Steps required to claim TPD
This article is in partnership with Smiths Lawyers.
A permanent illness or injury could make it challenging or impossible for individuals to return to work.
In such cases, a Total and Permanent Disability claim offers financial safety to support you and your family and covers rehabilitation and medical costs.
However, the insurers often reject TPD claims even when the claim should have been approved.
This happens because people are unaware of the proper procedure and make mistakes on the claim forms that could have been easily avoided.
Many people seek the assistance of experienced TPD lawyers to help them file and win the TPD claims. Whether you seek legal help or file the claim yourself, it is crucial to understand the steps required to claim TPD.
Step One: Getting in touch with the superannuation company
You need to inform them about the situation, what happened, how you are suffering, and the last date of your employment.
Get the required forms you would need to fill out, including employer statement, certificate of releases, medical attendant statements, and initial claim form.
Step Two: Determine the validity of the policies at the time you were injured or fell ill
If you want to make a claim against a certain policy, you have to make sure that policy was valid during the time you became ill or got injured.
This could be a grey area since certain injuries and illnesses form over time. Focus on the date you first realised you were ill or injured and determine which TPD policies were valid back then.
Step Three: Get educated about the approval criteria
One of the most key steps to making a TPD claim a successful one is to thoroughly understand the process and the policies.
Find out what qualifies for a sum payout as there might be different conditions for different policies. For instance, a TPD policy would cover you for:
- Not being able to continue employment in your particular occupation
- Not being able to continue employment in any occupation
Therefore, according to certain TPD policies, you don't have to be unfit for all employment opportunities to file a successful claim.
Step Four: Complete all forms
Make sure you have all the forms and then fill them out with accurate information.
Keep in mind; the forms might require you to include specific information, like confirming your job duties and work capacity from your previous employer or/and medical certificates from two different doctors. Make sure you have everything in order.
Step Five: Submit the forms to the superannuation company
Once all the forms are in order, it is time to submit them to the insurer. Don't hesitate to ask any questions from the company and clarify any doubts or issues you might have regarding the forms before you submit them.
Step Six: Liaise with the claims assessor
After the forms have been submitted, a claims assessor will be assigned to your case and will get in touch with you for further details, if needed, and to update you about the claim.
Remember, the superannuation company is obliged to get in touch with you after 20 days to update you about the claim. You have the right to file a complaint if this doesn't happen.
Step Seven: Finalising the claim
The superannuation company must make a decision on your TPD claim within six months of you filing the claim with complete information. The company would make one of the following decisions:
- Procedural Fairness: On the basis of the information they have, they are likely to decline the claim, but they still give you an opportunity to submit more documents to support the claim and give you 28 days to make your case stronger.
- Decline The Claim: If they are not satisfied with the claim you submitted and not convinced of your injury or illness or if you don't meet their eligibility criteria, then your claim would be denied.
- Accept The Claim: If you meet their eligibility criteria and have provided strong proof to convince them of your injury or illness, then they will accept your claim. This means you will get the lump sum of the TPD compensation.
These steps must be followed when filing the claim. You can read more about the key steps to making a TPD claim successful by ensuring you have a stronger case that can't be declined.
Educating yourself about the criteria and procedure will better equip you to make this challenging task easier.
Having a permanent injury or illness is challenging enough on its own on top of stressing over the TPD claim, which is why consulting a legal expert will further improve your chances and make the entire process go smoothly.
