There is a misconception that claiming Total and Permanent Disability (TPD) compensation is a straightforward process, however, preparing a TPD claim requires the inclusion of detailed information and substantial evidence, not to mention dealing with insurers who have plenty of experience defending claims.
Starting a TPD claim can be overwhelming and confusing as this area of law is complex. This is why we strongly suggest you seek legal advice from an experienced lawyer.
What is considered a TPD?
TPD is a term used by insurers, superannuation funds and the legal profession, to describe a sickness or injury that prevents a person from working in their occupation. For example, a surgeon who is no longer able to operate due to carpel tunnel.
TPD compensation is a lump sum payment for those who have sustained permanent disability and are unable to work. Most insurers have specific requirements a person has to meet to be able to claim TPD and these requirements can vary between different insures.
You will need to carefully read through your insurance policy to see what is and isn’t included.
When can I make a TPD claim?
Your entitlement to make a TPD claim depends on the requirements laid out by your insurer or super fund.
Criteria varies between insurers, but some common requirements for making a claim can include:
- Demonstrating your level of disability by proving you are suffering a minimum level of disability, including your ability to return to your previous employment.
- That you are unable to work in any other type of occupation to which you are suited by your education, training or experience.
- Whether any TPD cover is included in your superannuation policy – you will need to contact your superannuation provider to find out if you are covered under your policy.
- Waiting periods – most policies require a waiting period as this allows for all injuries and symptoms to stabilise so the full extent of damage can be assessed.
- A minimum level of employment before you are eligible for TPD.
If you are unsure as to whether you qualify for a TPD payment, we recommend you speak to one of our experienced lawyers.
Benefits of a using a lawyer to help with my TPD claim
Making a claim for TPD compensation involves completing onerous claim forms. One advantage of having an experienced lawyer is that they will make the form-filling process much easier as opposed to filling out the forms yourself.
Claim forms will require detailed information from a claimant which can confuse people as to whether they are either providing too much or too little information.
A medical certificate is required to be submitted with your TPD claim. It is vital your medical specialist has the correct details about how you sustained your injury, as well as any pre-existing medical conditions you may have. If you do not provide details of pre-existing conditions relevant to your injury and the insurer discovers this, they may challenge the validity of your claim.
An experienced lawyer can also ensure medical evidence addresses definitions and other criteria contained in the TPD policy. This may require a more detailed statement or opinion from a medical practitioner.
Your lawyer will also be able to gather other relevant evidence to support your claim, such as:
- statements from your previous employer and evidence about why you are unfit for other type of work;
- clinical notes from your doctors and other medical practitioners;
- if you were on WorkCover or receiving any benefits under a CTP scheme, your statutory benefits claim file;
- an employer statement, if self-employed, your BAS, business tax returns, and pay slips;
- ATO and Medicare records; and
- Centrelink records, if applicable.
It is clear that preparing a TPD claim requires a substantial amount of information and evidence gathering. To ensure you have included everything you need in your claim, we strongly recommend you speak to an experienced lawyer.
It is obvious from the above discussion that TPD compensation is a complex area of law and entitlement to claim TPD is not a one size fits all approach. Whether you are entitled to claim TPD will depend on your particular situation.
Seeking help from a lawyer experienced in TPD compensation can ensure your claim is completed properly at first instance, which can save you time, money and stress. It can also ensure that you are not placed at a disadvantage in dealing with insurers who are experienced in defending TPD claims.
If you or someone you know wants more information or needs help or advice, please contact us on (02) 9708 2222 or email [email protected].