A guide to total and permanent disablement insurance from OwenHodge

Total and permanent disability insurance may provide valuable assistance for individuals who are unable to continue to work because of injury or illness. Yet, many people are unsure whether they have this coverage, find the claims process dauntingly complex or become discouraged when a claim is denied. Advice from an expert insurance claims lawyer or financial adviser can be invaluable at these times.

What is Total and Permanent Disability Insurance?

Often called TPD, this insurance makes payments to people who suffer an accident or injury that affects their ability to work and earn a living. Like WorkCover, Public Liability Damages or other forms of accident insurance, total and permanent disability insurance is especially important to anyone whose family depends on his or her income. However, it does not require that an employee be injured at work or through the negligence of another person. Under some circumstances, lump sum payments are available or survivors or an estate may also be able to lodge a claim for a death benefit.

Some individuals have standalone policies, but others have total and permanent disability insurance as a feature of other financial arrangements, including income protection insurance, a super account or mortgage. Many are unaware that they have this valuable coverage and fail to lodge claims.

How Do I Make a Claim?

In general, you may be entitled to benefits if:

  • You’ve ceased your employment or duties as a result of an illness and/or injury,
  • You have been unable to work for a period of at least six months,
  • You are unlikely to return to work as a result of this illness or injury,
  • You were under 65 years old when you stopped working.
  • In addition, if your employment has terminated, you must also bring your claim within two years of its termination.

The first step in lodging a claim is to contact your insurer for the forms. The process of completing them can be quite lengthy and complex, and they will require a statement by your employer, as well as a medical certification and copies of medical records.

Depending on the details of your coverage, you may be required to demonstrate only that you are unable to do your previous job or you may have to show that you are unable to do any job for which you are suited by education, experience and training. The task of meeting the latter standard requires the production of educational and employment records as well as medical evidence. It can be very difficult to satisfy these conditions and claims are frequently denied.

What if My Claim is Refused?

First, be assured that this is not an unusual occurrence. Often all that is required is that you submit additional supporting information. However, sometimes it is necessary to lodge a complaint with either the Superannuation Complaints Tribunal or Financial Ombudsman Service. Please note that you will need to seek authorisation from the SCT or FOS for a lawyer to represent you as there is not an automatic right. Alternatively, you may begin proceedings in a court to challenge the decision made by the fund or a fund’s delay in making a decision.

Get the Help From Us

The process may become more complicated, however. You may also have a legal claim if you are not covered by total and permanent disability insurance under your super fund because your employer failed to make legally required contributions or if you received negligent advice from a financial adviser or other professional, resulting in the refusal of your claim.

As always, of course, it is important to evaluate the extent of your insurance coverage before you need it. It is also possible that coverage that was once adequate would now fall short in protecting you or your family because of your growing responsibilities and their growing needs. You may also have “hidden” coverage as part of another financial arrangement.

A quick review by your lawyer should indicate whether your claim is likely to be more complex to assemble. In that case, some legal assistance may be the best way to avoid the risks of unnecessary delay or denial.

At Owen Hodge Lawyers, our insurance claims lawyers would be happy to work with you to ensure the best result. Call us at 1800 770 780 or contact us via ohl@owenhodge.com.au for a free consultation, so that we can help you evaluate your situation and take the appropriate next steps.