Written by: Angelica Adhar A successful TPD claim meets your insurance policy’s definition of total and permanent disability. Most TPD claims in Australia are approved, and GMP Law has secured TPD payouts for clients ranging from $91,000 to over $500,000 for physical injuries, mental health conditions, and claims initially delayed or rejected by insurers.
In this guide, we share real client stories of successful TPD claims and what to do if your claim has been delayed or rejected.
What percentage of TPD claims are successful in Australia?
Most TPD claims in Australia are approved, with ASIC reporting approval rates of around 82%. Approval rates vary depending on the type of cover you hold and how your claim is presented.
Claims lodged through superannuation generally have higher approval rates than retail policies held outside super. Claims assessed under stricter definitions, such as activities of daily living, have significantly lower approval rates than those assessed under standard TPD definitions.
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Successful TPD claim stories
The following case studies show how GMP Law has secured successful TPD claims for clients across a range of conditions and circumstances, with payouts ranging from $91,000 to over $500,000.
John's $500,000 TPD claim after a spinal injury
John was 44 and working as a senior software engineer when a motorbike accident in 2017 left him with a serious injury to his right shoulder. Over the next five years, he underwent five surgeries and made several attempts to return to work, including a period at 30 hours a week after his third surgery, before his employer terminated his role.
A workers’ compensation assessment cleared John for four hours of work, one day a week, with restrictions that did not match the demands of his role. Sitting at a computer caused ongoing pain and headaches, and the combination of his physical limitations and the psychological impact of the injury meant he could no longer perform the work he had built a 19-year career around.
GMP Law advised John to wait until after his final surgeries before lodging the TPD claim. Lodging earlier would have meant the claim was assessed against the workers’ compensation report stating John could return to work with limitations. Waiting allowed the full picture of his physical and psychological injuries to be supported by evidence from his treating specialists, including his spinal specialist. The TPD claim was approved for $500,000, just over a year after lodgement.
$400,000 TPD payout for a project manager with multiple sclerosis
Another client was 39 and working as a project manager when she stopped work in early 2019. She had been diagnosed with multiple sclerosis in 2003 and managed the condition through bi-annual infusions while maintaining full-time employment for over fifteen years. Over time, she developed lower leg weakness and lost the ability to stand or walk without assistance, and eventually became wheelchair dependent.
The key issue in the claim was the date of disablement. Our client had lived with MS for sixteen years before stopping work, so the insurer could have argued her date of disablement was 2003, when she was first diagnosed, rather than 2019, when she could no longer manage her symptoms. An earlier date would likely have meant the claim was unsuccessful.
GMP Law argued that our client had successfully managed her condition for many years and only became disabled when she could no longer cope with her ongoing symptoms. The claim was prepared alongside an income protection claim attached to the same policy. The income protection claim was approved within 17 days of lodgement, and the TPD claim was approved for $400,000 within 5 months.
$300,000 TPD payout for a construction worker after a two-year delay
Mr L was 38 and working in construction when a workplace injury caused bulging discs in his spine. The injury left him in significant pain, on ongoing medication, and unable to return to work. His treating doctors advised that a safe return to work was unlikely.
The client initially lodged the TPD claim himself after his workers’ compensation claim was resolved. Two years later, the claim had still not been decided. The insurer was requesting supporting material in small batches rather than assessing what had already been provided, and the process had stalled.
GMP Law took over the claim and wrote to the insurer demanding immediate payment. The submission argued that the evidence already on file was sufficient to meet the policy terms, and that the insurer’s requests for further material had unreasonably delayed the assessment. The insurer initially resisted, but approved the claim in full for $300,000.
$91,000 TPD payout for a 25-year-old workshop mechanic
In 2022, another GMP Law client was 25 and working as a field service fleet manager and workshop mechanic when he injured his lumbar spine lifting heavy parts. The injury was initially diagnosed as a disc bulge with nerve root impingement, and worsened when he returned to work on light duties. Surgery followed, including a microdiscectomy at two levels in his spine.
On his return to work, our client was subject to workplace bullying and harassment. He developed anxiety and depression alongside his physical injury, and despite ongoing psychological treatment, found little relief from his symptoms.
When the claim was lodged, the insurer accepted that the back injury would prevent him from returning to a laborious role. However, the insurer was not willing to accept that the psychological injuries from the workplace bullying and harassment were a contributing factor in his inability to return to any form of work, particularly given his age. GMP Law gathered the medical evidence and treatment history needed, and the TPD claim was approved for $91,000.
Truck driver's claim resolved in two weeks of court filing
Finally, another client was a truck driver who was involved in two motor vehicle accidents. The second accident left him with significant injuries, including chronic pain, nerve pain, reduced mobility, cognitive impairments, psychological injury, and chronic headaches. The physical heavy lifting and manual functions required to operate a truck were no longer tasks he could perform.
GMP Law’s superannuation team identified the cover attached to our client’s super fund and prepared the claim with supporting medical evidence. Detailed submissions were made to the super fund, addressing our client’s condition alongside his education, training, and experience to demonstrate that he could not return to any suitable role.
Despite the evidence provided, the super fund and insurer subjected the claim to extensive delays. GMP Law filed proceedings in the Supreme Court of New South Wales. The super fund approved the claim within two weeks of the court documents being filed.
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What makes a TPD claim successful?
A successful TPD claim shows that your condition meets your policy’s definition of total and permanent disability, supported by evidence that is complete at lodgement. This includes medical evidence from your treating doctors and a claim form consistent with your medical records and employment history.
To support a successful TPD claim, insurers generally look for:
- Active cover at the date of disablement
- Medical evidence that addresses your policy’s definition of total and permanent disability
- A clear date of disablement
- A complete file at lodgement, including specialist reports, employment history, and treatment records
- Consistency between your claim form, medical records, and any earlier statements made to a workers’ compensation insurer or employer.
Key takeaway
The severity of your condition does not determine whether your TPD claim succeeds. What matters is whether your evidence addresses your policy’s definition of total and permanent disability, and whether your claim is complete at lodgement.
Can a rejected TPD claim still be successful?
Yes, a rejected TPD claim is not necessarily the end of the process. Many declined claims are successfully challenged and overturned.
If your claim has been rejected, you can challenge the decision through:
- Internal dispute resolution through your super fund or insurer
- A complaint to the Australian Financial Complaints Authority (AFCA)
- Court proceedings, generally used as a last resort.
Because strict time limits and procedural requirements can apply, it is important to act early. Getting advice from a personal injury lawyer can help you understand your options, respond to the insurer’s decision, and improve your chances of a successful outcome.
