📆 When Can You Claim TPD Insurance?
You can claim TPD insurance when illness or injury leaves you totally and permanently disabled under your policy's definition - not simply when you're diagnosed.
💡 TPD claims are definition-based. Insurers assess:
- Whether you can ever work again (not just now)
- Whether you meet an own occupation or any occupation definition
- Whether the disability is considered permanent, not temporary
⚙️ How Do TPD Insurance Claims Work?
TPD claims are assessed over time and require multiple forms of evidence across different domains.
1. Claim notification
The insurer (or adviser) is notified that a potential TPD claim exists.
2. Information gathering
This may include:
- Medical reports from treating doctors and specialists
- Evidence of work history and duties
- Functional capacity assessments
3. Assessment against the policy definition
The insurer determines whether the claim meets the exact wording of the TPD definition that applies to your cover.
4. Decision and payment (if approved)
If successful, the benefit is paid as a lump sum (or via the policy structure if instalments apply).
⏱️ How Long Do TPD Claims Take?
According to APRA industry data, TPD claims take longer than most other life insurance claims - and for good reason.
| Timeframe | Approximate % of Claims |
|---|---|
| Under 2 months | ~48% |
| 2-6 months | 34% |
| 6-12 months | 18% |
| 12+ months | Small number |
This doesn't mean claims are being delayed unnecessarily - it reflects the time required to gather specialist evidence, and assess work capacity. Because of these factors, TPD is one of the most complex claim types in Australian life insurance.
📂 What Evidence Is Required?
🩺 Medical
- Doctor & specialist reports
- Diagnosis, treatment & prognosis
- Independent exams (sometimes)
💼 Occupational
- Job role & duties
- Training & experience
- Retraining capacity
💰 Financial
- Income history
- Tax or business records
🔐 TPD Claims Through Superannuation
TPD claims held through superannuation are assessed differently from policies held outside super. While the underlying purpose is the same, superannuation law adds an extra layer of requirements that can affect both eligibility and payment timing.
When held through super, two tests must be met:
Policy Requirement
Insurer's TPD definition
Super Law Test
Legal incapacity definition
🤔 What that means in practice
Most TPD cover held through super uses a more restrictive “any occupation” style assessment. This generally requires that, due to illness or injury, you are unlikely to ever work again in any role that you are reasonably suited to by education, training, or experience.
📅 Why TPD Claims in Super Can Take Longer
Because of these additional legal requirements, TPD claims through super can involve:
More detailed assessment of work capacity
Additional documentation
Separate trustee decision before funds are released
📌 Key Takeaway
- ⚠️ Stricter eligibility at claim time
- ⚠️ Less flexibility around occupation definitions
- ⚠️ Greater reliance on superannuation law
Understanding these differences upfront helps improve claim confidence and payout timing.
🔗 How SuperLink TPD Claims Are Assessed
SuperLink TPD arrangements are designed to address some of the limitations of holding TPD cover entirely inside superannuation. A SuperLink structure splits TPD cover across two parallel policies - one held inside super, the other outside super.
This hybrid setup allows for broader definitions while managing cost. They act as a mirror image and many aspects of the policy must remain in sync including the sum insured. any payment made on one policy reduces any remaining sum insured for both polices.
The claims are assessed in a specific order:
Step 1:The insurer first assesses the TPD cover held inside super.
Step 2:If approved, the benefit is paid to the super fund and reduces any remaining cover under both policies.
Step 3:If not approved inside super, the insurer then assesses the linked cover held outside super (often using an own occupation definition).
Step 4:If paid outside super, the benefit reduces both policies.
📊 TPD Claim Acceptance Rates (What the Data Shows)
APRA data shows material differences in claim outcomes depending on how cover is arranged.
| Cover Type | TPD Admission Rate | TPD Paid Ratio |
|---|---|---|
| Individual advised | ~83% | ~71% |
| Individual non-advised | ~70% | ~44% |
| Group super | ~92% | unavailable |
This highlights the impact of policy structure, product type, and claims support - not just the insurer.
🚫 Why TPD Claims Are Declined or Delayed
Most unsuccessful or delayed TPD claims relate to:
❌ Policy definition not met
❌ Capacity to work in another role
❌ Insufficient or inconsistent medical evidence
❌ Superannuation release conditions
❌ Policy lapses or structural issues
📋 If You Disagree With a Decision
Most insurers have a multi-stage review process for disputed claims:
Speak to the claims consultant
Request an internal review
Escalate to the Australian Financial Complaints Authority if required