What is superannuation?
Most superannuation policies include an insurance benefit known as a Total and Permanent Disability (“TPD”) benefit.
Alternatively you may have “stand alone” TPD cover, outside of your superannuation policy, but this is much less common, as most superannuation policies include the benefit.
Am I entitled to claim a TPD benefit?
If you are no longer able to earn income, you may be entitled to claim a TPD benefit.
The eligibility criteria for accessing a TPD benefit will be outlined in the policy document. You must be able to satisfy the definition of TPD within your own policy.
Although every policy is different, in most cases the definition of TPD contains two criteria which must be satisfied:
- The applicant has been unable to work for a specified period of time; and
- The applicant is unlikely to ever be able to engage in their usual occupation, or any occupation for which they are qualified by reason of their education, training and experience.
The circumstances that resulted in your injury or medical condition are not relevant, to the extent that there is no requirement to prove fault or negligence against another party.
How does the claims process work?
The claims process will differ depending on the insurer on the policy however, as a general rule, the initial steps in the process will involve completion of a claim form by the applicant and provision of supporting documentation.
Supporting documentation will usually include:
- A statement from the relevant employer.
- A report from your treating doctor – GP and / or specialist.
It may be necessary to provide additional medical evidence from your doctors, to specifically address the definition of TPD. It may be reasonable for the insurer to request your attendance at an independent medical examination.
The insurer will ultimately issue a determination based on all of the evidence available.
In the event of a successful claim, you will receive a tax-free lump sum which represents your TPD benefit. A successful application will also entitle you to access the balance of your superannuation fund, usually upon medical certification of permanent incapacity.
Are there any avenues for review?
If the claim is denied, the first step is to request a review of the determination by the insurers internal review process.
If you are unhappy with the outcome following the internal review, an application can be made to challenge the decision by lodging a complaint with the Superannuation Complaints Tribunal, or commencing Court proceedings.
Do any time limits apply?
Although there are usually no time limits which apply to a claimant’s entitlement to seek TPD benefits in the first instance, there may be strict time limits which apply to any application for review of a determination or application to a Tribunal or Court.
What if I have more than 1 superannuation policy?
If you have more than 1 superannuation policy, it may be possible to claim TPD benefits under each of those policies. The success of each individual application will depend on whether you satisfy the relevant eligibility criteria under each policy.
What can Marsdens do to help?
Marsdens can advise and represent you if you are seeking to claim TPD benefits. We can provide expert legal advice and guide you through the process, contact us today!
How much will it cost?
In most cases if we are of the view that your claim has reasonable prospects of success, we will accept your instructions on a “no win no pay” basis.
This means that you will not be required to pay for our professional costs up front or on an ongoing basis.