TPD Claims

"Total and Permanent Disability (TPD) Insurance provides a lump sum when you become totally and permanently disabled by illness or injury. The definition of what this means can vary significantly from policy to policy."

Total and Permanent Disability Claims

Claiming for TPD can be a confusing, stressful and overwhelming experience. You are expected to deal with forms, insurance companies, doctors and all the other requirements that go with lodging a claim.

We understand there is so much more involved in presenting a TPD claim than just completing claim forms. In fact, lodging a claim form is the smallest part of what we do. 

That’s why we offer our advocacy service for our clients. Having a third-party advocate to represent you with your TPD claim provides a great advantage and leverage when presenting TPD Claims. As your claims advocate, we will liaise with the Insurer on your behalf, taking away the emotion and stress that comes with dealing with Insurers.  

The level of work that is required to get a claim over the line can be quite extensive. Which is why the cost of a lawyer can be quite expensive given the time it takes to lodge a successful claim. Our vast industry experience across all aspects of insurance, Centrelink and Financial Planning gives us the edge and the ability to advocate for clients to achieve the best results possible.

 

Advocating for greater results

In this video, Christine explains the benefits of advocacy and highlights just how powerful a third party advocate can be in getting the maximum benefit out of your claim. 

These three case studies are great examples of the extensive work our claims team undergo in preparing, researching and lodging a claim on your behalf. 

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Frequently Asked Questions

Do you need a lawyer for a TPD claim?

The short answer is no.  We see many advisements for Lawyers who offer a “no win no fee” TPD Claims Service, however the difference between us and a typical lawyer is the cost. There is a significant of work and a high level of complexity involved in preparing and presenting a TPD Claim. These hours will quickly add up and so will your final bill from a lawyer.  

Although Lawyers do great work in this area, there is definitely a gap in the market for alternatives.  The point of difference, aside from the significant cost saving, is our vast industry experience across all aspects of insurance, Centrelink and Financial Planning gives us the edge and the ability to advocate for clients to achieve the best results possible.

What is the difference between “Own Occupation” and “Any Occupation”?

Own Occupation definition is based on the criteria that you cannot perform the duties of your own occupation. This definition provides you with the highest opportunity of a successful claim, which is reflected in the higher premiums. This definition is only available to certain occupation categories and is usually held outside superannuation.

Any Occupation Definition is the most common TPD definition, which is usually held inside superannuation, such as automatic cover under employer superannuation funds. Any Occupation definition is much harder to meet as you need to be rendered not only to be unable to work in your own occupation, but also any occupation you are reasonably suited to by your past education, training and experience.
The advantage this this type of definition is that it offers an alternative to the occupations who cannot access the own occupation definition, the premiums are generally lower and the policy can be owned under superannuation, allowing premiums to be funded from your superannuation funds.

What happens if my claim is declined?

Sometimes claims get rejected. If this happens, this may not be the end. Insurers will issue a detailed summary outlining the reasons for their decision to consider declining a claim. It’s important to look at the decision and why it was rejected. Is the decision fair? If it is, then there is not a claim to be made and that is fine. If it is not fair, you need to keep going, lodge an appeal, present further evidence if required, find out what is needed to get the claim through. Persistence is key when dealing with insurance companies.  

 Our Claims Team are experienced at working through the appeals process and will look at all options available to give your claim the best chance of success.

How do I find out what Insurance Cover I have?

It is important to understand what insurance cover you have in place. Research your policy terms and conditions. Definitions can vary depending on the type of cover you have in place.  You can find this information in your Product Disclosure Statement and Policy Schedule.  You can also check any old employer superannuation funds as there is often automatic cover attached to these funds, which you may not be aware of. You may even be able to claim on closed funds providing your accident or illness commenced prior to closing your fund.

Our Claims Team are experience in conducting research and interpreting policy terms and conditions.

Why do TPD Claims take so long to assess?

The level of complexity can vary greatly as does the length of time and expertise required. TPD, or Total and Permanent Disability Claims, are quite complex and can take a great deal of time and work to get through. In most cases with TPD, you
will need to prove that you are unable to ever return to work based on your education, training and experience.
 The
definition will vary depending on your policy wording. 
Insurers need to assess that you have been fully diagnosed and exhausted all reasonable treatment options available.

Insurers also assess any transferrable skills that you may have acquired over your working history to see if you are reasonably suited to any other positions based on your education, training and experience.

Our Claims Team are experienced in navigating through the complex and detailed requirements of a TPD claim and will guide you through the process to ensure that your claim is presented to target the specific definitions and requirements in mind.

Do I have to pay tax on a TPD benefit?

This depends on the type of TPD policy you have. The general rule of thumb is, if the cover is direct direct through an insurer and owned by you personally, then the benefit is paid to you tax free. Premiums for this type of policy are paid by you direct and you do not receive a tax deduction for these premiums.

If your cover is held inside superannuation, then there may be tax payable when it is paid outside the
superannuation environment. A TPD benefit is not considered taxable income, however if you withdraw part or all of your
TPD benefit from your super fund as a lump sum, you may need to pay tax. The calculation is different for everyone, and if you have multiple super funds, the calculation may be different for each fund you make a withdrawal from. This can have a significant impact on how you choose to receive your TPD payout. Therefore, it is imperative that you seek advice from a Financial Advisor prior to receiving your lump sum benefit. 

Our Claims Team will work with your Financial Advisor to ensure that you are informed of any taxation, Centrelink and other factors that may impact your individual situation prior to receiving your TPD payout. 

How do Financial Framework charge for a TPD Claim?

Financial Framework offer an upfront agreed “no win no fee” policy with TPD Claims, with no hidden costs or added extras. This fee will only be payable on the successful outcome of your claim. Should your claim be declined, and all avenues of appeal be unsuccessful, there will be no fee for our time.

The fee for a TPD Claim can vary depending on the complexity of your claim as well as the sum insured.  This fee ranges from $10,000 (plus GST) to $20,000 (plus GST). 

Contact our Claims Team for an obligation free quote. 

The decision for you is:

a) Do you take on your claim yourself?

b) Do you seek the assistance of a Claims Specialist?

Introducing our Claims Manager Christine Morgan

Our specialist claims team is headed up by Christine Morgan who has been in the insurance and financial planning industry since 1990 and brings with her a wealth of knowledge and experience in insurance and claims. 

Christine brings not just her experience of dealing with claims, and the technical expertise she has developed over many years in the financial advice industry, but also her true understanding of the stress and emotional impact the claims process can have at a time when the circumstances giving rise to the claim are stressful enough for you and your family.

Along with Christine, our team of claims specialists have years of experience dealing with insurers and understand insurance contracts and the assessment process involved in successful TPD Claims. As your advocates we will exhaust every avenue possible to get your claim over the line.   

Disclaimer:

Our Claims Team are not authorised to give financial or legal advice. Submission of a claim does not guarantee success. Our Claims Team act as an advocate to support clients through the claims process.

 It is important to get financial advice prior to receiving a lump sum TPD benefits.

Contact us today and see how we can help

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The information contained on this website is general in nature and does not take into account your personal situation. You should consider whether the information is appropriate to your needs, and where necessary, seek professional advice from a financial adviser.

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