Total & Permanent Disablement claims factsheet

This factsheet provides information about making a claim to receive Total and Permanent Disablement benefits from the fund.

 

What is a Total and Permanent Disablement benefit claim?

A Total and Permanent Disablement (TPD) benefit is a lump sum, one-time payment paid to you to help you meet expenses if you suffer an illness or injury that leaves you totally and permanently disabled. The lump sum paid can consist of your super balance and the amount of TPD insurance cover you hold with the fund.

When you make a TPD benefit claim, you are making a request to receive these benefits from the fund.

 

When you can make a claim

To make a claim to access a TPD benefit through the fund, you first need to meet certain eligibility criteria.

 

Who is eligible to claim a TPD benefit?

Whether you’re eligible to claim a TPD benefit will depend on several factors:

  • The type of insurance cover you hold with the fund
  • Any exclusions or limitations that apply to your cover
  • Whether you meet the conditions to be declared totally and permanently disabled*:

Part 1 –  you are unable to return to work  as a result of injury or illness for three consecutive months, you have seen a doctor, received all reasonable treatment, and are declared unable to return to work.

Part 2 –

A) You have had a Mental Disorder for at least three consecutive months and are unable to work for that period as a result of the Mental Disorder, you are seeing a psychiatrist and receiving all medical treatment reasonably recommended, and you’re declared unable to return to work.

OR

B) as a result of injury or illness, you are totally prevented from performing two of the Daily Functioning Activities without assistance from another adult, aid or adaptation for at least three consecutive months, you have seen a doctor, received all reasonable treatment, and are declared unable to return to work.

*For a comprehensive explanation of these conditions and definitions, please see our Insurance Guide or contact our Member Care Team for a copy of our Group Policy Life Insurance.

As part of the claims process, we will look at the information available and perform an eligibility assessment to determine whether you’re eligible to claim a TPD benefit.

 

How you can make a claim

If you’re thinking of making a claim, you or your legal representative will need to contact us to let us know of your intent to claim and the type of claim you wish to make. The sooner you contact us, the better.

Before you contact us, make sure you have the following information to help us determine whether you’re eligible to make a TPD benefit claim:

  • Your member number
  • Your date of birth
  • The date you were diagnosed as totally and permanently disabled
  • Personal details of your legal representative (if they are the key contact for the claim)

Once you contact us, a Member Care Case Consultant will walk you through the claims process and help you understand what to expect.

 

What to expect during the TPD claims process

When you need to make an insurance claim, it can often be an emotional and stressful time. That’s why throughout the claims process, you can expect our team to handle your claim with deep empathy and care.

To help you know what to expect during the TPD benefit claims process, below is a step-by-step guide of what happens when you make a claim.

 

Detailed claims process:

1. You contact us
  • Call or email us to let us know you’ve been diagnosed with total and permanent disablement and that you intend to claim.
  • We’ll outline the eligibility criteria and key steps in the claims process.
2. We contact you
  • A Member Care Case Consultant will be assigned to support you through the process and will send you the relevant form(s)* so we have the right information to process your claim.
  • You will be given contact details for your assigned Member Care Case Consultant to keep you informed and connected during the process.
3. You complete claim forms
  • You’ll complete the forms sent to you and return to us.
  • With the forms, you’ll need to send us supporting documents*, as indicated on the forms.
  • We’ll review the information you give us plus the information already available to determine whether you’re eligible to make a claim.
4. We’ll review your claim
  • If you’re eligible, we’ll review and process your claim.
5. Your claim is lodged with the insurer
  • If you held TPD cover with the fund when you stopped working and we accept your medical diagnosis of total and permanent disability, we’ll lodge your claim with the insurer and notify you when we do.
  • If you held no TPD cover with the fund at that time, we will still lodge your claim with the insurer to help us assess whether the evidence of your total and permanent disability is enough to pay TPD benefits. If so, we’ll let you know if you have the option to still access your super balance early.
6. Your claim is assessed
  • The insurer will review your claim and may ask for more information. If more information is needed to assess your claim, we’ll let you know. Sometimes, you or your doctor may receive these requests directly from the insurer.
7. Your claim is resolved
  • The insurer will confirm their decision to either accept or decline your claim. We’ll let you know the outcome and the next steps.
  • If the insurer accepts your claim, we’ll pay the super balance plus insurance benefits to you.
  • If the insurer declines your claim, we’ll review the insurer’s decision based on information collected during the claims process.
  • If your claim is denied after we’ve reviewed the insurer’s decision, we’ll tell you the reasons for the decision and how you can make a complaint if you’re not satisfied.

*Notes:

  • Relevant forms: Members Statement form, Employer’s Statement form, and Confidential Medical Report form.
  • Supporting documents: member’s certified proof of identification and any additional documents supporting the claim (e.g. payroll records, work duties performed).

 

How long is the claims process?

The length of the claims process depends on several factors and the circumstances of your claim. No two claims are the same. However, we will do all we can to process your claim as quickly as possible and keep you informed of its progress. To help us do so, we ask that you contact us as soon as you can if you plan to make a claim and respond promptly to any requests for more information.

 

What benefits are paid?

If your TPD benefit claim is accepted, you’ll either receive:

a) Your super balance; or
b) Your super balance plus any insurance benefits.

 

Who receives the benefits?

TPD benefits are paid to you only as the total and permanently disabled member.

 

Are taxes paid for benefits received?

In some circumstances, you may need to pay tax on any TPD benefits paid from the fund. This depends on how your benefit is paid, the date you joined the fund, your last day at work, and your age. To understand the financial impact and what taxes you may need to pay, please seek independent advice.

 

We’re here for you

If you have any questions or need support at any point during the claims process, we’re here to help. To contact our in-house Member Care Team, click here.

Further information on our TPD insurance can be found in our Insurance Guide. If you would like a copy of our Group Life Insurance Policy, please contact our Member Care Team.