Personal injury / Total and permanent disability
Total and permanent disability claims
A TPD claim is not a personal injury claim. It is a claim under an insurance policy, and it is decided by what that policy says rather than by whether anyone was at fault.
That difference matters in two useful ways. You do not have to show that anyone was to blame. A condition that developed on its own, or an injury that was entirely your own doing, can still support a claim. And it can be pursued at the same time as a personal injury claim arising from the same event.
Most people have cover without knowing it
TPD cover is commonly attached automatically to superannuation accounts. If you have had several jobs, you may have several accounts, and cover under more than one. Claims can be made on each.
People routinely miss this. It is worth checking every fund you have ever held, including ones you have long since stopped contributing to.
What the policy requires
The test is set by the policy wording, and wordings differ. A common formulation asks whether, because of illness or injury, you have been unable to work for a specified period and are unlikely ever again to engage in gainful employment for which you are reasonably suited by education, training or experience.
Each part of that does work:
“Unlikely ever”:
A forward-looking assessment, not a description of how you are today.
“Gainful employment”:
Paid work, not necessarily your old job.
“Reasonably suited by education, training or experience”:
This is the contested phrase in most disputes. A labourer with a back injury who could theoretically do sedentary work may still satisfy the test if they have no education, training or experience that would get them such a job.
Some policies use different tests again, such as activities of daily living, or occupation-specific definitions. Which one applies to you depends on your policy, and sometimes on when the cover started.
Income protection
Separate cover, often held alongside TPD, paying a proportion of income during a period of incapacity. Different test, different waiting periods, different benefit periods. Where both exist they are usually worth claiming together.
If your claim is declined
Declined TPD claims are not uncommon and a decline is not the end of the matter.
Internal review.
The insurer reconsiders, usually with further evidence. Often the most efficient route, particularly where the decline turned on a gap in the material rather than on a genuine disagreement.
Court.
Available where the other avenues do not resolve it.
Declines frequently rest on the insurer’s assessment of what work you could do, supported by a vocational report prepared without meeting you. Those assessments are contestable, and are regularly contested successfully.
What helps
Medical evidence that addresses the policy test, not just your diagnosis. A specialist saying you have a disc injury is not the same as a specialist saying why you are unlikely ever to return to work for which you are suited. The second is what the insurer has to answer.
A clear employment history also matters more here than in other claims, because the test turns on what your education, training and experience actually equip you to do.
This page is general information about how the law works in Queensland. It is not legal advice, it does not take account of your circumstances, and it should not be relied on as a substitute for advice about your own claim.