TPD Claims Through Super: Total and Permanent Disability

If an illness or injury has left you unable to work, a TPD claim through superannuation may be one way to access financial support. Many Australians hold total and permanent disability (TPD) insurance inside their super without realising it. This article explains the basics of how TPD cover works, what insurers look at and why delays can matter. It is general information only.

What is TPD insurance in super?

TPD insurance pays a lump sum if you become totally and permanently disabled as defined in the insurance policy. Many super funds provide default TPD cover to members, and the premiums are usually deducted from your super balance. The insurance policy is held by the fund trustee, and the definition of TPD, the amount of cover and the conditions are set by that policy, so they differ from fund to fund. If you have changed jobs or consolidated funds, you may have more than one policy, or cover that has lapsed.

How is TPD defined?

Definitions vary, so always read your own policy. Two common approaches are:

• Any occupation: you have been unable to work for a waiting period (often several months) and are unlikely ever to work again in any occupation for which you are reasonably suited by education, training or experience.
• Own occupation: in some policies, the test is whether you are unlikely to return to your own usual occupation. This is generally regarded as easier to satisfy, but it is not available in every policy.

The wording matters. A diagnosis alone is not enough, because insurers look closely at how your condition affects your capacity to work.

How does the claim process work?

1. Find your cover. Check your fund statements, contact each fund you have held, and ask for the policy documents.
2. Read the definition and any time limits. Policies may require you to notify the insurer within a certain period, so do this early.
3. Gather evidence. Insurers commonly ask for medical records, treating doctor reports, employment history and sometimes tax or Centrelink records. They may also arrange independent medical examinations.
4. Lodge the claim with the fund, which passes it to the insurer.
5. Decision and release. If the insurer accepts the claim, the fund trustee must also be satisfied that you meet a condition of release, usually permanent incapacity, before money is paid.

What evidence matters most?

Medical evidence that speaks directly to the policy wording is usually the most helpful, for example how your condition limits sitting, standing, concentrating or working a reasonable number of hours, and whether it is likely to continue. Evidence of your work history, your attempts to return to work and your skills and education can also be relevant. Consistent, well-documented information tends to make the process smoother.

If your TPD claim is declined

A declined claim is not necessarily the end. The usual steps are:

• Ask the fund or insurer for written reasons and a copy of the claim file.
• Use the fund's internal dispute process.
• Lodge a free complaint with the Australian Financial Complaints Authority (AFCA), which can review the decision and, where it finds the decision unfair, substitute its own.
• In some cases, court proceedings may be an option.

Time limits apply to these steps. AFCA complaints are generally subject to a limit measured from the fund's final decision, which is generally two years from the fund's final decision, although strict time limits can apply to disability benefit complaints. Check the current AFCA rules and get advice immediately, as court time limits are different again. Do not wait to see whether you feel better, because delay can reduce your options and make evidence harder to gather.

Common issues to watch for

• Lapsed cover: cover can end if an account is inactive or the balance is low, so check promptly.
• Pre-existing condition exclusions: some policies limit cover for conditions that existed before cover began.
• Waiting periods: you may need to be off work for a set period before you can claim.
• Age limits: cover often reduces or ends at certain ages.

Why get advice early?

TPD claims involve medical evidence, policy interpretation and strict deadlines. A solicitor can help you locate cover, prepare the claim and respond if the insurer raises questions. Outcomes cannot be promised, as each claim turns on its own facts and policy wording.

Frequently Asked Questions

Do I have TPD insurance in my super?

Possibly. Many funds include it by default, but not all members have it. Check your statements or contact your fund and ask for the policy details.

How long does a TPD claim take?

It varies with the complexity of your medical evidence and the insurer. The Life Insurance Code of Practice sets expectations for insurers, but claims can take months, so start early.

Can I claim TPD if I am still working part-time?

It depends on the policy definition. Some require inability to work at all in any occupation, while others focus on your own occupation or on a set number of hours. Check your policy wording.

Can I claim if my super fund declined my claim?

You may be able to dispute the decision through the fund's internal process and then AFCA. Deadlines apply, so seek advice soon after you receive the decision.

This article is general information only and is not legal advice. Laws and processes change, and every situation is different. Speak to a lawyer about your circumstances before you act.