TPD Claims in Australia: Eligibility, Evidence and What to Do if You’re Denied

If illness or injury has left you unable to work again, a Total and Permanent Disability (TPD) claim can provide vital financial support. But navigating the process, understanding eligibility, and knowing how to handle delays or denials can feel overwhelming.

At Gordon Legal, we cut through the confusion. This guide covers the most common questions about TPD claims, what they are, how to make one, and what happens if your claim is rejected.

Whether you’re just starting the process or you’ve hit a roadblock, you’re not alone. We’re here to help.

A TPD claim allows you to access a lump sum payment from your superannuation if you become unable to work due to illness or injury.

This isn’t about workers’ compensation or Centrelink, it’s an insurance benefit included in many super funds. You don’t have to prove your employer was at fault. You just need to meet the criteria in your policy, which often means showing you’re unlikely to return to your usual work (or any work you’re suited for).

You may be eligible if:

• You’ve stopped working due to illness or injury
• You were working when the condition developed or worsened
• Your super fund includes TPD insurance
• A doctor confirms you’re unlikely to return to work again

Some policies are stricter than others. For example, some define “permanent disability” as being unable to do any job, while others focus on your usual occupation.

The best way to check? Review your insurance policy wording and speak to a lawyer who understands how insurers assess claims.

You can usually check this through:

• Your super fund’s website or online portal
• Your annual superannuation statement
• Calling your fund directly and asking for your insurance summary

Most Australians with an active super account have TPD cover, especially if they’re employed and have employer contributions going in. But coverage can lapse if your account is inactive, or you opted out.

Medical reports are the backbone of a strong TPD claim. You’ll usually need:

• A detailed report from your treating GP or specialist
• Information about your diagnosis, symptoms and prognosis
• Confirmation that your condition prevents you from working again

Some super funds may request assessments from independent doctors, especially if they need clarification. If you have multiple conditions like chronic illness and depression, make sure all are documented.

TPD claims can take:

• 3 to 6 months for straightforward claims
• 6 to 12 months for more complex or disputed cases

The timeline depends on:

• How quickly you can provide medical evidence
• Whether your fund asks for more information
• If the insurer contests your claim

You can speed things up by having a lawyer manage the paperwork and push for updates, especially if you’re not getting clear communication from your fund.

Yes. TPD claims are based on your ability to return to work, not how or where the injury happened.

This means you can claim for:

• Chronic conditions like MS, cancer or Parkinson’s
• Mental health conditions
• Injuries sustained outside of work (e.g. car accidents, sporting injuries)

Even if you’ve never made a workers’ compensation claim, you could still be eligible for a TPD payout if your condition meets the criteria in your policy.

They can be. Depression, PTSD, anxiety, bipolar disorder and other psychiatric conditions are increasingly recognised in TPD claims.

The key is showing that your mental health condition is severe and permanent, and backed by ongoing medical care. You’ll usually need supporting evidence from a psychiatrist or psychologist, plus details about your treatment history.

Insurers reject claims for many reasons, including:

• Not meeting the policy’s definition of “total and permanent”
• Insufficient medical evidence
• Delays in submitting paperwork
• Missing documentation
• Disputes over whether you’re truly unable to work

Sometimes, claims are denied simply because the insurer wants more proof. That doesn’t mean the end of the road, it just means you need to gather more evidence or challenge the decision.

Yes, and many people do successfully.

You can:

1. Request an internal review from your super fund or insurer
2. Complain to the Australian Financial Complaints Authority (AFCA)
3. Engage a lawyer to formally dispute the decision
4. Issue court proceedings

At Gordon Legal, we’ve helped many clients turn denied claims into successful outcomes. We’ll gather stronger evidence, deal with the paperwork, and push back where it counts.

Time limits apply, so don’t delay if you’ve received a rejection letter.

A TPD lump sum can affect your Centrelink entitlements, depending on how it’s treated.

The payout itself may:

• Be exempt from the income test if it stays in super
• Count towards your assets test if withdrawn
• Affect payments like the Disability Support Pension or JobSeeker

Everyone’s financial situation is different, so it’s worth getting financial advice before accessing the funds. We can also help you speak with Centrelink if needed.

A TPD claim can give you financial breathing room when you need it most, but the process is rarely simple. From understanding eligibility to appealing denials, there are a lot of moving parts.

At Gordon Legal, we don’t believe in one-size-fits-all advice. We listen to your story, fight for what’s fair, and keep the process as clear and compassionate as possible.

Thinking about making a TPD claim? Already had one denied?

Let’s talk. Your first consultation is free, and we’ll explain everything in plain English.
Contact us today and find out how we can help.