Imagine a situation wherein you face a tragedy and find yourself unable to carry on with your regular and normal professional activity. In cases when you are extremely ill or injured and have ceased your employment owing to such illness or injury or when there is a doubt as to your return to work, it signifies that you are totally or permanently disabled. A permanent disability continues with you during your remaining life and the chances of recovery are negligible.

In such circumstances it is essential that you have financial security to cope up with the circumstances that has arisen from the disability. If you have become Totally and Permanently Disabled, you can either claim for your early superannuation or apply for Totally and Permanently Disabled insurance. Most superannuation funds have a Totally and Permanently Disabled insurance component. Totally and Permanently Disabled insurance offers financial security by providing you with a lump sum benefit upon medical examination that you are not capable to return to work in future because of your injury or illness.

Totally and Permanently Disabled

The Totally and Permanently Disabled includes following situations:

Loss of two eyes, arms or legs;

Absence from work for 6 months or more, due to an accident or illness, without the expectation of returning to work;

Unlikely to ever work in your own or any occupation again; or

Permanently unable to perform activities of daily life without someone else’s physical help like:

Bathing and showering;

Dressing and undressing;

Eating and drinking;

Using a toilet to maintain personal hygiene;

Getting in and out of bed (or a chair or wheelchair); or

Moving from place to place by walking, wheelchair or walking aid.

There are 4 types of Totally and Permanently Disabled insurance available across all States and Territories. They are:

Any occupation: In this kind of insurance the insured is unable to return to the profession or to the business or any other occupation for the rest of the life for which the insured is trained, has gained experience and is well versed on the subject. Payouts on this type of Totally and Permanently Disabled insurance usually need to be verified by 2 medical professionals. For example, a surgeon who loses a hand will not receive a payout under this type of insurance as he/she can still return to work as a general physician.

Own occupation: In this situation the insured are unlikely to resume work for the rest of their life, in their own occupation. Being highly experienced and qualified in their own occupation, it is impertinent to expect a person to take a different role.

Home duties: It applies to those who are engaged in normal domestic duties and are unable to continue with them, for a continuous period of at least 3 months. In this type of TPD insurance medical evidence is thoroughly considered to ascertain the actual level of incapacity.

Modified: In this situation the insured is unable to perform any duty without substantial help from someone or suffers from cognitive impairment and therefore needs constant supervision or has been disabled for the rest of the life.

There is no time limit for lodging a claim against your super fund/insurer for Totally and Permanently Disabled claims. However, you can make a claim under Totally and Permanently Disabled only if you remain absent from your work for a continual period of at least 6 months.

In order to make a claim under Totally and Permanently Disabled, you need to contact your super fund/insurer. You have to fill out various application forms. You are required to provide additional documents such as medical reports to support your claim. You will be asked to attend 1 or 2 medical assessments to assess the exact nature of your disability.

If your claim for a disability insurance benefit has been rejected or you are unhappy with the assessment of your benefits, we have the resources to explore all possible avenues to challenge the fund or insurer’s decision to give you the best chance of obtaining fair and just entitlement.

At Owen Hodge we have a dedicated team of experts who understand and are experienced with the breadth of superannuation and disability insurance policies in Australia. Our team can represent you while your claim is being processed to ensure that it is assessed fairly and reasonably by the superannuation fund or insurer.

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