Moving forward after an illness or injury that prevents you from working can be daunting, especially with the accompanying financial strain and uncertainty about your future. Fortunately, Total and Permanent Disability (TPD) insurance offers much-needed relief.
Understanding the most common TPD claims can significantly impact your approach to filing a claim. Whether you are dealing with a long-term physical illness, a serious disease, or a mental health condition, knowing what insurers typically approve or deny can help you build a stronger case. In this article, we’ll explore the leading causes of TPD claims, key factors for success, and how to navigate the process smoothly.
Unsure if you have a claim? Get a free claim check today.
What Are TPD Claims?
TPD insurance is designed to provide financial relief to individuals who can no longer work due to a permanent disability. These claims are typically made through your superannuation fund. In Australia, around 86% have some level of TPD coverage included in their super, according to a 2021 ASIC report.
A successful TPD claim can provide a lump sum payout, which can be used for medical expenses, rehabilitation, or general living costs. However, not all conditions qualify, and insurers often scrutinise applications carefully. Having a clear understanding of the most commonly accepted claims can improve your chances of success.
Check if you’re eligible for a Compensation Claim
Find out if your injury or illness is eligible to make a compensation claim. Your online check only takes 3 minutes.
The Most Common TPD Claims in Australia
Chronic Back Pain & Spinal Injuries
Severe back pain and spinal injuries often result from workplace accidents, heavy lifting, or long-term physical strain. These conditions can cause chronic pain, reduced mobility, and even nerve damage, making it impossible to continue working, especially in physically demanding jobs.
Arthritis & Joint Disorders
Arthritis, including osteoarthritis and rheumatoid arthritis, causes joint stiffness, swelling, and pain. Over time, it can severely limit movement and the ability to perform even basic work tasks, particularly for individuals in jobs that require manual dexterity or prolonged standing.
Repetitive Strain Injuries (RSI)
RSI conditions, such as carpal tunnel syndrome and tendonitis, develop over time due to repetitive motions in jobs like typing, factory work, and construction work, especially those requiring the handling of power tools (Sevy et al, 2023; HealthDirect). These injuries can lead to persistent pain, numbness, and loss of function, preventing individuals from performing essential job duties.
Cancer
Advanced stages of cancer and aggressive treatments like chemotherapy and radiation can cause extreme fatigue, pain, and organ damage. Many individuals are unable to return to work due to the long-term side effects and the impact on their overall physical and mental well-being. According to a 2008 study published in the journal Cancer, over half experience fatigue and strength issues, compared to just 21% of those without a cancer history. Many also suffer from depression (10-25%) and anxiety (6-23%), with symptoms lasting five years or more after treatment.
Heart Disease & Stroke
Studies show cardiovascular diseases, including heart attacks and strokes, are the leading cause of permanent disability among workers. Interestingly, activities in the workplace with the development of CVD, especially those exposed to high-heat environments (Makar et al., 2024). Survivors often experience fatigue, weakness, cognitive impairment, and mobility issues, making it difficult to return to work in any capacity.
Neurological Disorders
Conditions such as Multiple Sclerosis, Parkinson’s disease, and Motor Neurone Disease progressively affect the nervous system, causing muscle weakness, tremors, and cognitive decline. As these conditions worsen, individuals lose the ability to perform work-related tasks independently.
Mental Health Issues
Mental health conditions, such as Major Depressive Disorder, PTSD, and anxiety disorders, are significant contributors to TPD claims in Australia. Depression, affecting 1 in 7 people, can lead to persistent sadness, lack of motivation, and fatigue, making it challenging to maintain employment. In fact, KPMG reported in November 2024 that 36% of TPD claims among Australians in their 30s and 40s are linked to mental health issues. Similarly, PTSD and anxiety, often triggered by traumatic events, cause symptoms like panic attacks and flashbacks, severely hindering one’s ability to function in the workplace.
Traumatic Brain Injuries (TBI)
An estimated 200,000 Australians experience TBI annually, which is more prevalent among men according to AIHW. Often caused by falls, car accidents, or assaults, TBI can lead to cognitive impairments, memory loss, and personality changes. Even mild TBIs can cause long-term difficulties in processing information, making decisions, and maintaining focus at work.
Spinal Cord Injuries & Paralysis
Severe spinal injuries from accidents or degenerative conditions can lead to full or partial paralysis. These conditions drastically reduce mobility, limit independence, and make traditional employment impossible, requiring lifelong medical support and adaptive living arrangements.
Recent Data Insights
Recent reports highlight key trends in TPD claims, revealing crucial insights into acceptance rates, causes, and timelines.
- The June 2023 APRA report shows a 92.3% acceptance rate for TPD claims across the industry.
- KPMG found that mental health conditions are behind 80% of the recent rise in TPD claims.
- On average, TPD claims take 4.2 months to finalise, with delays linked to the complexity of proving permanent disability.
By knowing these trends, you can set better expectations for the TPD claims process.
Steps to a Successful TPD Claim
Reviewing Your Policy
Before lodging a claim, carefully review your superannuation policy to understand your TPD coverage. Different policies have different definitions of ‘total and permanent disability’—some cover you if you’re unable to work in your current role, while others require proof that you cannot work in any role.
Gathering Strong Medical Evidence
Your claim must include clear medical documentation proving that your condition is permanent and prevents you from working. This typically includes:
- Specialist reports
- Hospital and treatment records
- Imaging results (X-rays, MRIs, CT scans)
- Psychiatric assessments (for mental health claims)
Submitting Your Claim
Complete the necessary forms from your superannuation fund and submit them along with your supporting medical evidence. Any errors or missing documents can cause delays or lead to claim rejection.
Undergoing Independent Assessments
Insurers often require you to attend an independent medical examination (IME) to verify your condition. Being honest and prepared for this assessment is essential. Doing so ensures the accuracy of your condition, builds trust with the insurer, and strengthens your claim. Any inconsistencies or dishonesty can harm your credibility and potentially jeopardise your benefits.
Why Legal Support Matters
Around 25% of TPD claims are rejected, and 81% are withdrawn due to failure to meet specific contractual definitions. Working with an experienced Super and TPD Claims Lawyer can make a huge difference by guiding you through the process, ensuring your claim meets all the requirements to reduce the risk of rejection.
Next Steps: Get the Support You Deserve
If you’re considering a TPD claim, don’t navigate the process alone. A single mistake in paperwork or medical evidence can mean the difference between approval and rejection.
Rest assured our experienced Super and TPD Claims Lawyers are here to help you:
- Assess your eligibility
- Compile strong medical documentation
- Handle insurer negotiations
- Appeal rejected claims
If you have any questions or if you’re ready to commence your claim, consult for FREE with one of our expert TPD and Super Claims Lawyers on the Gold Coast and in Brisbane, or our Bundaberg Compensation Lawyers, Hervey Bay Compensation Lawyers, or Rockhampton Compensation Lawyers. Call us now!
Check if you’re eligible for a Compensation Claim
Find out if your injury or illness is eligible to make a compensation claim. Your online check only takes 3 minutes.