TPD Claim...how long does the process take?

If an illness or injury has affected you and you cannot go back to work, you might qualify to file a claim for total and permanent disability benefits, also referred to as a TPD claim. 

This article will cover essential aspects of TPD claims, including what they are and the process for making a claim.

What is a TPD CLAIM?

TPD stands for total permanent disability. If you have experienced a permanent injury or illness, you might qualify for a TPD claim. TPD insurance typically offers a lump sum payment if you become totally and permanently disabled due to illness or injury. This insurance can serve as a financial safety net to support you and your family if a permanent injury or illness prevents you from returning to work. 

TPD Claims- Eligibility requirements

The eligibility criteria for TPD claims can differ between policies. Generally, you must demonstrate that your condition or injury prevents you from returning to work to file a TPD claim. 

It's important to understand that applying for a TPD benefit usually requires completing a comprehensive application that clearly demonstrates how you meet the policy's definition. At Bespoke Injury Lawyers, we can help you investigate and submit your TPD claim on a no-win-no-fee basis.

Process for a TPD Claim

When submitting a TPD claim, it's essential to follow these steps: 

• Step 1: Identify and evaluate your TPD insurance policies, ensuring they are valid.  

• Step 2: Examine the approval criteria and relevant definitions. 

• Step 3: File your application. This typically requires completing a detailed application that demonstrates how you meet the policy definition, along with any necessary supporting documentation to justify your claim. 

• Step 4: Follow up with the insurer regarding the claim assessment.  

Once you have completed these steps, you should await the final decision. If your claim is denied, you have the option to appeal the decision. 

Challenges with TPD Claims 

Insurers frequently deny TPD claims for various reasons. Based on our experience, some of the primary factors leading to rejection include:

• Not adhering to necessary procedures, such as missing documents. 

• Insufficient supporting evidence, like inadequate medical records. 

• Filing a claim before the required waiting period has ended. 

• Pre-existing conditions potentially affecting the claim outcome, resulting in denial. 

  
  

TPD Claim Timeline 

TPD claims are typically evaluated within 6 to 12 months.

The initial part of this timeline is the waiting period, starting from the day you ceased working due to a disability. This period usually lasts between 3 and 6 months, depending on your policy, and must pass before you can submit a TPD claim. 

Once the waiting period is over, you can file a claim. The initial assessment is usually completed within 6 months of providing all necessary information to the insurer. After the insurer's decision, it may take an additional two or more months for the superannuation fund trustee to finalize their decision regarding the claim. 

Note that assessment timelines can vary significantly from one case to another. Contact our approachable lawyers to learn about the estimated timeline for your case. 

Factors Influencing the TPD Claim Timeline 

Several factors can affect the overall timeline of your TPD claim. In our experience, the key factors include: 

• Type of injury or disability. For example, physical disability claims are generally processed faster, provided the claimant has reached maximum medical improvement, compared to mental illness claims. 

• The severity of the injury or disability and whether further surgery is required can also influence the timeline. This is because the insurer may be unable to determine TPD status if the condition might improve with treatment. 

• The availability of medical evidence. Detailed and supportive medical reports generally expedite the assessment process for TPD claims. 

Duration to Receive a TPD Claim 

Receiving a TPD claim in Australia can take up to 12 months. This period includes the initial waiting period, typically 3 to 6 months from the date you stopped working due to your injury or disability. Afterward, the insurer should complete the initial assessment within 6 months of obtaining all relevant documents. The claim is then usually referred to the Trustee for further determination, which typically takes up to 2 months. 

Ways Insurance Companies May Delay the Process 

It's well known that insurance companies aim for profit, and claim assessments can sometimes be prolonged due to ongoing delays. At Bespoke Personal Injury Lawyers, our experienced team can assist by following up with the insurer to ensure your claim is processed as swiftly as possible. 

Role of a TPD Lawyer 

At Bespoke Personal Injury Lawyers, our TPD lawyers can guide you through legal procedures, compile necessary documentation and evidence, and ensure your claim is lodged effectively to maximize approval chances. 

If your claim has been denied, you need to consult a legal professional for advice on potentially overturning the decision. 

Possibility of Multiple TPD Claims 

Yes, if you hold more than one TPD policy, you may be eligible to file multiple claims. This situation is common, as individuals may have several superannuation funds with their own insurance policies due to job changes over the years. In such cases, we recommend seeking legal advice to avoid conflicts between multiple policies before submitting your claims. 

Winning Your TPD Claim with Professional Lawyers 

At Bespoke Personal Injury Lawyers, we have a strong focus on personal injury law and offer specialised legal services. Let us demonstrate our capability to handle your TPD claim efficiently and without stress.  Like to know more?

Contact us today to discover how we can assist you in winning your case. 

Disclaimer

This article is provided for general information purposes only and does not constitute legal advice. The law in this area is subject to frequent change, and readers should verify whether any updates have occurred since the time of publication. While care has been taken in preparing the content, readers must exercise their own due diligence before acting on any information. Professional legal advice should always be obtained for specific circumstances.