Areas of practice / TPD, income protection & super
TPD, income protection and superannuation claims
If injury or illness has stopped you working, there is a good chance you are insured and don't know it. Most Australian super accounts carry total and permanent disability cover, many carry income protection, and a declined claim is a decision that can be challenged, not the end of the road.
Where the cover sits
Superannuation funds add TPD and, often, income protection and death cover to members' accounts by default. You may also hold cover through a policy bought directly or through a financial adviser, through your employment contract or enterprise agreement, or across more than one fund if you have changed jobs. Each policy can pay independently, so the first step in every matter is finding all of it.
Total and permanent disability (TPD)
A TPD benefit is a lump sum, paid when an injury or illness means you are unlikely ever to return to work in an occupation suited to your education, training and experience. It does not matter who was at fault, and it can be claimed alongside a WorkCover or motor vehicle claim arising from the same event. Physical injuries, chronic illness, mental health conditions, neurological conditions and chronic pain can all qualify. What decides the claim is the exact wording of the policy's disability definition, and the medical evidence measured against it.
Income protection
Income protection pays a monthly benefit, usually a percentage of your pre-disability earnings, while you cannot work. Unlike TPD it does not require the incapacity to be permanent, so it can start much sooner, and it can be paid and later stop as your condition or work situation changes. Many people hold both. Where they arise from the same injury or illness we run them together, so the evidence gathered for one supports the other, and we act when an insurer stops, reduces or offsets payments you were relying on.
Death and terminal illness benefits
Super usually carries death cover alongside TPD, and most policies pay a terminal illness benefit early, during the member's lifetime, where the medical certification the policy requires is in place. We assist families and members with both, including disputes about who the benefit should be paid to.
How we run a claim
You deal with your lawyer throughout. We identify every policy you hold, read each definition, and gather what the insurer will need before it asks: medical records and statements from your treating doctors, employment history, and records from bodies such as the ATO, Medicare and Centrelink. Preparing a claim properly usually takes a few weeks and depends on how quickly doctors and employers respond. Once lodged, insurers work to the Life Insurance Code of Practice timeframe of around six months, and we chase the file so that it does not drift.
If a claim is declined or disputed
Most declines come down to a handful of things: medical evidence that describes a diagnosis but not what it stops you doing at work; an argument that you could retrain for other work; a claim that cover had lapsed before you stopped working; or inconsistencies between the claim form, medical history and employer records. Each can be answered. The pathway is:
- Procedural fairness: if the insurer is minded to decline, it must give you a chance to respond first. A strong response here often resolves the matter.
- Internal review: every fund runs an internal dispute process. We engage with the trustee's actual reasons, with fresh medical evidence where needed.
- AFCA: a free complaint to the Australian Financial Complaints Authority, which can substitute its own decision and direct that a benefit be paid.
- Court: for larger or more complex claims, proceedings against the trustee or insurer, with a candid assessment of prospects before any step is taken.
Time limits
Super and insurance claims are not governed by the strict notice periods that apply to CTP and WorkCover claims, and it is common to claim years after stopping work. But cover can lapse when contributions stop, evidence gets harder to gather with time, and court proceedings do carry limitation periods. Start early.
Fees
- No win, no fee. Our professional fees are only payable if the claim succeeds. We fund the outlays needed to run it, and in most cases they are not payable if the claim is unsuccessful; the exceptions are in the costs agreement, explained in writing before you sign anything.
- The first consultation is free, by phone, Zoom, at our office or wherever suits you.
The questions we get asked most
Can I claim TPD and income protection at the same time?
Usually yes, where you hold both. They are assessed differently, and one being paid does not stop the other, though some income protection policies offset other benefits.
I've changed jobs a few times. Do I have more than one policy?
Very possibly. Each fund you have belonged to may have carried cover, and each can pay a benefit. We search for every account you have held.
Do I have to be injured at work or in an accident?
No. TPD and income protection turn on your capacity to work, not on how the condition arose. Illness, including mental illness, qualifies.
My claim was declined. Is that final?
No. A decline is a decision that can be reviewed internally, taken to AFCA, and, where warranted, to court. Many declined claims are ultimately paid.
Your lawyer answers the phone.
Your first consultation is free, by phone, Zoom, at our office or at yours. We answer most enquiries within the hour and all of them within a business day, and we will tell you plainly whether you have a claim.