Introduction: The Shocking Truth About TPD Claims
Imagine this: You’ve worked hard for decades, paying into your superannuation fund, believing it’s your safety net. Then, an accident or illness strikes—leaving you permanently unable to work. You file a Total and Permanent Disability (TPD) claim, expecting support, only to receive a rejection letter from your insurer. You’re not alone. Over 25% of TPD claims are denied initially, often due to technicalities, lack of evidence, or insurer pushback.
For many Australians, a TPD payout isn’t just money—it’s the difference between financial survival and ruin. Yet, most people don’t understand how these claims work, what they’re entitled to, or how to fight back when insurers play hardball.
This guide cuts through the confusion. Whether you’re a construction worker with a back injury, a nurse battling chronic pain, or someone with a progressive illness like MS, you’ll learn:
What a TPD claim actually is (and how it differs from income protection)
Who qualifies (Hint: It’s not just physical disabilities)
The 3 biggest reasons insurers deny claims (and how to avoid them)
Step-by-step: How to lodge a strong TPD claim
What to do if your claim is rejected (Spoiler: Most appeals succeed with legal help)
By the end, you’ll know exactly how to maximise your payout—and why waiting even a few months could cost you hundreds of thousands of dollars.
What Is a TPD Claim?
A Total and Permanent Disability (TPD) claim is a lump-sum payment from your superannuation or insurance policy if an injury or illness leaves you unable or unlikely to ever return to work in your usual job (or any job, depending on your policy).
Key Facts Most People Don’t Know:
- It’s not automatic – You must apply, and insurers often fight payouts.
- You don’t need to be bedridden – Mental health conditions (e.g., PTSD, severe depression) and chronic pain often qualify.
- The right financial advisor or Insurance Broker – is crucial when it comes to TPD cover.
Real-Life Example:
Sarah, a 45-year-old teacher, developed severe rheumatoid arthritis. Her super fund rejected her claim, arguing she could “work remotely.” With legal help, she proved her pain made even desk work impossible—and won a $400,000 payout after appeal.
Who Qualifies for a TPD Claim?
Your eligibility depends on your policy’s definition of “total and permanent disability.” Most fall into two categories:
- “Own Occupation” TPD – Can’t return to your specific job (e.g., a tradie with a spinal injury).
- “Any Occupation” TPD – Can’t work any job suited to your skills/education (stricter, but still possible with strong evidence).
Surprising Qualifiers:
Mental health conditions (PTSD, anxiety, bipolar disorder)
Progressive diseases (MS, Parkinson’s, MND)
Chronic pain syndromes (fibromyalgia, CRPS)
Physical conditions ( Back, Shoulder, legs, neck)
Who Gets Denied?
- Pre-existing conditions.
- Insufficient medical proof to meet the relevant TPD Definition
- Working part-time? Insurers may argue you’re not “totally” disabled—even if you’re struggling.
- Other policy related issues including- at work and/or reasonable retraining clause.
The 2 Biggest Mistakes That Get TPD Claims Denied
- Using Generic Medical Evidence
- Insurers demand detailed reports linking your condition to work incapacity.
- Fix: Get assessments from specialists (e.g., psychiatrists for PTSD, orthopaedic surgeons for back injuries).
- Not Understanding Your Policy
- Some policies exclude pre-existing conditions or require you to prove you’ll never recover.
- Fix: Have a lawyer review your policy before applying.
How to Lodge a Winning TPD Claim
Step 1: Check Your Superannuation Policy
- 90% of Australians have TPD cover through super but don’t realise it.
Step 2: Gather Strong Evidence
- Medical reports (specialists > GPs)
- Employer statements (confirming date last worked)
- Financial records (Tax, payslips)
Step 3: Submit & Prepare for Pushback
- Insurers may delay, request an IME, or Employability Assessment.
- Pro Tip: 70% of rejected claims win on appeal with legal help.
What If Your Claim Is Denied?
Don’t panic—most declines are negotiable. Options include:
- Internal dispute resolution (free, but often ineffective)
- AFCA complaint (free independent external dispute resolution intervention)
- Court Proceedings
Final Advice: Act Now
TPD claims take 6–24 months. The sooner you start, the sooner you get paid.
Need Help? Book a free policy review with WKB Lawyers on 1800865225.