A successful mental health TPD (Total and Permanent Disability) claim requires comprehensive medical evidence from specialists. This evidence must show how your condition prevents you from working now and in the future.
Your superannuation fund assesses whether you meet the policy definition of ‘total and permanent disability’ based on the medical documentation you provide.
Common factors:
- Many people delay lodging TPD claims because they worry they may have to repay the benefit if their mental health improves.
- Others fear that retraining for different work in the future could affect their entitlement.
These misunderstandings prevent people from claiming benefits they are genuinely entitled to.
This guide explains:
- What medical evidence is required for a TPD claim
- How insurers assess and approve applications
- Some common situations that arise
What Makes a Mental Health Condition ‘Total and Permanent’?
Total and Permanent Disability (TPD) insurance looks at whether your mental health condition currently prevents you from working.
Depending on your policy, this means:
- Your own job, or
- Any job you could reasonably do, based on your skills and experience
The key question insurers ask is whether you’re unlikely to return to work, based on the medical evidence at the time you make your claim.
Qualifying mental health conditions include:
- Major depressive disorder that hasn’t responded to treatment, making it hard to concentrate or hold down a job.
- Post-traumatic stress disorder (PTSD) that causes severe anxiety, flashbacks, and avoidance behaviours, making work impossible
- Bipolar disorder with repeated episodes despite treatment, preventing you from consistently managing workloads
- Anxiety disorders, causing panic attacks or social withdrawal, that prevent you from functioning at work
Essential Medical Evidence Required
Psychiatrist's Comprehensive Report
This is essential. Superannuation funds require specialist evidence from psychiatrists or psychologists, not just GP reports.
Your specialist's report must include:
- DSM-5 or ICD-11 diagnosis codes (standard clinical codes doctors use to formally classify mental health conditions, kind of like a ‘mental health manual’)
- Detailed treatment history (minimum 6 months)
- Specific information outlining your work limitations (focus, concentration, travel, etc.)
- Explicit statement that you're ‘unlikely to ever return to work’
Treatment History Documentation
Insurers heavily scrutinise treatment compliance. You need:
- Appointment records from all providers (psychiatrist, psychologist, therapist)
- Medication history and pharmacy records
- Evidence showing regular attendance despite ongoing symptoms
Functional Capacity Assessment
Your evidence must explain exactly how your symptoms prevent you from working. These might include:
- Concentration and memory difficulties
- Social interaction challenges
- Stress tolerance limitations
- Inability to complete tasks consistently
Supporting Documentation
- Psychological testing results: Cognitive assessments and symptom severity scales
- Hospital records: Any psychiatric hospitalisations or intensive treatment
- Workplace evidence: Failed return-to-work attempts or employer statements
- Rehabilitation reports: Unsuccessful vocational rehabilitation attempts
Common Questions and Scenarios
Can I make a claim for depression even if my condition might improve?
Yes. TPD claims are assessed based on your condition at the time of claim, and future improvement typically won’t require you to repay the money.
What to do:
- Focus on your current situation: if you genuinely cannot work now, you may have a valid claim
- Document the severity now, including failed treatment attempts
- Understand ‘unlikely to ever work again’ doesn't mean absolutely impossible with zero chance of improvement
Remember: Delaying a valid claim means delaying the much-needed financial support you need to cover things such as treatment and living expenses.
Is a GP report enough for a mental health claim?
No. While GP evidence helps, insurers require specialist evidence from psychiatrists or psychologists. Many rejected mental health TPD claims fail because they rely solely on GP evidence.
What to do:
- Book an appointment with a professional
- Explain what you’ve been feeling and your daily struggles
- Request documentation that clearly states their observations
Do failed return-to-work attempts help or hurt my claim?
They help. Failed attempts demonstrate that your condition is preventing you from working and that you’ve made a genuine effort to try.
Document:
- What accommodations were made
- How long you remained after these accommodations were implemented
- Why you couldn't continue
- Statements from your employers to confirm this
Will insurers say I’m too young to claim at 35?
No. Age alone doesn't disqualify you. What’s important is to have comprehensive evidence showing severity and the likelihood of the condition staying around for the long-term.
Key evidence:
- Treatment resistance: multiple medications and therapies without improvement
- Long-term prognosis explaining why your condition won't improve sufficiently
- Treatment history of 12+ months showing persistent symptoms
What happens if I receive a payout, then later feel well enough to try working?
You can typically work after receiving a TPD payout without repaying the benefit, provided your claim was valid when assessed. In most of the available information, this is implied in the term ‘lump sum’.
- TPD is assessed based on your medical condition at the time your claim is evaluated, not on what may happen years later.
- Future improvements in your condition do not affect the validity of an approved claim.
- Repayment is only required if the claim was approved using fraudulent or misleading information.
How do I prove I'm complying with treatment but not improving?
Most of the time, this can be done by providing the right information:
- Appointment records documenting regular attendance
- Pharmacy records showing medication adherence
- Specialist notes documenting persistent symptoms despite compliance
Step-by-Step Process
1. Schedule a Specialist Assessment
Book an extended appointment with a psychiatrist or psychologist to discuss your work capacity and the possibility of claiming TPD.
2. Request Detailed Report
Provide your specialist with a list of required elements:
- Diagnosis
- Treatment history
- Functional limitations
- Prognosis
- Work capacity assessment
3. Collect Treatment History
Obtain records from every healthcare provider you've seen for your mental health condition, including GPs, psychiatrists, psychologists, and information on any hospital admissions.
4. Gather Functional Evidence
Collect workplace documents, failed return-to-work reports, rehabilitation assessments, or employer statements demonstrating your inability to work.
5. Submit the Complete Package
Many claims are rejected because applicants fail to supply all necessary evidence upfront. Ensure your initial submission contains everything that is required.
Red Flags and Common Mistakes
Warning Signs
Act immediately if:
- Your insurer demands additional evidence without a clear explanation
- Your claim exceeds 12-18 months without reasonable progress
- Your claim is denied without an explanation that you deem appropriate
Mistakes to Avoid
- Submitting a claim before gathering comprehensive evidence can weaken your claim, as rushing gives insurers grounds to deny the application
- Relying only on GP reports is a common mistake. Make sure to get a specialist report.
- Not addressing treatment compliance significantly undermines claims, especially where there are gaps in care or missed recommendations
- Failing to provide work-specific limitations reduces credibility, since general statements about disability are rarely sufficient
- Not keeping copies of all documents creates unnecessary risk, so always retain complete records of everything you submit
When to Seek Legal Advice
Get advice early if:
- You're unsure whether your condition meets the definition outlined in your policy documents
- Your claim has been denied
- You're receiving conflicting advice about working after a payout
- Your insurer is delaying unreasonably
- You have a workplace injury claim alongside your TPD claim
- You're considering withdrawing due to repayment fears
Why Early Advice Matters
- Understand your full rights and entitlements
- Lodge a complete, strong claim initially
- Avoid common pitfalls leading to your claim being rejected
- Management of strict deadlines (often 1-2 years from stopping work)
Key Takeaways
- Specialist evidence is essential, with comprehensive reports from psychiatrists or psychologists that explicitly state you are ‘unlikely’ to ever return to work (not impossible)
- Treatment compliance matters, as documented adherence to medication and therapy significantly strengthens claims
- Work-specific limitations are required, so clearly explain how your symptoms prevent you from performing particular job tasks
- Future improvement typically does not require repayment, because once a claim is approved, you generally do not have to repay the benefit if your condition later improves
- Submitting complete evidence from the outset is critical, since many claims are denied simply because not all the necessary documentation was provided from the outset
Get Help Now
If you're living with a mental health condition that prevents you from working, early legal advice can help you understand whether you have a valid TPD claim and the evidence you need. Understanding your rights also provides reassurance that future recovery won't require you to repay benefits you're entitled to right now.
Contact Smith's Lawyers today:
- Call 1800 960 482 for a free consultation with our TPD specialists or request a callback using the form below.
- No upfront costs. We operate on a No Win, No Fee, No Catch® basis
- Nationwide TPD expertise with Queensland knowledge. We handle TPD claims all across Australia while bringing years of experience in Queensland personal injury law
Don't let fear about future improvement or confusion about evidence requirements stop you from accessing TPD benefits you're entitled to. Our team can guide you through gathering the right medical evidence and lodging a comprehensive claim.
