This is a difficult time. If you have a health issue or are suffering from a flare-up dealing with the paperwork can be daunting. But we are here to help you out. For members who are eligible, TPD or total and permanent disability insurance will provide coverage in case you are too sick or injured to be able to work. With our TPD claim cover, you will be allowed to make a claim that will support you during this tough time.
What does a TPD benefit entail?
The TPD claim will allow you to claim a lump sum. This payment is designed to pay for your living expenses. In case you have a debt, the TPD will also cover the monthly payments especially if you have a serious disability that could be permanent.
What are the eligibility criteria for the TPD benefit?
Getting your life back on track is a priority even with a permanent and serious disability. However, to be eligible for the TPD benefit, there are a few criteria that have to be fulfilled. For example, you will need to be medically certified to prove a total disability. Apart from the medical certification, you will also need to meet TPD’s eligibility criteria to get the TPD benefit. For more information, please get in touch with a lawyer.
Are there any specific eligibility requirements to make the TPD claim?
As with all insurance companies, there are specific conditions and criteria that have to be followed before making a TPD claim. The criteria will vary depending on the policy, the individual and the type of coverage that was selected at the time of making the policy. If you are planning to make a claim, we recommend we recommend checking the policy and eligibility requirements well in advance. The most common requirements are listed below.
- Differences in eligibility due to variations in the insurers.
- Assessment of the disability: Complete, partial, temporary or permanent Depending on the disability, companies will also assess the likelihood to return to work or any kind; same as previous employment or different due to limitations due to accident. Some companies also consider loss of limbs and limitation of work due to the type of disability as a part of the eligibility requirements before a claim can be made.
- Waiting period requirements also seem to vary. A few conditions may not have a waiting period and claims can be done immediately. However, in some conditions, the waiting period may be for 3 months. Depending on the seriousness of the disability, some companies may have a waiting period of 6-9 months as well.
- Proving work history is also important. For most companies, you have to prove that you were employed for at least a year before the claim can be made. You will also have to provide that you were in full-time employment before the claim was made. Other companies may also require a set number of hours to be completed daily fore the claim is made.
- Loss of independence is sometimes a determining factor as well. Some companies will require you to prove that you cannot perform your day-to-day activities. This may involve your activities of daily living like bathing, cooking or washing. We recommend getting in touch with a lawyer for more information.
- Complying with medical care is also an important factor. As a patient undergoing care, you will have to prove that you are visiting and following up with a medical specialist. Regular care from a certified medical practitioner has to be documented. If required, regular rehabilitation may also be required.
How Do Start the TPD claim process.
The process of making a claim will vary from company to company. A good insurance lawyer will guide you through the process. However, the general process is as follows.
- Get in touch with the insurer. Once you have contacted the company, discuss the claim you will be making and find out what eligibility requirements are in place. You will be put in touch with a claims representative who will help you understand the process. They will also discuss the next steps with you. Once the process is clear, you may be assigned a case manager as well. At this stage, its always a good idea to have a lawyer ready to help you with the process.
- File your claim. Once you have understood the documentation process, fill out the correct forms. Make sure you have included the correct documentation and evidence that is required. This may include medical documentation, employer verification forms, personal documentation and other relevant documents. The information is shared with your case manager and he will keep you updated as the process passes through its various stages.
- The claim will be assessed. Once the documentation is submitted, the insurance manager will assess the claim and determine eligibility. In some cases, additional evidence may be required. Sometimes, a second opinion and further medical evaluations may be required. If you feel the need for additional help, we recommend hiring a lawyer to deal with the paperwork.
- A tentative decision is usually made. After assessing the reports, a tentative initial decision is taken. This may involve accepting, rejecting, or deferring the claim based on the documentation provided and the assessor’s opinion. If the claim is accepted, the insurance will finalize the payment process and get in touch with you. The decision may be deferred after further assessment is done. In some cases, the claim is declined as policy conditions have not been met. The process may seem lengthy and we recommend hiring a lawyer to ensure that the claim is accepted as soon as possible.
- A response from your end will be required. The claimant is allowed to contest the decision by filing additional documentation or proof. You can also lodge an appeal in case the tpd claim rejected.
In some cases, claimants who have TPD insurance with more than a single super fund are eligible to claim multiple benefits. However, you will have to contact your claims manager to find out exactly what benefits you are eligible for.
How long does the TPD claim process usually last?
On an average, the TPD claims process may last anywhere from 2-3 months. However, complex cases may last longer up to 6 months or more. Disputed cases may take years to settle. If you are dissatisfied with the time taken to resolve the claim, you can file a complaint with the insurer or the superannuation fund or the local financial complaints authority.
In some cases, you may have to hire a tpd claim lawyers to help you deal with the TPD claims process. A good lawyer will review the paperwork and ensure that your claim is processed as soon as possible.
Is there a difference between the “any” and “own” occupation terms?
There is a difference between the “any” and “own” occupation terms. The term “any” states that benefits will be provided in case the injury or disability prohibits you from working in any occupation. This option is cheaper, and you are more likely to get your claims accepted. However, when the term “own” is used, then you will get a benefit only when you are unable to work in your own occupation. As expected, this option is expensive, but it is far easier to prove during the claims process.
What are the TPD claim tax options on the TPD benefits?
The exact details cannot be explained here. However, a general rule of thumb is when the benefit is initially credited to your account, it won’t be taxed. However, if you withdraw it from you super account before the age of 60, then current tax rules will apply.
The usual tax rate will vary from 1% to about 15% or more. In some cases, due to multiple benefits, the tax rate may vary on each benefit. However, when the TPD insurance is through an insurer, then the benefit is not taxed. The tax was already paid on the premiums.
What is the easier process for getting my TPD claim approved?
Following the company documentation process is the best way to get your claim approved as soon as possible. In case additional paperwork or medical evaluations are required, it’s a good idea to cooperate as much as possible. The duty of disclosure is dependent on the claimant.
Does TPD have an option for partial disability?
Yes, most companies have an option of total and partial disability coverage to benefit the claimant. Benefits may be hours-based or duties-based. Some policies also recommend partial payment in specified list of disabilities.
Is mental illness covered in the TPD process?
Mental illness is not covered under many TPD claims as the conditions are difficult to prove. However, under certain conditions insurance company may pay out certain amounts. However, you may have to prove the treatment process and provide documentation of treatment being carried out.
Is it possible for the TPD claim to be disputed?
Yes, the TPD claim may be disputed. There are several reasons like varied definitions, ongoing requirements, waiting periods, exclusion criteria, etc. based on which you claim may be rejected.
What happens if the TPD claim is rejected?
The TPD claim may be rejected under various reasons, however, you can still get your case reassessed. We recommend you start by understanding exactly why the claim was rejected. You will have to get in touch with your company and understand the reasoning. This will help you build a counterargument or provide documentation for the same.
Once you have the reason, gather evidence to back your claim and prove the insurer wrong. If necessary, you may have to file a dispute with the insurer through the IDR or internal dispute resolution process.
It will take anywhere from 45 days to 90 days for the case to be reevaluated. If the dispute still does not work out, you can discuss the case with the AFCA or take legal action with the help of lawyers.