TPD and Income Protection Claims

People may be eligible to claim Total and Permanent Disability (TPD) or Income Protection (IP) benefits for a wide range of injuries and medical conditions, including:

• Workplace injuries, in addition to any workers’ compensation or common law claims
• Motor vehicle accidents, including car, motorcycle, or pedestrian accidents
• Chronic pain conditions that prevent ongoing employment
• Mental health conditions, such as anxiety, depression, PTSD, or other psychological injuries
• Cancer or serious illnesses requiring ongoing treatment or causing long-term incapacity
• Mobility, neurological, or spinal conditions
• Heart conditions, stroke, or degenerative diseases
• A combination of medical issues that together make returning to work unrealistic

You do not need to prove that someone else was negligent or at fault. Superannuation insurance claims are assessed solely by reference to the terms of the policy and whether the medical and vocational evidence shows that you meet the relevant criteria.

A TPD claim is assessed based on the policy definition and the supporting evidence provided. While requirements vary between insurers and superannuation funds, evidence commonly includes:

• Medical evidence, such as reports from your treating GP, specialists, psychologists or psychiatrists, outlining your diagnosis, treatment, prognosis, and work capacity
• Employment evidence, including your work history, job descriptions, and details of your education, training, and experience
• Financial information, such as income records or superannuation statements, depending on the policy
• Vocational evidence, where required, addressing whether you are likely to return to work in your usual role or any other role suited to your background
• Claim forms and declarations, completed by you and your treating practitioners

The quality and consistency of the evidence is often critical. Insurers assess whether the evidence, taken as a whole, satisfies the specific TPD definition in the policy. We help identify what evidence is required, coordinate reports where needed, and ensure the material presented properly reflects your circumstances.

Yes, pre-existing conditions can be relevant to a TPD or Income Protection claim, but they do not automatically prevent you from claiming. What matters is how the policy defines disability and whether the medical evidence shows that your condition now prevents you from working in accordance with that definition. Many policies focus on your current and future capacity for work, rather than when a condition first arose.

Insurers will however closely examine:

• Whether the condition existed before the policy commenced
• Whether it was disclosed at the time cover began
• Whether the condition has worsened, progressed, or combined with other conditions to cause incapacity

Carefully addressing pre-existing conditions in the medical and vocational evidence is often critical. We can help identify how your policy treats these issues and ensure your claim is supported by evidence that properly reflects your circumstances.

TPD claims can be complex because they are assessed strictly against insurance policy definitions, rather than general ideas of incapacity. The process often involves multiple claim forms, detailed medical evidence, and ongoing requests for further information or assessment by the insurer. Insurers may also conduct their own investigations or seek independent medical or vocational opinions before making a decision.

Claims are commonly delayed or disputed where there are questions about how the policy definition applies, the impact of pre-existing conditions (even if they were not previously symptomatic), or whether the available evidence adequately addresses work capacity over the long term. Careful preparation of the claim and supporting material from the outset can reduce these risks. We can guide you on the evidence required and help present your claim clearly, so it is assessed on its merits under the policy.

The time it takes to finalise a TPD claim can vary significantly depending on the policy, the complexity of the medical issues, and how long it takes to gather the required evidence. As a general guide, many TPD claims take several months, and more complex claims can take 12 months or longer to resolve. Delays can occur where:

• detailed medical or specialist evidence is required
• insurers request independent medical or vocational assessments
• further information is sought during the assessment process
• the claim involves complex work history or multiple conditions

Because TPD claims are assessed strictly against policy definitions, careful preparation from the outset can help avoid unnecessary delays. We keep you informed throughout the process and explain what is happening at each stage, so you have realistic expectations about timeframes and next steps.

Claims may be denied for a range of reasons, often linked to how the policy definition is applied to the available evidence. Common issues include:

• The policy definition is not met, particularly where the insurer considers some form of work may still be possible based on education, training, or experience, or with reasonable retraining.
• Insufficient or inconsistent medical evidence, especially where reports do not clearly address long-term work capacity or prognosis.
• Pre-existing conditions, where the insurer argues the condition existed before cover commenced or was not adequately disclosed.
• Waiting periods or benefit periods, which have not yet been satisfied under the policy terms.
• Gaps in employment or income history, affecting how eligibility or benefits are assessed.
• Conflicting medical opinions, including reliance on independent medical or vocational assessments obtained by the insurer

A claim being denied does not necessarily mean it was invalid. In many cases, denials arise from how evidence is interpreted or whether the policy requirements have been fully addressed. Understanding the specific reasons for a decision is an important first step in determining whether it can be challenged or reviewed.

If your TPD or Income Protection claim is denied, it does not always mean the end of the road. Insurers must provide reasons for their decision, and your options will depend on why the claim was declined and the terms of the policy.

Common next steps may include:

• Requesting an internal review, where further medical or vocational evidence might be provided for the insurer or trustee to reconsider the decision, or responding to specific issues raised, such as gaps in evidence, how the policy definition was applied, or how pre-existing conditions were assessed
• External dispute resolution, such as lodging a complaint with the Australian Financial Complaints Authority (AFCA), where appropriate.
• Court proceedings, in some cases, if the dispute cannot be resolved through other avenues

Strict time limits can apply, and the way a denial is challenged often has a significant impact on the outcome. We can review the reasons for the decision, explain your options, and help you determine the most appropriate next step based on your circumstances.

A TPD benefit is usually paid from an insurance policy held within your superannuation fund, rather than directly from your existing superannuation savings. In many cases, the benefit is paid into your superannuation account first and may then be released to you, depending on your circumstances and the fund’s rules.

Superannuation, insurance, and tax treatment can be complex, and the impact will differ from person to person. We can explain how the claims process works and how your policy operates, but we do not provide financial advice. You may wish to seek independent financial advice about how a payment could affect your broader superannuation position.