Written by: Angelica Adhar A total and permanent disability (TPD) claim is made against your TPD insurance policy when illness or injury permanently prevents you from working. In most cases, this cover is already in place through your superannuation fund, which means you may be entitled to claim without needing a separate policy.
In this guide, we walk you through whether you are eligible to make a TPD claim in Queensland, how much you could receive, and what to do if your claim is rejected.
TPD claims eligibility in Queensland
TPD claim eligibility in QLD is set by your policy. To be eligible, your condition needs to meet your policy’s definition of total and permanent disability, and you need to have held valid TPD cover at the time you became unable to work. Most policies also require you to have been off work for a continuous period, typically three to six months.
Insurers will usually assess both medical evidence and vocational capacity when deciding whether these requirements are met. This means they will look at your diagnosis as well as the work you are realistically able to perform given your training, experience, and restrictions.
The definition of total and permanent disability varies between policies, and there are three main types of TPD cover used in superannuation policies.
1. Own occupation
Own occupation applies if you are unable to return to the specific occupation you held at the time of your injury or illness. You may still qualify even if you are able to work in another capacity. For example, a surgeon who develops a condition affecting fine motor control may qualify under an own occupation definition, even if they could still perform other roles outside of surgery.
2. Any occupation
Any occupation applies if you are unable to work in any occupation suited to your education, training, or experience. Most superannuation policies use this definition. It requires showing that you cannot perform any suitable role, not just your previous one. For example, if you are an office worker with a severe back condition, you would need to show that you are unable to perform any desk-based role, not just your specific position.
3. Non-occupational
Non-occupational cover applies where you can no longer perform basic daily living activities, such as dressing, bathing, or feeding yourself, rather than being assessed against your ability to work. This definition most commonly appears in retail or stand-alone TPD policies.
Key takeaway
Most superannuation policies in Australia use the any occupation definition, which requires you to show you cannot work in any suitable role, not just your previous one. Knowing which definition applies to your policy is an important early step, as it determines what you need to prove to make a successful claim.
TPD claims payout in Queensland
TPD payouts in Queensland generally range from $60,000 to $500,000, though they can be higher or lower depending on your level of cover. The amount you receive is set by the sum insured under your policy, not by the severity of your condition.
The figure depends on the cover attached to your super fund and how much insurance you hold when you make your claim. A person who has been with the same fund for 15 years may hold significantly more cover than someone who joined recently, even if their conditions are identical.
TPD payout amounts can include:
- The level of cover attached to your super account at the time of your claim
- Your age and occupation when you took out the cover
- Whether you hold cover across multiple superannuation accounts
- The type of TPD definition that applies to your policy.
Your most recent super fund member statement will show the sum insured under your policy.
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How to claim TPD in Queensland
To make a TPD claim in Queensland, you submit a claim to your superannuation fund or insurer with medical evidence, employment history, and supporting documentation. The steps you take before you submit can make a significant difference to the outcome.
Step-by-step, here’s how the TPD claims process works:
- Confirm your TPD cover is active with your superannuation fund
- Request a copy of your policy document so you understand the definition of total and permanent disability that applies to your cover
- Establish your date of disablement
- Obtain written medical reports from your treating specialists
- Prepare your employment history, including your job description and any return-to-work attempts
- Complete your claim forms, ensuring the information is consistent across all supporting documents
- Lodge your claim with your super fund or insurer, together with all supporting documentation
- Respond promptly to insurer requests for further information during the assessment
- Attend any independent medical examinations the insurer arranges, and request a copy of the report afterwards.
Most TPD claims take between six and 12 months to finalise, though claims involving disputed medical evidence or multiple super funds can take longer.
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Can you claim for TPD and WorkCover Queensland?
Yes, you can make a TPD claim and a WorkCover Queensland claim at the same time. The two operate separately and cover different things, and in some circumstances, you may be entitled to both.
WorkCover covers lost income and medical expenses connected to a workplace injury. While TPD pays a lump sum if your condition is considered permanent and prevents you from working, whether or not the condition was caused at work.
How a WorkCover claim can affect your TPD claim
A WorkCover claim can affect a TPD claim where work capacity is in dispute. If your WorkCover claim has resulted in an impairment assessment or a return-to-work report stating you can perform light or modified duties, the TPD insurer may rely on that evidence to argue you still have the capacity to work. This is one of the most common reasons TPD claims are declined where there is an active workers’ compensation matter.
For example, a scaffolder who suffers a back injury may have an active WorkCover claim with weekly payments and medical expenses being paid. If the WorkCover insurer determines they can perform lighter duties, the TPD insurer may use that finding to argue against permanence, even though the scaffolder cannot return to scaffolding work.
When to get TPD claims advice in Queensland
You do not always need TPD claims advice in Queensland, but legal support is often most valuable at three stages: before lodgement, after a procedural fairness letter, and after a claim has been declined.
A TPD lawyer can help by:
- Confirming the definition of total and permanent disability that applies to your policy
- Working out your date of disablement and confirming your cover was active at that time
- Gathering medical evidence from your treating doctors and specialists
- Preparing your claim to ensure consistency across all forms and supporting documents
- Communicating with the insurer and responding to requests for further information
- Challenging delays, disputes, or unfavourable decisions during the assessment.
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What if my TPD claim is rejected?
If your TPD claim is rejected, you have the right to challenge the decision. A rejection does not mean the claim is over, and many declined TPD claims are overturned on review. The industry acceptance rate for TPD claims in Australia is around 92 per cent, according to APRA and ASIC.
Common reasons TPD claims are declined include:
- Your condition does not meet the policy’s definition of total and permanent disability
- Medical evidence is insufficient or inconsistent across reports
- The insurer argues your disability began before your cover was active
- A workers’ compensation report suggests you retain some capacity to work
- Claim forms contain gaps or inconsistencies between the member statement, employer statement, and medical reports
- Employment history records are not detailed enough to show that you cannot return to any suitable role.
Procedural fairness letter
A procedural fairness letter may be issued by your insurer or super fund before a final decision is made on your claim. The letter explains the information they are relying on to decline the claim and gives you a chance to respond.
For example, if the insurer is relying on a single independent medical report, additional evidence from your treating specialists addressing the specific concerns raised can lead the insurer to reconsider before finalising the decision.
Reviewing a rejected claim
You can ask your super fund or insurer to review the decision internally. If the internal review does not resolve the matter, you can lodge a complaint with the Australian Financial Complaints Authority (AFCA). AFCA complaints generally need to be lodged within two years of the insurer’s decision.
If your claim has been declined or you have received a procedural fairness letter, getting legal advice early can help you respond before the decision is finalised.
