Total & Permanent Disability (TPD) insurance cover exists to provide compensation for people who have been injured (e.g. a workplace injury) or become unwell to the point where they are no longer able to work.

Your eligibility for a TPD claim will depend on you meeting the criteria as outlined by your insurance company. You may have standard TPD cover where you receive compensation if you can no longer perform any type of work. You may have opted for occupation specific cover which covers you if you are injured and no longer able to perform your particular occupational duties. You may also have TPD cover through your superannuation provider.

When assessing your eligibility for a TPD claim, your insurer will look at a range of factors and make a judgment as to your fitness to work.

TPD claims can be complicated as there are usually a number of factors to consider and you may need to engage with your insurance provider over a period of time. This can be difficult to sustain, and it is important to have support. Legal advice is important when making a TPD claim to ensure that all the appropriate elements are managed correctly.  

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Although this insurance may be provided by your Superannuation fund provider, the payout you receive is not an advanced payment of your own funds that are held in Super. Rather, it is a payout from a separate insurance policy, so you can make a claim no matter how little or how much is in your Superannuation fund. It will not affect the amount that is left in your Superannuation fund and you are still entitled to draw on these funds when you reach retirement age.

What will my insurer consider?

In making an assessment for a claim, your insurance provider will look at a range of factors including:

• Your level of disability, including whether you have lost a limb, eyesight or other physical or mental function
• Whether you can perform another role or different duties with the same employer
• Whether you can no longer reasonably perform any type of employment, or if you are unlikely to be able to work again in your own profession
• If you have superannuation cover
• How long ago you were injured
• Whether you have been continually absent from work for a certain period of time
• Your ability to perform daily tasks and activities
• If you need ongoing medical care or rehabilitation

Your TPD cover will fall under either an own occupation or any occupation cover. Depending on your insurance provider you’ll need to meet their definition to be eligible to claim.

- Own occupation. This is when you are unlikely to be able to return to full-time work in your previous occupation.

- Any occupation. This is when you are unlikely to be able to engage in any form of regular paid work ever again.

How do I know if I qualify for a TPD claim?

This depends on your insurance provider. For some companies it is sufficient to show that you are unable to perform your current duties. For other insurance providers you will need to present a range of disability factors.

Example - Jack works driving a forklift and unloading pallets at a factory. He is injured at work one day and his leg is crushed. After extensive rehabilitation and recovery Jack can walk again, but he is no longer able to drive the forklift. This means that he cannot reasonably perform his own occupation duties, but he may be able to work in another role within his workplace or within another industry. In this instance, it would be unlikely that Jack would be able to make a TPD claim under an any occupation cover policy. However, Jack might be able to make a WorkCover claim for his injuries.

It’s best to contact your insurance provider or super fund to find out what their criteria are for TPD claims.