your TPD insurance is ending because you've stopped working, left your employer or changed super funds. This is important because coverage typically ends without ongoing contributions and claims must be lodged while you’re still covered.
- Your condition is deteriorating rapidly or you've been advised by specialists that your prognosis is poor, making it crucial to notify your fund immediately, even if you're not ready to lodge a full claim.
- You're considering resigning from employment before understanding how this affects your TPD claim, as continuing employment (even on leave) often strengthens claims by showing you want to work but cannot.
Common mistakes to avoid:
- Waiting too long to lodge your claim while hoping your condition improves, potentially missing policy time limits and losing your entitlement to benefits you've already paid for through insurance premiums.
- Lodging a claim without adequate medical evidence that shows permanence, functional limitations and work capacity, leading to rejection and requiring you to start the appeals process with stronger evidence you should have gathered initially.
- Failing to try recommended treatments even when prognosis is poor, giving insurers grounds to argue your disability isn't permanent because you haven't attempted all available therapies.
When to Seek Legal Advice
In cases such as these, it is always recommended to get legal advice as quickly as possible, especially if:
- You need help lodging your claim, as it’s important you understand your policy definition, gather the appropriate medical evidence and present the strongest possible claim from the outset to avoid common pitfalls that lead to rejection.
- Your condition is complex or involves multiple issues such as both physical birth trauma and psychiatric injury, as it will require a sophisticated evidence strategy to prove permanent disability from combined effects.
- Your claim has been denied and you need to understand the specific reasons for rejection, what additional evidence could strengthen your case and how to navigate the internal review and appeals process effectively.
- The insurer is arguing your condition isn't permanent because pregnancy complications typically resolve, requiring expert legal representation to counter this argument with strong medical evidence and case law.
Early advice is so important because it helps you:
- Understand your full rights and entitlements under your specific superannuation policy before making decisions that could affect your claim eligibility.
- Access rehabilitation and support services sooner by understanding what your fund will pay for during the claims assessment period.
- Protect your compensation claim from common pitfalls like missing time limits, lodging claims with inadequate evidence and making statements that undermine permanence.
Key Takeaways
Remember these essential points:
- TPD claims for pregnancy and childbirth disabilities are possible when complications permanently prevent you from working in any suitable occupation.
- Common qualifying conditions include severe perineal injury with lasting dysfunction, post-partum cardiomyopathy, treatment-resistant psychiatric injury, permanent nerve damage and disabling chronic pain syndromes that prevent gainful employment.
- Proving permanence requires comprehensive specialist medical evidence addressing diagnosis, treatment history, functional limitations, prognosis and specific opinions that you've reached maximum medical improvement with no prospect of returning to work.
Get Help Now
If you’ve suffered a disabling complication from pregnancy or childbirth 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.
Problems with TPD claims can have a serious financial and emotional impact, particularly when you're unable to work and facing mounting expenses. You don't have to navigate this frustrating process alone.
Contact Smith's Lawyers today for a free, no-obligation consultation with lawyers experienced in TPD claims involving pregnancy or childbirth 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.
