What Is the Process for Filing a TPD Claim in Queensland?

July 28, 2023
Posted by: Seymour Furlong
Category: Superannuation/ TPD Claims

Serious injury or illness can abruptly halt your hopes, dreams, and plans for the future. Few things are more frightening than realising you’ll never be able to work again. Severe disability caused by injury or illness not only results in a loss of income but also incurs significant additional care costs.

Total and Permanent Disability (TPD) insurance is designed to ease your burden and secure your future in such cases. Unfortunately, filing a TPD claim is a daunting and lengthy process. Proving your eligibility for a TPD claim can be challenging, despite the relatively high success rate of claims (an average of 82.5 per cent across insurers).

While consulting a skilled personal injury lawyer offers the best chance of success, claimants should also thoroughly understand the TPD claims process. This guide is dedicated to helping you make sense of a very stressful period in life.

What Is Total and Permanent Disability TPD?

Total and Permanent Disability (TPD) is a legal concept describing people rendered permanently unable to work due to injury or illness. Totally and permanently disabled people can no longer work in their own professions or any other for which they are reasonably qualified.

A TPD payment in Queensland provides a lump sum to help permanently disabled people cover their medical costs and allow them to continue providing for themselves and their families. The maximum coverage is $1 million for unemployed people and casual workers and $3 million for full- and part-time employees and self-employed people.

Queenslanders usually have TPD coverage through their superannuation funds. However, private life insurance policies or workers’ compensation can also provide TPD coverage.

Eligibility Criteria for TPD Claims in Queensland

People eligible to file TPD claims have been rendered permanently unable to work, with no expectation of recovery to the point where they can resume employment or self-employment. Before filing a TPD claim, individuals must have exhausted available treatment options.

TPD coverage isn’t limited to people who have sustained workplace accidents. You may also file a TPD claim if you can no longer work because of:

Accidents that happened at home or anywhere else.
Severe physical illnesses or conditions like cancer, stroke, or severe lung disease.
Mental illness such as Depression with a poor prognosis.

Types of TPD Claims

Queenslanders have access to two types of TPD coverage:

Unitised coverage is unit-based coverage.
Fixed coverage yields a fixed amount selected by the individual.

Unitised coverage costs vary with age, as does the cost of fixed coverage. You can also apply an occupational rating (based on the risk level associated with your profession), a choice that can influence the cost of your TPD coverage.

Gathering the Necessary Information for Your TPD Claim

Substantial evidence proving total and permanent disability is required to back up a TPD claim in Queensland.

Documenting Medical Evidence

Part A of the TPD claim form requires claimants to authorise their healthcare providers to share relevant medical evidence with QInsure:

Authority 1 allows your GP to release all relevant information except consultation notes.
Authority 2 releases your medical records to Qinsure.

Claimants can provide additional evidence about the scope of their disability to strengthen the basis for the TPD claim and must provide statements from at least two doctors.

Collecting Financial Records

People getting ready to file a TPD claim should gather:

Proof of previous income.
Previous tax returns.
Bank statements proving the level of care required to manage the disability.
Proof of assets and liabilities.

These financial records do not affect a person’s TPD eligibility but can impact the compensation.

Obtaining Relevant Insurance Policy Details

Most Queenslanders have TPD coverage through their Super. You will be asked to provide your client number while making a claim. However, those with additional TPD coverage — such as through private life insurance companies — should provide the relevant information about those insurance forms, too.

Engaging a TPD Lawyer

Most legitimate TPD claims will ultimately be successful — but a favourable outcome is far from guaranteed. Even if your claim is successful, your compensation may be insufficient.

Engaging a skilled personal injury lawyer is the best way to ensure you don’t get left behind and get the compensation you are entitled to without unnecessary delays.

Importance of Legal Representation

People filing a TPD claim are experiencing the most challenging time in their lives. The disability at the core of their claim changed their life’s path forever and may also make handling complex paperwork more difficult.

The outcome of a TPD claim is high-stakes, and perhaps more so than anything you’ve done before. Combine this with the fact that simple mistakes lead to the rejection of the claim, and it becomes clear why partnering with a competent personal injury lawyer is the only course of action that makes sense.

You wouldn’t want to “wing it” if you got arrested — and the outcome of your TPD claim is no less serious.

Finding a Qualified TPD Lawyer in Queensland

At Seymour Furlong Lawyers, we specialise in helping people who were injured or have serious illnesses receive the compensation they deserve. We understand how stressful the aftermath of illness or accident is and know precisely what is at stake: your future.

Our no-win, no-fee model ensures that clients filing TPD claims will not have to pay anything unless our skilled lawyers assist with a successful claim.

Initial Consultation and Case Evaluation

Has a serious accident or medical condition left you unable to work? Do you need help with your next steps? Seymour Furlong Lawyers ensure your TPD claim receives the personal attention it deserves.

Contact us for an initial consultation when you’re ready. After discussing the details of your case, we’ll evaluate your claim and advise you about the next steps.

Initiating the TPD Claim Process

In the aftermath of an injury or illness that renders you unfit for work and limits your ability to perform daily activities, starting the TPD claims process is unquestionably daunting. Claimants working with Seymour Furlong can find peace of mind knowing that an experienced professional is taking care of their needs.

Whether you file on your own behalf or seek legal guidance, the TPD claims process consists of multiple steps.

Preparing the Claim Application

The first step lies in carefully reviewing the TPD claim forms, which consist of three parts. The forms are designed to be simple to complete, but the manner in which you do can impact the outcome. When you engage a qualified lawyer, you will receive assistance in completing the forms to maximise your chance of success.

Submission to the Insurance Company

Once your claim forms are completed, the time to submit them to your insurance provider, whether a private insurer, arrives. The insurer will carefully evaluate the merits of your claim and determine whether to approve it.

Required Timelines and Deadlines

The scope of the disability is often unclear immediately following an injury or diagnosis. Claimants are expected to wait until it becomes apparent that the injury is total and permanent and will leave them unable to work.

While claimants must file TPD claims for retirement age, there are no strict deadlines. Those who were injured a year or two ago and have been living off savings in the meantime may still file.

Assessment and Investigation

The outcome of a TPD claim is never guaranteed, and insurers launch investigations into each case. They will:

Evaluate the medical evidence based on documentation provided by healthcare professionals.
Review the terms and conditions of your insurance company.
Review your pre-disability income and the cost of your ongoing medical care.
Assess whether you would reasonably be able to work in a different profession.

Partnering with a skilled lawyer is the best way to ensure that your insurer understands the depth and scope of your disability and needs and to maximise your TPD payment.

Negotiation and Settlement

A TPD claim may be approved or rejected; you can appeal in both cases. If your claim is approved, you may wish to negotiate for more compensation, while rejections may be appealed.

The claimant and their lawyer don’t have to accept the initial offer. By proving your ongoing medical and daily care needs and demonstrating the merits of your case through additional documentation, it is often possible to get more compensation.

A skilled personal injury lawyer works tirelessly on your behalf, aiming to ensure you receive the compensation you deserve. You may be dealing with insurance companies for the first time, but your lawyer does it daily — and knows exactly how to negotiate a favourable outcome for you.

Dispute Resolution

When claimants (and their lawyers) and insurers cannot reach a settlement, taking the case to court is the option of last resort.

People filing TPD claims in Queensland have other options before reaching that stage, however:

Claimants may choose to engage in mediation or alternative dispute resolution (ADR) to settle the dispute through an independent third party.
Where there is evidence of bias or unfair treatment, a complaint may be lodged with external and impartial bodies like the Australian Financial Complaints Authority or the Office of the Australian Information Commissioner.
Should these options not lead to a satisfactory resolution, TPD claimants can seek legal recourse through the courts. Your lawyer will be with you every step of the way.

Filing a TPD Claim in Queensland: A Final Word

The TPD claims process aims to provide Queenslanders who are left permanently unable to work due to injury or illness with adequate compensation as a lump sum payment. While TPD coverage is designed to give you the support you need, filing a claim is a lengthy and challenging process.

The personal injury lawyers at Seymour Furlong have your back.

Do you want to:

Maximise your odds of a successful TPD claim in Queensland?
Get the compensation you need to continue enjoying a comfortable life, including access to the ongoing care you need?
Streamline the TPD claims process to get access to your TPD payment faster?

Seymour Furlong operates on a no-win, no-fee basis. If we don’t help you get the compensation you deserve, you don’t need to pay us — but if we can help you get the compensation you deserve, you can count on the financial support you need to keep thriving.