The most common TPD claims in Australia involve mental health conditions and musculoskeletal conditions such as chronic back pain and arthritis. Injuries, cancer, heart disease, stroke and neurological conditions account for many of the rest. According to the Council of Australian Life Insurers, almost one in three TPD claims in 2024 were for mental health conditions.
Your diagnosis is rarely what decides the outcome. A total and permanent disability claim succeeds or fails on whether your evidence meets the exact definition of disability in your policy, and whether you meet the policy’s other conditions. The latest APRA figures bear this out. Of the TPD claims through super that insurers declined in the year to 30 June 2026, 91% were declined because the claim did not meet the policy definition or another eligibility requirement.
This guide explains which conditions most often lead to a TPD claim, what the common definitions mean, why claims are declined, what insurers and super funds must do when they assess you, the time limits that apply in Queensland, and how to give your claim the best chance.
What is a TPD claim?
Total and permanent disability (TPD) cover pays a lump sum if illness or injury leaves you unlikely ever to work again. Most people hold it through their super fund, often without realising. When ASIC reviewed TPD insurance in 2021, around nine million Australians held TPD cover and about 86% of them held it through super.
A TPD claim is not a compensation claim. Nobody needs to be at fault, and negligence is irrelevant. It is a claim for an insurance benefit, and the central question is whether you meet the definition of disablement in the policy.
When your cover is held through super, the insurer assesses the claim and the trustee of your super fund holds the policy for you. The trustee has its own duties to you, and if the claim is accepted the benefit is usually paid into your super account before it is released to you.
Which conditions most often lead to a TPD claim?
Almost any illness or injury can support a TPD claim if it stops you working for good. These are the conditions that most often lead to claims, and the evidence issues that usually come with each.
Mental health conditions such as depression, anxiety and PTSD
Major depressive disorder, posttraumatic stress disorder (PTSD), anxiety disorders and bipolar disorder are now the leading cause of TPD claims. A November 2024 KPMG report for the Council of Australian Life Insurers found that mental health conditions accounted for 36% of permanent disability claims by people aged 30 to 40 in 2022, up from about 10% in 2013. That study used data from policies held outside super, but insurer data for cover held through super shows a similar trend.
Mental health claims are scrutinised closely because the evidence is clinical rather than visible on a scan. A long and consistent treatment history with a psychiatrist or psychologist carries far more weight than a recent diagnosis, and gaps in treatment are often used to argue that a condition is manageable or not permanent.
Back injuries and spinal conditions
Degenerative disc disease, chronic back pain, nerve impingement and spinal injuries are among the most frequent causes of TPD claims, particularly for people in trades, nursing, transport and other physical work. In AIA’s 2024 claims data for group cover provided through super funds, musculoskeletal conditions such as arthritis and chronic back pain accounted for 23% of TPD claims.
These conditions often build over years rather than starting with a single incident. That creates its own evidence problem, because there may be no clear date of injury. The claim then depends on showing when the condition stopped you working and why it will not improve enough for you to return.
Arthritis and joint conditions
Osteoarthritis and rheumatoid arthritis progressively limit movement, grip and the ability to stand, kneel or walk for any length of time. For someone whose work depends on their hands or knees, the practical loss of capacity can be total well before the condition looks severe on paper. Medical reports should explain what you can no longer do, not only what the imaging shows.
Cancer
Advanced cancer, and the lasting effects of treatment, often prevent a return to work even after treatment has succeeded. Fatigue, pain, reduced strength, problems with concentration and the psychological impact of the illness can continue for years. The evidence needs to show how those effects limit your work in practice, not only that the cancer was diagnosed and treated.
Heart disease and stroke
A heart attack, heart failure or a stroke can end a working life. Survivors commonly live with fatigue, reduced exercise tolerance, changes in memory and thinking, and mobility problems. Where your work was physical, the question is often whether any lighter work within your skills remains realistic.
Neurological conditions such as MS, Parkinson’s disease and MND
Multiple sclerosis, Parkinson’s disease and motor neurone disease are progressive, which affects the timing of a claim. The question is often not whether the definition will be met, but when. Lodging before the evidence supports permanence can lead to a decline, but waiting too long carries its own risks, which are explained in the section on time limits below. The timing should be planned with advice.
Traumatic brain injury
Falls, road accidents and assaults are the usual causes of brain injury. The Australian Institute of Health and Welfare reports that someone in Australia is hospitalised with a head injury about every four minutes, with falls the leading cause, followed by transport accidents. Even a mild brain injury can leave lasting problems with concentration, memory, processing speed and emotional control.
These difficulties can be disabling for office work and are often invisible on a scan, so neuropsychological assessment is frequently central to the claim.
Spinal cord injury and paralysis
These claims are less common, and they rarely turn on whether the definition is met. The issues are usually practical. They include confirming how much cover you hold, finding every policy, and managing how a TPD payout fits with any compensation claim arising from the same accident.
What does total and permanent disability mean in your policy?
There is no single legal definition of total and permanent disability. It means whatever your policy says it means, and the wording varies between funds, between insurers and sometimes between members of the same fund. Reading the definition that applies to you is the most important step before you lodge a claim.
Two people with the same medical condition can get opposite outcomes simply because different definitions apply to them. These are the main types.
Any occupation
Under an any occupation definition, you must be unlikely ever to work again in any occupation you are reasonably suited to by your education, training or experience. This is the standard definition for cover held through super, and the hardest to meet. A bricklayer who could realistically retrain as a dispatcher may not satisfy it.
Since 1 July 2014, super trustees have generally only been able to provide new TPD cover that is consistent with the permanent incapacity condition of release in superannuation law, which is framed in similar terms.
Own occupation
Under an own occupation definition, you only need to be unlikely ever to return to your own occupation. That is much easier to meet. Own occupation cover is generally found only in policies held outside super, or in older cover held in super that started before 1 July 2014 and has been kept in place.
Activities of daily living and activities of daily working
Some policies apply a much stricter test. You must be unable to perform a set number of basic activities such as bathing, dressing, eating, toileting and moving about, or in some versions a set of basic work tasks. These tests usually apply to people who were not working, or were working limited hours, before they stopped work, and in some policies to people in hazardous occupations.
When ASIC reviewed TPD claims in 2019, it found that about three in five claims assessed under an activities of daily living test were declined. Many funds have since removed or narrowed these tests, but some policies still contain them. The test that applies to you depends on the policy wording in force at the relevant time.
Home duties
Some policies include a separate definition for people who were not in paid work because they were caring for a home or family. The test varies between policies, so the exact wording matters.
Waiting periods and employment conditions
Most policies also require a waiting period, commonly three or six consecutive months off work, before permanence can be assessed. Many also depend on your employment status and hours when you stopped work. The date you stopped work, and whether your cover was in force on that date, can decide the claim.
How often are TPD claims accepted?
Most TPD claims are accepted. APRA’s statistics for the 12 months to 30 June 2026 show that insurers accepted 88% of TPD claims under group cover held through super, and 81% of claims under individual policies arranged through a financial adviser. Taking super and other policies together, APRA estimated the average time to finalise a TPD claim at 3.9 months.
Those figures are reassuring, but they can mislead. They count only claims that were lodged and decided, so they leave out people who were told informally that they would not qualify and never lodged. They are also averages across all funds, insurers and definitions, and acceptance rates under the stricter definitions are much lower.
Why are TPD claims declined?
Most declines are not about whether you are unwell. They are about the fit between your evidence and the policy wording. These are the most common reasons.
The definition is not met on the evidence. This is usually an any occupation policy where the insurer decides you could retrain or do lighter work within your skills. Vocational evidence about the work realistically open to you can be decisive.
Permanence is not established. Treating doctors understandably write hopeful reports. A line such as “may improve with further treatment” can be enough for an insurer to say that permanence is not proven. Reports need to address permanence directly and give reasons.
The medical history is thin or inconsistent. Long gaps in treatment, or a condition first recorded around the time work stopped, invite the argument that the condition is less serious than claimed or was not the real reason you stopped work.
Your employment status on the relevant date. Cover can change or end when you reduce your hours, change jobs or stop receiving contributions. The date you stopped work, and the reason, matter.
The cover was not in place. Cover may have been cancelled because the account became inactive, may never have attached to that account, or may have ended when the account was closed or rolled over. Since 1 April 2020, insurance is generally not provided automatically to new members who are under 25 or have a balance below $6,000, unless they opt in.
Misrepresentation or nondisclosure. Where you answered health questions to obtain or increase your cover, the insurer may compare your answers with your medical records. For consumer insurance taken out, and in some cases varied, since 5 October 2021, the old duty of disclosure has been replaced by a duty to take reasonable care not to make a misrepresentation. Before an insurer bound by the Life Insurance Code of Practice treats your cover as void or changes it on this basis, it must write to you setting out the inconsistencies and give you a chance to respond.
Surveillance, social media or records that do not match the claim. Insurers can use information that is publicly available online and, in some cases, surveillance. The Life Insurance Code of Practice requires insurers to try to resolve inconsistencies without surveillance first, and limits how surveillance is carried out.
The reasons given in a decline letter are usually the roadmap to what the claim was missing.
What insurers and super funds must do when assessing your claim
You are entitled to a fair process, and the law gives you real protections.
Every insurance contract includes a duty of utmost good faith, which requires the insurer to act honestly and fairly towards you and with due regard for your interests. Since 1 January 2022, handling and settling insurance claims has also been a regulated financial service, so insurers must handle claims efficiently, honestly and fairly.
Where a policy makes payment depend on the insurer’s opinion, Australian courts, including in Queensland, have held that the insurer must consider the claim reasonably and fairly on the evidence. A decision that falls short of that standard can be set aside.
Your super fund’s trustee has its own obligations. Superannuation law requires the trustee to do everything reasonable to pursue an insurance claim for you if the claim has a reasonable prospect of success.
Life insurers that are members of the Council of Australian Life Insurers are also bound by the Life Insurance Code of Practice. Under the current Code, an insurer will generally decide a TPD claim within six months of receiving it, or of the end of the waiting period if that is later, unless circumstances beyond its control prevent it.
It must generally update you on progress at least every 20 business days, and you can ask for a copy of any independent medical examination report. If it sends you a procedural fairness letter setting out a preliminary view, it must give you a reasonable time to respond before deciding. If it declines the claim, it must give you written reasons, a summary of the information it relied on, and copies of the documents it relied on if you ask for them.
The Code binds insurers rather than super funds, unless a fund has chosen to adopt it, and it is being revised after an independent review that reported in June 2026, so some commitments may change. Where an insurer or trustee has not followed a fair process, that failure can itself be grounds for having the decision reviewed.
What to do if your TPD claim is declined
A declined or rejected claim is not necessarily the end. You can ask the insurer to review its decision or give it more information to consider, and a declined claim can be reopened or reassessed. New evidence that answers the specific reasons for the decline is usually the starting point.
You can also make a complaint. For cover held through super, you can complain to your fund or the insurer, and the trustee should give you a final written response within 45 calendar days. If you are not satisfied, you can take the complaint to the Australian Financial Complaints Authority (AFCA). AFCA replaced the Superannuation Complaints Tribunal for new complaints from 1 November 2018. It is free for consumers, and there is no cap on the amount in dispute for a super complaint.
Court proceedings are the other option. For a super complaint, AFCA’s decision binds both you and the fund, and it can only be appealed to the Federal Court on a question of law. That makes the choice between AFCA and court an important one to make with advice.
Strict time limits apply, so read the decline letter for any deadline and act promptly.
Time limits for TPD claims and disputes in Queensland
There is no single deadline for lodging a TPD claim, and claims can sometimes be made years after work stopped. That does not mean you have unlimited time. Three sets of rules matter.
Your policy. Policies set their own requirements for notifying a claim and providing evidence. Delay also makes a claim harder to prove, because records are destroyed, doctors retire and memories fade.
AFCA’s time limits for super complaints. If you stopped work permanently because of the condition you are claiming for, AFCA can only deal with a later complaint about the TPD decision if you lodged the claim with your fund within two years of stopping work. The complaint must then be made within four years of the decision. If you stopped work for another reason, the complaint must be made within six years of the decision. AFCA cannot extend these limits.
Your fund can still assess a claim lodged after two years, but if it is declined you may have lost the option of a free external review.
Court proceedings. In Queensland, an action to enforce a contract, including an insurance contract, generally must be started within six years of the date the cause of action arose, under section 10 of the Limitation of Actions Act 1974 (Qld). When that period begins depends on the policy and the facts, so do not assume it runs from the date of a decline letter.
For most people the practical rule is simple. If you have stopped work because of illness or injury, check your cover and get advice now, and aim to lodge your claim within two years of your last day of work.
Can I claim TPD from more than one super fund?
Often, yes. If you have held several jobs, you may have had several super accounts, each with its own TPD cover. You may be able to claim under each policy for the same condition, provided you meet each policy’s definition and conditions. The definitions can differ, so you might satisfy one and not another.
Check every fund you have ever belonged to, not just your current one. Once your myGov account is linked to the ATO, you can see the super accounts the ATO holds records of. People who changed jobs before 1 November 2021 are more likely to have several accounts, because since that date a new employer generally pays into your existing fund unless you choose another.
Also check whether any cover was cancelled under the inactivity rules. Since 1 July 2019, funds have had to cancel insurance on an account that has received no contributions or rollovers for 16 consecutive months, unless the member asked to keep it. If you stopped work because of your condition while the cover was still in place, you may still be able to claim, depending on the policy wording.
Before you combine or close any super account, check what insurance it holds, because closing an account generally ends the cover attached to it. Check too for cover held outside super, such as a policy arranged through your employer or one you bought yourself.
How does a TPD claim interact with workers’ compensation and other claims?
A TPD claim can often run alongside a workers’ compensation claim, a CTP claim after a motor vehicle accident, or a public liability claim arising from the same injury. The claims are separate, but they affect each other. Our guide to the personal injury claims process explains how those claims run.
The medical evidence and the statements you give in one claim are likely to be examined in the others, so consistency matters. The order in which claims are resolved, and the terms of any settlement, can also affect tax, Centrelink and other entitlements. The claims are best planned together rather than run in isolation.
What happens after a TPD claim is accepted?
When a claim on cover held through super is accepted, the insurer usually pays the benefit into your super account. To release it, the trustee must be reasonably satisfied that you meet the permanent incapacity condition of release. You can then usually take a lump sum, roll the money over, or start an income stream, and each choice has different tax and Centrelink consequences.
Is a TPD payout taxed?
It depends on how the cover is held and on your age. A TPD benefit withdrawn from super is generally taxed as a super lump sum. If you are 60 or older, a lump sum from a taxed super fund is generally free of tax. If you are under 60, the taxable part is generally taxed at up to 22%, including the Medicare levy.
That tax is often reduced, because a disability benefit can qualify for a larger portion free of tax if two legally qualified medical practitioners certify that you are unlikely ever to work again in a job you are reasonably qualified for. A TPD benefit under a policy held outside super is generally not taxed.
Get advice before the money is released, not afterwards.
Will a TPD payout affect my Centrelink payments?
It can. While a benefit stays in your super account and you are under Age Pension age, Centrelink generally does not count it under the income or assets tests. Once you withdraw it, the money is generally counted, and so are most assets you buy with it. That can reduce or stop payments such as JobSeeker or the Disability Support Pension, so get advice on the timing and form of any withdrawal before it happens.
How to make a TPD claim
A carefully prepared claim is faster to assess and harder to decline. These are the steps.
First, find all your cover. Identify every current and former super account and any policy held outside super. For each one, confirm the amount of cover, the definition that applies to you, and whether the cover was in force when you stopped work.
Second, read the definition that applies to you. Use the actual policy wording, including the waiting period and any employment or hours conditions, rather than a general description of TPD.
Third, build the medical evidence. Gather reports from your specialists and treating doctors, hospital and imaging records and, where mental health is involved, psychiatric assessments. The reports need to address permanence and your capacity for work, not just your diagnosis.
Fourth, document the work side. Collect your position description, duties and hours, the date you stopped and why, any attempts to return to work, and any retraining you have tried. Evidence of genuine attempts to work, and why they failed, can carry real weight.
Fifth, lodge a complete claim on time. Incomplete claims stall for months. If you stopped work because of your condition, aim to lodge within two years of your last day of work so that the AFCA time limits are preserved.
Sixth, be accurate at every assessment. Attend any independent medical examination and describe your symptoms and limitations accurately, neither minimising nor overstating them. You can ask the insurer for a list of examining doctors to choose from, and for a copy of the report. Inconsistency between what you say and what your records show can seriously damage a claim.
Frequently asked questions about TPD claims
What conditions qualify for TPD?
No condition automatically qualifies, and none is automatically excluded. Any physical or mental illness or injury can support a claim if it meets your policy’s definition, which usually means it has stopped you working and is unlikely ever to let you return to work you are suited to. Check your policy for any exclusion that applies to you.
Do I have to be unable to do any work at all?
Not necessarily. Under an any occupation definition, you must be unlikely ever to work again in a job you are reasonably suited to by education, training or experience. You do not need to be bedridden, but you must be unable to return to realistic employment. Under an own occupation definition, you only need to be unable to return to your own job.
Can I make a TPD claim for depression, anxiety or PTSD?
Yes, and these claims are common. They need a consistent treatment history, specialist psychiatric evidence that addresses permanence, and a clear account of how your symptoms prevent you from working. Early and continuous treatment records matter more than almost anything else.
How long does a TPD claim take?
APRA estimated the average time to finalise a TPD claim at 3.9 months in the year to 30 June 2026, although complex claims often take longer. Insurers bound by the Life Insurance Code of Practice commit to deciding a TPD claim within six months of receiving it, or of the end of the waiting period if that is later, unless circumstances beyond their control prevent it. If they cannot, they must explain why and tell you how to make a complaint.
Is there a time limit for a TPD claim in Queensland?
There is no single deadline for lodging a claim, but delay can cost you. If you stopped work because of your condition, lodging within two years of stopping work preserves your right to take a later dispute to AFCA, and court proceedings in Queensland are generally subject to a limitation period of six years. The section on time limits above explains the detail.
My TPD claim was declined. Can I challenge it?
Yes. You can ask for a review, provide new evidence, complain to your fund or the insurer, and then go to AFCA or to court. Ask for copies of the documents the insurer relied on, and use the reasons for the decline as a guide to what the claim still needs. Note any time limit in the decline letter.
Can I claim TPD if I have gone back to work part time?
Possibly. It depends on your definition and when you returned. Returning to some work does not automatically defeat a claim, but it is a significant fact. It should be explained directly in the claim rather than left for the insurer to discover.
Can I still claim if my super insurance was cancelled?
Possibly. Cover is often cancelled when an account stops receiving contributions or is closed. Under many policies, the key question is whether you were covered when you stopped work because of your condition, not whether the cover exists today. The policy wording and the fund’s records will decide this.
Do I need a lawyer for a TPD claim?
Not always. Straightforward claims with clear evidence are often accepted without legal help. Advice is worth getting where the definition is any occupation, where the condition is a mental health condition, where the claim has been declined, where you have cover in several funds, where a time limit may be close, or where there is also a compensation claim.
Talk to a TPD lawyer in Bundaberg, Hervey Bay, Rockhampton or across Queensland
ROC Legal acts for people making superannuation and TPD claims, including claims that have already been declined. We can check what cover you hold, identify which definition applies, work out what your evidence still needs, and deal with the insurer and your fund for you.
We act for clients in Bundaberg, Hervey Bay, Rockhampton and across Queensland. Your first consultation is free and confidential, with no obligation to proceed. Call ROC Legal on 1300 196 219 or request a consultation to discuss your situation.
This page provides general information about the law as at October 2026. It is not legal advice, and your rights depend on your policy and your circumstances.