Total and Permanent Disability (TPD) insurance is designed to provide a lump sum payment if an illness or injury leaves you unable to work again in your usual occupation, or in any occupation for which you’re reasonably suited. Most Australians hold TPD cover through their superannuation fund, often without realising it until they need to make a claim. Unfortunately, having a policy in place doesn’t guarantee a smooth payout — disputed and denied TPD claims are common, and understanding why they happen and what your options are can make a significant difference.
Why TPD Claims Get Disputed
Insurers and superannuation trustees assess TPD claims against the specific definition of disability set out in the policy, which can vary between funds and even between different policies within the same fund. A claim might be disputed for reasons including insufficient medical evidence, disagreement over whether you meet the “unable to work” test, gaps or inconsistencies in your claim history, or a view that you could be retrained for a different type of work. In some cases, the insurer’s own medical assessors reach a different conclusion to your treating doctors, which is one of the most common sources of dispute. It’s worth remembering that a denial at first instance isn’t necessarily the final word — many claimants who are initially knocked back go on to have the decision reviewed or overturned.
When to Bring In a Solicitor
You don’t need a lawyer to lodge a TPD claim in the first place, but once a claim is disputed, delayed without explanation, or denied outright, getting advice from a solicitor who handles superannuation and insurance disputes is generally worth considering. A solicitor can review the policy wording and the insurer’s reasons for decision, help identify what additional medical or vocational evidence might strengthen your position, and advise on whether an internal dispute resolution request, a complaint to the Australian Financial Complaints Authority (AFCA), or court action is the more appropriate next step. Because TPD definitions are technical and the evidentiary bar can be high, having someone who regularly works with these claims review your file before you respond to an insurer’s decision can help avoid mistakes that are difficult to undo later.
What the Process Typically Looks Like
In general terms, a disputed TPD claim tends to follow a few stages: first, the trustee or insurer’s internal review process, where you can submit further evidence and ask for the decision to be reconsidered. If that doesn’t resolve things, many disputes move to AFCA, an external and free dispute resolution scheme for financial and insurance complaints, before litigation is considered as a last resort. Each of these pathways comes with its own procedural requirements and, importantly, its own time limits — missing a deadline can affect your ability to pursue a claim further, so it’s worth getting advice early rather than waiting until a limitation period is close to expiring. Time limits and processes can also vary depending on the specific fund, policy, and the pathway chosen, so treat any general guidance as a starting point rather than a substitute for advice on your own claim.
Red Flags Worth Knowing
A few things are worth watching for if you’re navigating a TPD claim: requests to sign broad medical authorities without understanding what they cover, being asked to attend an independent medical examination without preparation, long unexplained delays in a decision, or a denial letter that doesn’t clearly set out the reasons relied on. None of these automatically mean something has gone wrong, but they’re commonly the points at which claimants benefit from a second opinion.
If your TPD claim has been disputed, delayed, or denied and you’re not sure what to do next, Request Legal Service can help connect you with a solicitor experienced in superannuation and insurance disputes. Submit a free enquiry through Request Legal Service and we’ll match you with a solicitor suited to your situation, generally at no upfront cost to find out where you stand.
This article is for general informational purposes only and is not legal advice. Laws vary across Australian states and territories, and can change over time — for guidance on your specific situation, speak with a qualified solicitor or lawyer. Request Legal Service does not act as a law firm or provide legal representation.