Who Is Eligible to Claim TPD?

Quick Takeaways: Who Can Claim TPD?

• You must have TPD insurance, usually through your superannuation fund.
• Your condition must prevent you from working in any suitable occupation.
• The illness or injury must be permanent with no expected recovery.
• Each TPD policy has different definitions—check your policy terms.
• You may be able to claim through multiple super funds if you have more than one.

What Is a TPD Claim?

A TPD claim allows you to access a lump sum payment if you’re permanently unable to work in your usual occupation—or any other job that matches your skills, education and experience—due to illness or injury. These benefits are usually held in your superannuation fund, but some people may also have private policies.

While policies vary, the essential requirement is that your condition prevents you from working permanently. Unlike workers’ compensation or other personal injury claims, your injury or illness does not have to be work-related.

Who Can Actually Make a TPD Claim?

To be eligible for a TPD claim, you generally need to meet certain conditions, including:

1. You Have TPD Insurance Coverage

Most Australians have TPD insurance through their superannuation fund. Many super funds automatically provide this cover, but the terms and coverage levels vary. If you’re unsure whether you have TPD insurance, check your latest superannuation statement or contact your fund.

If your policy is through a private insurer, review your policy details carefully to understand the eligibility criteria. Some policies offer more generous coverage, while others may have stricter definitions of permanent disability.

2. You Can No Longer Work Due to Injury or Illness

A key factor is that your condition prevents you from returning to work—not just in your current job but in any occupation that suits your skills, training and experience. This means:

• If you were a construction worker who suffered a severe spinal injury, you’ll likely qualify.
• If you were an accountant and lost mobility but can still do desk work, your claim may be more complicated.

Some policies have an “own occupation” definition (where you qualify if you can’t return to your specific job). Others have the “any occupation” definition (where you must be unable to work in any suitable job). The latter is generally harder to meet.

3. Your Condition Is Severe and Permanent

Your injury or illness must be deemed total and permanent, meaning there’s little to no chance of recovery that would allow you to return to work. Common conditions that qualify include:

• Physical Injuries – Spinal cord damage, amputations, traumatic brain injuries, loss of sight or hearing, severe burns, paralysis.
• Chronic Illnesses – Cancer, multiple sclerosis, severe heart conditions, degenerative diseases, and other progressive illnesses.
• Mental Health Conditions – PTSD, severe depression, anxiety disorders, bipolar disorder, schizophrenia.

The assessment is based on medical reports from specialists so proper documentation is key to proving your condition is permanent.

4. You Have Stopped Working for a Certain Period

Many policies require you to have stopped working for a certain period (usually 3 to 6 months) before you can submit a claim. This shows that your condition is not temporary and you can’t go back to work.

During this time, you may need to have medical treatment or rehabilitation. Some policies also require evidence that you’ve tried but can’t go back to work.

5. You Meet Your Super Fund’s Specific Criteria

Each super fund or insurance provider has different definitions of disability, so if you’re not sure, check your policy. Some policies require you to prove you can’t work at all, while others only need you to prove you can’t go back to your previous job.

Some funds may also have age limits – for example, some policies don’t cover people over 65. Review your policy to see if you qualify.

What If You Are Unsure About Eligibility?

If you’re unsure whether you’re eligible for a TPD claim, try this:

1. Check your super fund statements to see if you have TPD cover.
2. Speak to a TPD lawyer or superannuation expert to get advice.
3. Get medical reports from your treating doctors to support your case.
4. Read your policy terms to see what’s excluded or restricted.

4 Common Reasons TPD Claims are Rejected

Even if you meet the basic eligibility, some claims can be rejected. Here are some common reasons:

• Not enough medical evidence – If your condition isn’t documented well, insurers will argue it’s not permanent.
• Failed the work test – Some policies require you to work a certain number of hours before your injury.
• No TPD insurance – You might not be eligible if your cover has lapsed or your super fund didn’t include TPD.
• Exclusions in the policy – Some policies exclude pre-existing conditions or mental health claims.

If your claim is rejected, you can appeal the decision – often with legal help – to challenge the insurer’s assessment.

Get a Professional TPD Lawyer’s Help!

Claiming TPD benefits can provide essential financial relief if you cannot work due to a serious illness or injury. However, eligibility depends on multiple factors, including your insurance policy, medical condition, and ability to return to suitable work. 

If you’re considering a TPD claim, review your superannuation cover, gather medical evidence, and seek expert advice if necessary. 

At Wyatts, a team of experienced superannuation lawyers is available to guide you through the claim process. We do all the legal heavy lifting on your behalf so you can focus on your recovery and get compensated with maximum entitlements. Contact us at 1800 773 880 or fill out an online enquiry form to get your eligibility assessed today!