TPD insurance claims

There is no single definition. Cover held in super usually asks whether you are unlikely ever to work again in a job suited to your education, training or experience; some older policies, and some held outside super, use an own-occupation test instead. Which test applies, and whether your condition satisfies it, is often the critical question. It is worth getting advice before assuming you do not qualify.

An own occupation policy asks whether you can return to your specific job. An any occupation policy asks whether you can do any work you are reasonably suited for by education, training or experience. The wording of your policy determines which applies, and it can significantly affect whether a claim succeeds.

Sometimes. It depends on your policy's definition of TPD. Many definitions require you to have been off work, or working much less, for a set period (often 3 or 6 months), and then ask whether you are unlikely ever to work again in a job that suits your education, training or experience. Some policies allow a claim where you can still do limited work. A brief claim check can help clarify whether your situation is worth exploring.

Not necessarily. A refusal can often be reviewed or challenged through the fund's internal complaints process or external dispute resolution. In some cases, legal proceedings are also available. We can look at your decision letter and policy to advise on what options may exist.

Often, yes. If you hold several superannuation accounts with active cover, you may be able to make a separate claim under each. Each policy is assessed independently. There are some exceptions depending on policy structure, so it is worth checking all accounts you have held. Cover on an account with no contributions for 16 months is generally cancelled unless you chose to keep it, so check that each account had cover when you stopped work.

For super-linked cover, the benefit is often paid into your superannuation account first. The fund trustee then assesses whether to release it directly to you, usually on the permanent incapacity condition of release. For standalone policies, payment is usually made directly. We can explain the usual pathway once we know your fund and policy type.

Sometimes. Policies can be linked, meaning a TPD benefit may reduce connected cover such as life or death cover. It depends entirely on how your policies are structured. We can check this for you before anything is lodged.