TPD Eligibility in Australia: What You Need to Know Before You Claim

When illness or injury leaves you unable to return to work, Total and Permanent Disability (TPD) insurance can offer crucial financial relief. But the rules around eligibility are complicated and often hidden in fine print. At Gordon Legal, we specialise in cutting through the confusion so you can focus on your health, not legal jargon. If you’re wondering whether you’re eligible for a TPD claim or what could disqualify you, this guide will help.

A permanent disability is one that is unlikely to improve to the point where you can return to work again, either in your usual role or any suitable role, depending on your policy.

• Most TPD policies require medical evidence showing no reasonable prospect of returning to work.
• The definition of “permanent” often hinges on opinions from treating specialists, GPs, and sometimes independent medical examiners.
• Some policies require the condition to have lasted six months or longer before lodging a claim.

Only total disability is covered under TPD insurance.

• A partial disability will usually not meet the criteria unless your policy includes specific add-ons (rare in superannuation).
• “Total” typically means you’re unlikely to return to work you’re reasonably suited for by education, training, or experience.

Yes, but it can be more complicated.

• Some policies require you to have been gainfully employed for a set period before the disability.
• Others consider your work history and skills when assessing whether you’re able to return to the workforce in any capacity.
• Legal advice is especially helpful in these cases.

Yes. Receiving a disability pension does not stop you from making a TPD claim.

• In fact, it may help support your application by reinforcing the severity and permanency of your condition.
• Be aware: some funds may want to confirm you haven’t returned to work since going on the pension.

Your policy’s eligibility criteria are buried in the Product Disclosure Statement (PDS) or the insurance terms within your Insurance Policy.

• Request a full copy of your policy and insurance certificate from your superannuation provider.
• Look for sections titled “Definitions”, “Eligibility”, or “Exclusions”.
• If anything is unclear, a lawyer can interpret and explain the jargon for you.

They can be.

• TPD insurance still applies, but income verification and evidence of your inability to run your business may be harder to gather.
• You may need additional documentation such as tax returns, business activity statements (BAS), and accountant letters.

You can potentially claim on multiple TPD policies if you meet the eligibility criteria for each one.

• Each claim must be made separately and assessed under that policy’s terms.
• You must disclose other claims and policies to all insurers.
• Legal guidance can help avoid disputes or overlapping terms.

Sometimes.

• If your TPD benefit is built into your super, the payout often includes your super balance plus the insured TPD benefit.
• If your TPD cover has been cancelled due to inactivity or low balance, you may no longer be eligible, without even knowing it.

Always check your super account activity and whether your insurance is active.

If your claim has been rejected or delayed unfairly:

• Ask for a written explanation of the decision.
• Lodge a formal internal complaint with the insurer or super fund.
• Contact a lawyer to assess the merits of your case.
• You may be able to take your case to the Australian Financial Complaints Authority (AFCA) or Court

You are not alone. Many Australians find the process overwhelming, especially when dealing with illness or injury.

• Speak to your GP or specialist about how your condition impacts work capacity.
• Gather all medical records and documentation in one place.
• Get help from a lawyer experienced in TPD claims to manage paperwork, evidence, and communication with your insurer.

Dealing with disability is hard enough. Fighting for your rights shouldn’t be. Whether you’re unsure if you qualify or stuck in a never-ending claims process, Gordon Legal brings clarity, compassion, and gutsy legal know-how to every TPD case.

Talk to us today to understand your rights and start your TPD claim the right way.