TPD, Disability Insurance and Superannuation Claims

If you have suffered an injury or illness and are unable to work anymore, you may be entitled to a range of insurance benefits through your superannuation fund or private life insurance policies.

Disability Insurance is commonly provided through your superannuation fund. It can also be provided through your personal life insurance policy, employer sickness and accident insurance, and even mortgage and credit card insurance.

You can make a claim for disability insurance if you become sick or have been injured and you are unable to work, regardless of who was at fault for your injury or illness. Even if you are receiving benefits from CentreLink, WorkCover or some other organisation, or have a separate claim with a lawyer in regards to your injury or illness, you can still make a claim for disability insurance.

If you are sick or injured, the last thing you want to do is deal with difficult insurance companies. That is why Shine Lawyers has a specialist team of lawyers and disability insurance claims managers to help you:

• determine if you have a claim, and
• manage your claim through the claims process.

Types of disability insurance

There are 4 types of disability insurance benefits that you may have.

Total and Permanent Disability (TPD)

If you are sick or have been injured and have been off work for 6 months or more, and you don’t think that you will ever be able to get another job that you are qualified to do, you may be eligible for a TPD insurance benefit.

Income Protection

If you have income protection insurance and are unable to work, you may be eligible to receive a monthly benefit for a set period of time that pays up to 75% of your gross income.

Trauma

If you have been diagnosed with a defined medical condition or suffer a specific injury, you may be eligible to receive a lump sum, regardless of whether you can continue to work or not.

Death

A lump sum will be paid to a person you nominate (usually a spouse or your children), upon your death.

Finding your disability insurance

Most working Australians are members of a superannuation fund and it is very common for funds to provide a level of insurance cover to its members. It’s possible that you have disability insurance that you are not aware of.

Even if you do not have superannuation, you may have your own life insurance policy or your employer may provide you with some form of accident and sickness policy. You may also have mortgage insurance that will help you make the repayments if you cannot work.

If you are unsure whether you have any disability insurance, we can find out for you free of charge.

Benefits you can receive

Death, TPD and trauma benefits usually provide you with a lump sum payment, regardless of your wage or salary. This payment is usually tax free.

Income protection benefits are based on a percentage of up to 75% of your gross wage for a set period of time. The benefit is subject to taxation. It can also be reduced if you are receiving WorkCover statutory payments, Centrelink benefits or other insurance benefits at the same time, but not always.

You can usually find the amount of your benefit in your annual member benefit statements or on the schedule that comes with your insurance policy.

These documents can sometimes be quite complex and hard to understand, so if you are in doubt we can get this information for you free of charge.

How to make a successful claim

If you think you may have a disability insurance claim, it is best to lodge it as quickly as possible, together with the correct medical information. Unfortunately, funds and insurers can often be unhelpful in assisting you with this process, so it can be a huge relief to have the disability insurance specialist team at Shine Lawyers assisting you because we understand the claims process.

Successful TPD Claims

For TPD claims generally you need to show that:

• because of an injury or illness, you cannot do your job; and
• you cannot do any of the other jobs for which you have education training or experience.

Successful Income Protection Claims

For income protection claims usually you need to show that:

• you cannot do your job;
• you are under the care of a doctor;
• you are not working for a wage or income.

Expert medical evidence is often required to support your claim. As well as obtaining supportive medical evidence from your own doctors, we have established relationships with many experts across a range of medical fields who are able to assist us in assessing your medical condition.

The criteria for claiming benefits differ from policy to policy so it is important that you get accurate legal advice and proper medical evidence as soon as possible.

Rejected claims can be appealed

Funds and Insurers do not always get decisions about your claim right. If a fund or insurer has rejected your claim, you can appeal their decision and they will have to undertake a formal review process. If necessary, fresh medical evidence can be submitted in support of your claim at this time.

Even if your claim was initially rejected, we often find that it will be accepted at this stage. If your claim is rejected again there is still a chance that you can successfully appeal your claim through the Courts.

Time limits for making a claim

Generally there are no time limits for making an initial claim, but a claim should be lodged as soon as possible. The sooner a claim is lodged, the sooner the Fund or Insurer will begin assessing your claim which can lead to a speedier resolution to help you get back on your feet.

There is a 6 year time limit to file court proceedings. Usually that 6 year period commences when a fund or insurer rejects your claim for the first time, but that is not always the case. So it is important to seek accurate and expert legal advice as soon as possible to ensure your rights are protected.

When you are ready, we will be more than happy to discuss your circumstances and offer legal advice specific for your situation.

How long does it take?

Most insurance benefit claims only take between 6 and 12 months to be assessed by a fund or insurer. In less complex cases it is possible for it to be assessed earlier.

If the claim was rejected and needs to be appealed, it can take longer.

If the claim is not accepted at that time, appealing it through the state courts can take a further 12 months.

Thankfully, at Shine Lawyers we have specialist lawyers and disability insurance claims managers who are very familiar with the claims process and as a result, can ensure that the assessment process is not unduly delayed.

Are you a member of QSuper?

QSuper is the superannuation fund for almost all Queensland Government employees. QSuper’s rules in relation to claiming disability benefits are similar to most other funds, but there are some key differences. Importantly, decisions you make about your employment after you have suffered an injury or illness can have a significant impact on the amount of benefit, if any, that you are able to claim.

Most QSuper claims can only be appealed through the Superannuation Complaints Tribunal (SCT) and there are some strict time limits that apply in these claims.

You must:

• lodge your initial claim with QSuper within 2 years of the date that your employment was terminated;

AND

• lodge your appeal to the SCT within 2 years of the date that QSuper first rejected your claim.

If you fail to lodge your claim or appeal within the above timeframes you may lose your right to appeal any decisions that QSuper makes about your claim.

These claims can be more complex than most so it is important that if you are a member of QSuper and think that you have a claim, that you seek advice from a Shine Lawyers disability insurance specialist as soon as possible.

Shine Lawyers offer a no win, no fee arrangement for disability insurance claims

Shine Lawyers are one of the few law firms in Australia to offer advice in relation to these types of insurance claims on a no win no fee basis. We will only charge legal fees if the outcome of your claim is successful. This means that, despite the difficult financial circumstances that you may be facing, you have immediate access to the best quality legal representation and assistance.

Many firms will not cover the cost of outlays and those that do often ask clients to take out loans with external companies for outlays which charge credit card rate interest. This is important for you to consider when choosing a lawyer. We cover the cost of the outlays for you throughout the course of your claim and only recover the bank interest we have incurred on your behalf. Which means you don’t have any nasty surprises at the end of your claim.

To take the worry and stress out of your TPD claim, we also offer an obligation free first consultation and will even come to your home if you are unable to visit us at the office.

Want answers fast?

Please call our TPD team at Shine Lawyers on 13 11 99 today.