What to Know About Australian TPD Claims

This article outlines what injuries or conditions qualify for a viable TPD claim, how our team can assist with your claim, how pre-existing conditions are considered by the insurer, what kind of compensation your claim may attract and outlines some common reasons why a TPD claim may be rejected.

Have you recently suffered an injury or illness that means it is unlikely that you will be able to return to the work that you were previously doing? You may be eligible to lodge a Total and Permanent Disability (TPD) claim with your superannuation fund and receive a lump sum payment as compensation. At Gordon Legal, we offer no-win, no-fee legal assistance for TPD claims. Contact our expert team on (03) 9603 3000 or by completing an online enquiry form today to arrange an obligation-free appointment.

What injuries qualify for a TPD claim in Australia?

To be eligible for a TPD claim, you need to demonstrate that you are unlikely to be capable of returning to work in your pre-injury occupation, or an alternative occupation, that is within your education, training and experience. Therefore, the list of injuries that can lead to a successful TPD claim varies greatly.

Some common injuries and conditions that could lead to a successful TPD claim include:

• Physical injuries, including musculoskeletal conditions;
• Psychological conditions, including depression or anxiety;
• Occupational diseases;
• Serious illnesses such as cancer, heart attack, or stroke;
• Chronic conditions such as auto immune disease, multiple sclerosis, motor neurone disease or Parkinson’s disease.

Each superannuation fund has it’s own specific policy outlining the requirements for a TPD claim. However, our experienced TPD team is ready to listen to your story and provide tailored advice specific to your circumstances. Contact us on (03) 9603 3000 to arrange an obligation-free appointment today!

Do I need a lawyer to file a TPD claim?

Whilst it is possible to submit a TPD claim yourself, we do not recommend this. By securing legal representation from Gordon Legal, you will significantly increase your chances of success and ensure you access the compensation you deserve. Superannuation funds and insurers will typically deploy complex legal language, technical requirements and strict deadlines, with mistakes leading to unfair delays and rejections.

Our experienced team can assist by:

• Reviewing your insurance policy and determining your eligibility for a TPD claim.
• Assist with the gathering of medical records and other relevant documentation.
• Making detailed legal and medical submissions on your behalf to the insurer about how you satisfy the definition of TPD under the policy;
• Manage communication with the insurer and super fund; and
• Keep the insurer accountable about any requests for further information which may not be necessary, and could potentially cause delay to your claim;
• Lodge formal complaints on your behalf.

Our team operates on a no-win, no-fee basis, so you will not be charged legal costs unless your claim is successful. Contact us on (03) 9603 3000 to find out how we can improve your chances of success and increase the efficiency of your TPD claim.

Can I claim TPD if I have pre-existing conditions?

Yes, you can. However, it can complicate the process. Some TPD policies may have specific exclusions or limitations for certain pre-existing medical conditions. If this is the case, it does not mean the claim will automatically be rejected.

If your condition or injury is separate from the pre-existing one, or the policy did not have a valid exclusion at the time of your injury, you may still be eligible.

Our expert superannuation team can review your policy, interpret exclusion clauses and build a case that demonstrates your current disability is unrelated to your prior condition.

Even if your pre-existing condition contributed to your current disability, it is still advised that you contact us at (03) 9603 3000 so that the team can assess whether you have a viable TPD claim.

How much compensation can I get from a TPD claim?

The value of a TPD claim usually depends on your superannuation policy. The value can range anywhere from $50,000 to $500,000, depending on your age and level of coverage.

TPD payments are usually a one off, lump-sum payout, that is paid into your superfund, which you then have the option of withdrawing. It can assist with medical expenses, loss of income, and other long-term costs associated with your disability. Our experienced TPD lawyers will be able to outline the full scope of the potential compensation your claim may receive, so contact us to arrange an initial consultation today!

Why are TPD claims often denied?

Many TPD claims are rejected due to incomplete applications, insufficient medical evidence or overly strict policy interpretations. Some common reasons for denial include:

• Lack of clear medical evidence supporting the claim that your injury or illness will lead to permanent incapacity.
• Failure to meet the TPD definition under the relevant policy.
• Delays in providing documentation.
• Missing deadlines.

If your claim has already been rejected, you have legal options available, including:

• Submitting additional evidence for reassessment;
• Lodging a formal complaint with the superannuation fund or insurer;
• Filing a complaint with the Australian Financial Complaints Authority (AFCA); or

Taking the superannuation fund and the insurer to court. By contacting us at the outset of the claim process, we will work to ensure that common mistakes like these are avoided and that your claim has the best chance of succeeding. Our experienced team is ready to listen and advise today!

If you are ready to lodge your TPD claim, contact us to secure experienced legal representation. Our superannuation and TPD team are prepared to advocate on your behalf and ensure your claim has the best chance of succeeding. Contact a member of our legal team on (03) 9603 3000 or by completing an online claim form to discover more!

A death benefit claim is a request made to a superannuation fund by the beneficiaries or legal personal representative of a deceased member, seeking payment of the deceased’s superannuation account balance and any associated death insurance benefits. These claims provide critical financial support during an already difficult time, helping to cover expenses such as funeral costs, outstanding debts, and day-to-day living expenses.

Death benefits are typically paid to:

• A dependant or multiple dependants of the deceased, which may include a spouse or de facto partner, children (of any age), or anyone in an interdependency relationship with the deceased.
• The deceased’s legal personal representative (e.g., the executor of their estate), for distribution in accordance with the deceased’s will.
• In some circumstances, a non-dependant may also be eligible, subject to the specific rules of the superannuation fund’s trust deed and insurance policy.

For the purposes of these claims, a “dependant” is defined as someone who, at the time of the deceased’s passing, had a close personal relationship with the deceased and relied on them for financial or domestic support. In cases where the relationship is not formalised by marriage, such as in a de facto partnership, establishing eligibility might require additional evidence – such as statutory declarations, shared bills, or other documentation – to prove the relationship.

A binding nomination is a legally executed document where a super fund member specifies how they wish their death benefits to be distributed. If a binding nomination is in place and valid, the Trustee of the superannuation fund must distribute the benefits according to the member’s instructions.

It is important to note that a binding nomination will typically expire after a set period (usually three years) and must be reviewed periodically. In the absence of a binding nomination, the Trustee has discretion in determining the beneficiaries based on the fund’s trust deed.

The prompt payment of death benefits is crucial. Delays can compound the emotional and financial strain experienced by families during their time of loss. When funds are delayed, beneficiaries may struggle to cover immediate expenses such as funeral costs, outstanding debts, or everyday living expenses.

The inconsistency in claims processing timeframes across various superannuation funds underscores the need for clear, enforceable customer service standards to ensure that beneficiaries are not left waiting during critical moments.

At Gordon Legal, we specialise in TPD and Life Insurance / Death Benefit claims. If you or a loved one has experienced delays in receiving a death benefit, or if you are unsure of your entitlements, our experienced team is here to help. We can provide you with expert legal advice and guide you through the claims process, ensuring that your case is handled with the urgency and care it deserves.

Our no-win/no-fee approach means that you can seek our assistance without worrying about upfront costs, allowing you to focus on what matters most – that is, supporting your family during difficult times.

If you have questions about your death benefit claim or need assistance with any aspect of your TPD or life insurance matter, please contact us at Gordon Legal. We are committed to ensuring that you receive the financial support you deserve.

Loredana Trimboli (Senior Associate)