In circumstances where you suffer a serious injury or illness that prevents you from working, a payout under your Total and Permanent Disablement (TPD) policy may be important to obtain financial security.
Unfortunately, you may find that you no longer hold TPD coverage when this occurs. Your most recent statement with your superannuation fund may show you no longer hold TPD coverage.
While this may seem disheartening at first, you may not be prevented from making a TPD claim. Under certain circumstances, the policy may still be claimed.
The Importance of the Incident Date
Various TPD policies are triggered by an insured event. The TPD policies usually define this as the incident date, although this can vary.
Some policyholders may believe that the insured event is triggered when the claim is made. This is certainly the assertion made by some superannuation funds or insurers.
However, depending on the policy, the insured event may be triggered when you first start exhibiting the symptoms of your injury/illness or it may be triggered when you are first diagnosed with that condition from a doctor. This is important if you suffer from an injury or illness which is not initially serious enough to stop you working but it does deteriorate to a stage where you stop working.
If such circumstances arise, it is possible you may have paid premiums for the TPD policy when the insured event occurred and will thus be covered.
Examples
There are various examples where this may occur. Take for example the following scenario:
2 May 2022:
- The policyholder was diagnosed as suffering from a lumbar spine injury after he dug a trench as part of his duties as a plumber. At that time, he held TPD policy under his superannuation fund. However, the injury did not cause him to go off work.
11 October 2022:
- The policyholder’s condition deteriorates to the point where his doctors certify that he is unable to perform any work.
1 February 2023:
- The policyholder’s employer terminates his employment because he is unable to perform any work. He ceases receiving superannuation contributions which stops premium payments for TPD insurance.
8 February 2024:
- The policyholder decides to claim his TPD policy but finds his policy has since ceased because he has not paid premiums through the superannuation account.
In this situation, if the policy permits, the plumber may retrospectively make a claim because he first obtained a diagnosis on 2 May 2022 and has thus triggered the policy from that point.
Another clear example is where an officer of the NSW Police Force claims the TPD benefit after ceasing work. On 7 December 2022, the entitlement to the TPD benefit through the basic and additional policy ceased through Aware Super. Some officers may have been disentitled from making a claim under that policy because the claim was made after 7 December 2022. However, our office has successfully argued there exists an entitlement to this policy despite making applications for TPD benefits after 7 December 2022. You may read further about the changes to this coverage here.
Get In Touch With Us
These matters can be difficult to navigate, and it has been our experience that policies vary with each policyholder. In particular, the definition of the “incident date” and the “insured event” varies with each policy.
If you find yourself in this situation, you can contact our office for further information.
At Turner Freeman, we have dedicated lawyers who specialise in superannuation claims, and who will assess your case and provide personalised advice regarding your legal entitlements and will act for you on a “no win, no fee” basis. For further information contact us today on 13 43 63.
