When a person makes a total and permanent disability claim, i.e., a TPD claim, they may be entitled to receive payment if they’ve suffered an injury or illness. A person could be suffering from an injury or illness that prevents them from returning to work. Lawyers can help out with making such claims.
While this injury or illness need not be work-related, they can make a TPD claim only if it has prevented them from working. Moreover, if they get an injury from an accident, they can claim for workers compensation benefits along with a TPD claim.
The insurance industry in Australia is governed by many laws like the Insurance Act 1973. In this blog, we discuss certain important points in relation to making a TPD claim. More importantly, people always wonder if they need legal advice while making such claims. In this article, we will also highlight the importance of legal advice.
What Is Total and Permanent Disability?
If a person has not been able to work at all due to an illness or physical injury for an extended period (3 months and more), it is total and permanent disability. Moreover, the person must have no expectation to return to work. A person may be eligible to receive TPD insurance benefits if they:
- stop working due to an injury or sickness.
- do not work for the waiting period that can be around 3-6 months; and
- are unlikely to return to work that is in their education, experience, and training after this period.
Who Can Make a TPD Claim?
Many a times, different insurance policies will have different conditions. Therefore, you need to check your policy to see what it covers exactly. As an example, you policy may or may not include:
- If you are unlikely to return to work in your occupation, or work in any occupation.
Therefore, you can determine your basic eligibility depending on what’s mentioned in your policy. Moreover, if a person has been injured due to an accident, they can make other claims in addition to this one. It is important to speak with a lawyer to understand which claims you are eligible to make.
Amount You Can Receive from TPD Claims
The amount a person can receive from their claim will depend entirely on the insurance arrangements in their specific super funds. Generally, this amount is determined by checking how old the person was when they ceased working due to an illness or injury.
Also parties need to check the insurance cover that they had when they last worked, and not the one they had when they made the enquiry regarding TPD claims. Why is this so? Because it is quite possible for the insurance cover to change over time.
Medical and Occupational History
People making this claim need to provide their full medical and occupational history. This is because they must prove to the insurer that their claims are valid. They must show that they are no longer capable of meeting the physical and/or mental demands of their work due to the illness or injury.
They also need to consult a doctor and get their opinion on whether they can continue working. Moreover, employers will need to provide a statement to confirm that the party had stopped working from a certain date due to injury or illness.
Also, they need to prove the significance of their injury. Hence, they need to meet with a medical specialist who can review their injuries and illnesses. The specialists can then confirm that the person cannot work due to their illness/injury.
It is better to consult a specialist doctor because they might be better suited to clarify the nature of injuries or illness.
How Can Lawyers Help with Making TPD Claims?
It can be quite complicated to lodge a TPD claim by yourselves. Therefore, it is better to engage a lawyer who can help you with this matter.
Firstly, each insurance provider and policy may have a slightly different definition of “total and permanent disability”. Therefore, a lawyer can help you understand exactly what you are eligible for.
Moreover, quite often people make a claim only to be unsuccessful. Before you lodge a claim, you can seek advice from lawyers who can help you understand whether or not your claim will be viable.
Furthermore, when you make a claim, you will need lot of evidence and paperwork to support your claim. When people run behind gathering this evidence, they often lose focus of what matters – recovery. If you are suffering from an illness or injury, you need to use your energy to recover.
Lawyers can take care of every other aspect related to filing a claim such as gathering paperwork and collecting necessary evidence.
Lastly, it is quite possible that you must attend court hearings or trials to settle your TPD claim. While this may be rare, you cannot rule this possibility out. Therefore, it is essential to have a lawyer who can represent you in your case if required.
Contact our lawyers for more information.