Here’s the bottom line! If injury or illness cuts your career short, TPD insurance through your super can provide crucial financial support when you need it most.
We get it—you probably haven’t combed through your super fund’s insurance fine print. You’re not alone. Many Queenslanders don’t know they’re covered for total and permanent disability (TPD), or how to claim it.
But in the 2024 financial year, APRA reported over 30,000 TPD claims lodged through super, with nearly 21,000 approved for payment—many by people just like you.
This guide covers what TPD insurance includes, how to make a superannuation TPD claim, and how to improve your chances of success.
Understanding TPD insurance and how to make a claim
Total and permanent disability insurance provides a lump sum payout if a serious illness or injury permanently prevents you from working. This cover is often included in your superannuation, though some people choose to take it out through an insurer or financial adviser. You can make a TPD claim if a permanent illness or injury prevents you from working in your regular role, or any job matched to your skills and background.
What are the types of TPD claims in Queensland?
The type of TPD claim you can make depends on how your policy defines total and permanent disability. The type of TPD definition in your policy will impact both your eligibility and the documentation required:
- Own occupation TPD: You’re unable to return to the specific job you were doing before your illness or injury. This type of cover is more generous but is usually only available through individually purchased policies, not through standard superannuation funds.
- Any occupation TPD: You’re unable to perform any work reasonably suited to your qualifications, skills, or experience. This is the most common definition used in superannuation-based TPD insurance and requires a higher level of impairment to qualify.
- Activities of Daily Living (ADL): Some policies—especially lower-cost or default super policies—apply this stricter definition, which assesses your ability to perform basic personal tasks like dressing, bathing, or feeding yourself. Claims under this category often require a more severe disability.
Each definition sets a different threshold for what qualifies as a total and permanent disability. Knowing which one applies to your TPD cover is essential before lodging a claim.
Who can make a TPD claim?
To make a valid TPD insurance claim, you need to meet several eligibility conditions set out in your policy. These generally include:
- You had TPD insurance active at the time you stopped working.
- You’ve been off work for at least 3–6 months.
- Your diagnosis meets the definition of total and permanent disability as confirmed by doctors.
- You can provide strong medical and occupational evidence that supports your claim.
Conditions that commonly qualify:
- Physical injuries: Back injuries, traumatic brain injuries, amputations, spinal damage, chronic pain
- Mental health: PTSD, depression, anxiety disorders, bipolar disorder
- Serious illnesses: Cancer, multiple sclerosis, Parkinson’s, stroke
It’s not the diagnosis that matters—it’s how it affects your ability to work long-term. That’s what insurers assess when determining your eligibility.
How the TPD claims process works
Making a TPD claim involves more than just filling out forms. It’s a legal and medical process that requires detailed preparation and patience.
Here’s how the typical superannuation TPD claim process works:
- Request claim documents: Contact your super fund to get the correct forms, insurance policy details, and product disclosure statements.
- Compile medical evidence: Obtain reports from your treating doctors, specialists, and allied health providers that clearly explain how your condition prevents you from working.
- Complete your application: Fill out all forms accurately. You’ll need to outline your employment history, education, qualifications, and how your disability affects daily life.
- Submit supporting documents: Attach your medical reports, tax records, employer letters, job descriptions, and any other relevant paperwork.
- Insurer assessment: The insurer may request further evidence or arrange an independent medical exam. This stage usually takes 3–6 months but can take longer in complex cases.
- Await decision: Once the insurer finishes assessing your claim, you’ll be notified of the outcome in writing.
Remember: Consistency is key. Inconsistencies between your application, medical records, and employer information often lead to delays or rejection.
Why TPD claims get denied
TPD claims aren’t always approved. Here are common reasons insurers reject claims:
- Insufficient medical evidence: Vague reports or failure to link your diagnosis with your inability to work.
- Wrong policy assumption: Thinking your policy is “own occupation” when it’s actually “any occupation.”
- Pre-existing condition exclusions: Some policies exclude coverage for known conditions before your insurance began.
- Failure to meet waiting periods: Lodging your claim too soon may make it invalid.
- Inconsistent details: Conflicting information between forms, reports, and statements.
- Missed deadlines: Late lodgement can breach time limits, making the claim void.
Being aware of these pitfalls helps you avoid them from the outset. Importantly, don’t go it alone! At accident legal we do this type of work every day of the week. We know the pitfalls back to front.
What compensation is available from TPD insurance?
If your TPD claim is approved, a lump sum—usually tax-free—is deposited into your superannuation fund. You may then apply to access the funds based on severe financial hardship or permanent incapacity.
Factors that affect your payout:
- Policy amount: Standard TPD cover in super ranges from $50,000 to $200,000, but some standalone policies can reach $3 million.
- Your age: Some policies reduce cover as you age.
- Multiple policies: If you have more than one super fund with active TPD policies, you might be able to claim under each one.
- Partial benefits: In some cases, only a portion of your benefit is paid out, depending on the insurer’s assessment.
You can use your payout to:
- Replace lost income
- Pay for ongoing treatment or rehabilitation
- Clear debts
- Fund lifestyle modifications (like home alterations or mobility aids)
Careful planning ensures your payout serves you well into the future.
What happens if your TPD claim is denied?
If your claim is denied, there are still a number of ways you can challenge the decision.
- Internal Review
Ask the insurer for a formal review. Submit new or clearer medical evidence and directly address the reasons for denial.
- AFCA complaint
The Australian Financial Complaints Authority offers free dispute resolution for super and insurance complaints. They may compel the insurer to release your benefit if the rejection was found to be unfair or incorrect.
- Legal action
If internal and external reviews fail, court proceedings may be your next step. Our TPD Claims Lawyers are ready to provide strategic advice.
Act fast
Strict time limits apply to dispute a denial. Delaying your response could reduce your ability to take legal action. To maximise your payout, get a free consultation with one of our Compensation Lawyers now. Nothing to lose, but everything to gain!
Do I really need a superannuation/ TPD claims lawyer?
Getting legal help early often improves your chances—especially if your situation is complicated, your claim has been delayed, or you’ve already been denied. We’ve seen cases where self-represented claimants get significantly lower compensation than what they deserve.
You should especially contact our TPD Claims Lawyer if:
- You’re unsure whether your condition meets the policy definition
- You’ve been off work for months but haven’t started a claim
- You’re dealing with mental health conditions that are harder to prove
- You’ve received a rejection or partial payout
- You want to check if you have multiple TPD policies
- You’re overwhelmed by paperwork, medical jargon, or the insurer’s process
At accident legal, we’re here to help you secure the full compensation you’re entitled to. Call us now.
Frequently asked questions about TPD claims
What percentage of TPD claims are successful?
Approximately 80–90% of TPD claims are accepted when detailed medical proof is provided and the application is properly completed. However, success rates drop if the claim lacks documentation or doesn’t meet the policy’s definition of total and permanent disability.
How long does a TPD claim take?
TPD claims usually take 3-6 months, with around 80% of claims get processed within 6 months, and up to 95% of claims are assessed within 12 months. More complex cases or those requiring additional medical reviews can take up to 12 months or more.
Is a TPD claim taxable?
The TPD insurance payout itself isn’t taxed. However, tax may apply when you withdraw a portion or the entire benefit from your superannuation, depending on your age and the components of your super balance.
Final thoughts
TPD claims can be the financial lifeline you need when facing life-changing injury or illness. But with varying definitions, strict requirements, and time-consuming procedures, navigating the system alone can be risky.
Understanding what total and permanent disability insurance is, knowing your policy terms, and collecting strong evidence early on can significantly boost your chances of a successful superannuation TPD claim. If in doubt, don’t hesitate to seek expert advice from one of our expert TPD Claims Lawyers.
We cut through the complexity, handle all communication with insurers, and build your case using a detailed medical and legal strategy.
Whether your claim is just starting or you’ve already been rejected, we offer:
- Free initial claim assessment
- No-win no-fee representation
- Coordination with your doctors and insurers
- Fast and effective dispute resolution
- Flexible meeting options, including home or hospital visits
We know the system. We make it work for you.
Don’t hesitate to get in touch with one of our Compensation Lawyers today. We’re ready to help you take the next step toward peace of mind.
