There is no standard definition of TPD claims, some polices require waiting periods of up to 3 months and some are 6 months.
It’s important to understand your policy requirements. Some polices will need the claimant to follow specific ongoing advice of a specialist or even a rehabilitation program. Some TPD claim payouts will often have exclusions for pre-existing medical conditions
One of the more general and common definitions of Total and Permanent Disablement is:
“Due to an illness or injury, a person is unable to work in any occupation for which they are suited by training, education, or experience.”
Depending on your policy, the TPD definition and waiting periods may vary. It is extremely important to understand your policy, which Insurance Claims Solutions will assist you with.
Read Steve’s Story on His TPD Claim
Steve aged 45 worked as a FIFO worker and had recently separated from his wife of 10 years. They have 3 children together. He was earning $100,000 a year but had lots of debt due to the separation and was now renting again, while continuing to work so he could save money to buy his own house again.
As he worked underground, every 3 years his employer would make all employees complete a physical to show they were healthy and fit to continue working underground. Imagine Steve’s surprise when he couldn’t pass the physical test and lost his job!
He was distraught and was not trained to do anything else aside from truck driving. Therefore, any new employer would require him to pass the medical and physical exam, which he couldn’t. Steve was forced to go to Centrelink and apply for disability pension, however they did not at this stage class Steve as disabled enough to not work. He was then placed onto unemployment benefits, including having to provide a medical form every month to Centrelink just to get money to help pay his bills and put food on the table.
Unfortunately, Steve was diagnosed with muscular dystrophy and thought he wouldn’t be able to make a Total and Permanent Disablement claim. He had wrongly assumed the insurance company would class it as a pre-existing disability given it is normally a disease you get earlier in life. However, Steve had no history of this disease showing prior to then.
Steve contacted Tracey and her team here at ICS, to see if he had a case to make a claim for his Total and Permanent Disablement Insurance from his super fund, as Centrelink did not provide enough funds to cover his bills. On top of this he also had the constant need to see his Doctors to provide them with medical forms which was also causing extreme stress.
Tracey reviewed his policy and contacted his Superannuation Fund to read the policy definitions of his policy and agreed that Steve did in fact have a case to lodge a TPD claim. With the help and guidance of Tracey and her team, Steve was able to gather all the medical reports required and the claim was lodged with his Super Fund.
After 6 months Steve was paid his Total and Permanent Disablement policy in full and also had access to his superannuation money, as he had met a condition of release even though he was under 60 years of age.
Steve suffered anxiety through this ordeal as he went from a hard-working man who provided for his children to someone who struggled to put food on the table for himself, let alone help his ex-wife to bring up their children.
As you can imagine, Steve is very grateful to Tracey and her team and recommends them to anyone who needs to make a claim or is unsure if they have a case to make a claim.
TPD Claims – The Criteria…
1. Level of disability;
- Some insurers will require a minimum level of disability for TPD Claims. They will look at the likelihood of you recovering from your disability.
- You are unlikely to return to work.
- Unlikely to return to your previous role.
- You have lost a limb or your eyesight.
2. Is your cover included in your super?
- ‘Any” versus “Own” Occupation, your TPD cover will typically fall under either an own occupation or an any-occupations cover.
- TPD inside super only comes with an Any occupation definition, this is a broad definition that can be hard to prove sometimes. Any definition is when you are unlikely to ever be able to engage in any job suited to your education or experience. Eg; a job that has basic requirements. Own definition is when you are unlikely to ever return to full time work in your previous job eg construction worker.
3. Waiting periods, there is usually a minimum waiting period from the time you make a claim to when you are paid.
- 3 months continuous absence from work.
- 6 months continuous absence from work.
- No waiting periods for some conditions such as major head trauma.
4. Minimum work history, some insurers require you to meet a minimum level of work before you are eligible.
- Show 12 months of employment.
- Full time work.
- Minimum hours.
5. Your ability to perform “daily activities”.
- For some policies you’re required to demonstrate an inability to perform a certain number of daily living activities.
- 2-3 daily living activities eg; bathing, dressing, walking unaided.
6. Ongoing medical care.
- Some policies require you to show ongoing medical care to improve your condition or to prevent further illness eg; rehab and regular appointments.
We Are Here To Help You..
Our specialist team are on board to assist you through the processes and paperwork of your TPD claims, leaving you the time to concentrate on your own wellbeing.
Total and Permanent Disability claim benefits are paid out to you as a lump sum – this payment is combined of your personal and employer superannuation contributions and an insured component.
TPD lump sum benefits can help cover:
- Medical expenses
- Rehabilitation programs
- Debt repayments
- Ongoing income needs
Terminal Illness – Guiding You Through…
Terminal Illness is an insurance benefit much like a Total and Permanent Disablement Claim. If you suffer from a terminal illness and are likely to pass away within a 2-year period, this benefit is provided tax free.
This benefit offers you the opportunity to access your superannuation in order for you to finalise your affairs in advance and as per your wishes.
Allow the team at Insurance Claims Solutions to help you process your Total Permanent Disability insurance claims today. Call us or connect with us on our Contact Us page.
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