TPD Insurance provides cover only of you become ‘totally and permanently disabled’.
Generally speaking, to be eligible to make a claim you will need to have been disabled continuously for a minimum of 3 to 6 months as a result of the injury or illness.
A smaller % of people hold occupational specific cover which means you can make a claim if you not able to work again in your specified occupation, even if you are able to work in another occupation. For example, if a surgeon had occupational specific cover and a hand injury meant they could not work again as a surgeon but they could work in an office based role then they could apply for payout if they had occupational specific cover but not if they had standard TPD cover.
If you wish to claim on your TPD policy you will have to show that because of an incident or illness it is unlikely you will ever return to your usual job or to any employment (depending on your policy requirements).
Be aware that TPD policies also contain exclusions. Exclusions are particular injuries or circumstances giving rise to an injury that are not covered under your TPD policy.
For example, if you have disclosed to your insurer a pre-existing medical condition such as a back injury, they may decide to exclude all back conditions from your cover. This means that if you become totally and permanently disabled due to a back injury, you will not receive a payout under your TPD policy. Exclusions are however generally reviewable and can be removed from your policy if you can prove that you no longer suffer with a particular condition at a later time.
Similar exclusions may be included in policies with regard to family medial history, unusual occupational risks and self inflicted injury or illness.Cover may also be denied if you fail to provide a complete disclosure of your medical history at the time of purchasing TPD cover.
All policies are different so it is important that you read your product disclosure statement and seek advice if you are not sure about what you are covered for.
It’s important to get advice for your specific situation. Check if you can make a risk-free compensation claim and get free initial advice from our Principal lawyer, Greg Smith.
Your TPD claim has been denied. Now what? Find out options to appeal a rejected TPD claim.
Step by step on making a TPD claim in Australia directly with insurer or via a TPD expert lawyer including pro's & con's to each. Free expert information.