Total and Permanent Disability (TPD) insurance provides a financial safety net if you become permanently disabled and can no longer work. Making a successful TPD claim can be a complex process, however – so we’ve collected the key information points here and provided tips on how to present strong evidence to support your claim.
Key Factors Insurers Consider When Assessing TPD Claims
Knowing that each case is different, an insurer will consider several factors when assessing your TPD claim. Let’s take a look at the different considerations.
Definition of TPD in Your Policy
The definition of TPD can vary between policies. Generally, there are two main types of definitions:
- Any Occupation: You are unable to work in any job suited to your education, training, or experience.
- Own Occupation: You are unable to work in your specific occupation.
Understanding the definition of your policy is crucial as it determines the criteria you need to meet to make a successful claim.
Medical Evidence
Medical evidence is a critical component of a TPD claim. Insurers will require detailed medical reports from your treating doctors and specialists. These reports should outline the nature and extent of your disability, your treatment history, and your prognosis. The evidence must demonstrate that your condition is permanent and prevents you from working as defined in your policy.
Work Capacity
Your capacity to work is a significant factor in TPD assessments. Insurers will evaluate whether you can perform any work suited to your education, training, or experience. This assessment may include reviewing your employment history, skills, and qualifications. If your policy uses the "own occupation" definition, the focus will be on whether you can perform your specific job.
Waiting Period
Most TPD policies have a waiting period, typically ranging from three to six months, during which you must be continuously unable to work. This period allows your condition to stabilise and the full extent of your disability to be assessed. Insurers will check if you meet this requirement before processing your claim.
Age and Employment Status
Your age and employment status at the time of your disability are also considered. Some policies have age limits, and you must have been employed or actively seeking employment when you became disabled. Insurers will review your employment records to ensure you meet these criteria.
Consistency of Information
Insurers will scrutinise the consistency of the information provided in your claim. Any discrepancies between your medical reports, employment history, and personal statements can raise red flags and potentially lead to a claim denial. Ensuring all information is accurate and consistent is vital.
Tips for Providing Strong Evidence to Support Your TPD Claim
The more time and effort you put into collecting evidence and presenting a strong case, the better you will position yourself to receive financial support. Here are a few steps you can take to provide solid evidence.
1. Gather Comprehensive Medical Evidence
- Obtain detailed medical reports from all treating doctors and specialists.
- Include information about your diagnosis, treatment history, and prognosis.
- Provide evidence of any ongoing treatment and rehabilitation efforts.
2. Document Your Work History
- Provide a detailed resume outlining your employment history, skills, and qualifications.
- Include statements from previous employers about your work performance and reasons for leaving.
- Ensure the information is accurate and does not overstate your abilities, as this can lead to incorrect conclusions by the insurer.
3. Maintain Consistent Records
- Keep all documentation organised and ensure consistency across all forms and reports.
- Double-check all information for accuracy before submitting your claim.
4. Seek Professional Medical Opinions
- Consider obtaining an independent medical assessment to support your claim.
- Ensure the medical opinions align with the definition of TPD in your policy.
5. Follow Up Regularly
- Stay in regular contact with your insurer to check the status of your claim.
- Promptly provide any additional information or documentation requested by the insurer.
How a TPD Lawyer Can Help
Navigating the TPD claims process can be daunting, and even a small mistake can jeopardise your claim. Engaging a TPD lawyer can significantly increase your chances of a successful outcome. Here’s how a TPD lawyer can assist:
Expert Guidance
A TPD lawyer has in-depth knowledge of insurance policies and the claims process. They can help you understand the specific requirements of your policy and guide you through each step of the claims process.
Preparing and Reviewing Documentation
Professional lawyers can help you gather and prepare all necessary documentation, ensuring it is complete and accurate. They can also review your medical evidence and employment records to ensure they meet the insurer’s requirements.
Communicating with Insurers
Dealing with insurers can be challenging. A TPD lawyer can handle all communications with the insurer on your behalf, ensuring that your claim is presented in the best possible light. They can also follow up with the insurer to prevent unnecessary delays.
Challenging Denied Claims
If your claim is denied, a TPD lawyer can help you understand the reasons for the denial and advise you on the best course of action. They can assist with lodging an appeal or taking legal action if necessary.
Note: It is much harder to appeal an already denied claim than to get a claim accepted on its first go. So, while it can seem like a good strategy to attempt a claim yourself first without legal assistance, this can end up being costly if the claim is rejected.
Maximising Your Entitlement
A TPD lawyer will work to ensure you receive the maximum benefit you are entitled to under your policy. They can help you navigate any complex legal issues and advocate on your behalf to secure a fair outcome.
Next Steps
Making a successful TPD claim requires careful preparation and a thorough understanding of the factors insurers consider. By gathering comprehensive medical evidence, documenting your work history, and maintaining consistent records, you can strengthen your claim.
Engaging a TPD lawyer can provide expert guidance and support, increasing your chances of a successful outcome. If you are considering making a TPD claim, seeking legal advice early in the process can help ensure you receive the benefits you are entitled to. Smith’s Lawyers offer free initial advice and all claims are 100% risk-free with our industry leading No Win, No Fee, No Catch promise.
