Total and Permanent Disablement Insurance Claims

Illness or injury is often unexpected and can leave someone unable to work. This can have devastating consequences for people and their families, especially for those who do not have insurance entitlements such as workers compensation or income protection. However, often people in these situations are entitled to make a claim for total and permanent disablement if their superannuation fund has taken out a group policy of insurance for their members. It may be the case that someone is unaware they are entitled to make a claim. However, it is well worth investigating, as if a claim is successful, it could make a significant difference in a time of financial hardship.

For a claim to be successful, a person must meet the definition of total and permanent disablement contained in the insurance company’s policy. These definitions can vary, depending on the policy and insurance company. Usually, in order to be considered totally and permanently disabled, someone must be unable to work for approximately 3–6 months before making a claim, and (depending on the policy) be unlikely to work again, in either:

1. Their own occupation;

2. Another occupation for which they are reasonably qualified by way of experience, education and training;

3. Any other occupation at all.

The former two types of policies are easier to satisfy than the latter. For example, take someone who has all their life worked as a Fitter, performing heavy manual work. Suddenly, they injure their shoulder and cannot perform heavy work anymore, and therefore cannot ever work again as a Fitter (what they are trained and qualified to do). However, it may be that they can later re-train into another industry, which does not involve as much physical work, such as bus driving or office work. They are likely to be successful in a claim where the policy is one of the first two types, as they are unable to work in their own occupation or another occupation for which they are reasonably qualified by way of experience, education and training.

Policies such as the latter, where the insurance company needs to be satisfied that someone is unlikely to work again in any occupation, are more difficult to satisfy. But these are still likely to be successful where someone has sustained a severe injury or contracted a serious illness, for example, if someone suffers a stroke and is unable to work at all.

A common misconception regarding total and permanent disablement claims is that someone has to be severely physically disabled in order to lodge a claim. Much like the Fitter example above, if an illness or injury renders someone unable to work in their own occupation (but they can later re-train) they may very well be successful in a claim.

The insurance company generally requires medical evidence regarding the injury or illness. Often, a person’s last employer will also be required to provide information about their last job role. A claim is significantly more likely to be successful if additional medical evidence and information is provided to the insurance company.

If you have been unable to work due to injury or illness, you should obtain legal advice and enquire about whether your superannuation fund has taken out a policy of total and permanent disablement insurance. Turner Freeman is experienced in assisting people with the claims process and with making submissions to the insurance companies about why a claim should be approved. Having a lawyer assist you means you can ensure a professional is handling your claim correctly and submitting the most important and relevant information to the insurance company. You can also be confident that if any issues arise from the insurance policy, you have a lawyer to advise you about the best way forward.

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Jade is based in Newcastle and specialises in workers compensation, industrial deafness and total and permanent disability insurance claims.