SUPERANNUATION & TPD CLAIM LAWYERS ADELAIDE

What is a TPD claim?

A TPD claim is an insurance claim made through your superannuation fund, or through a policy you hold directly, when an injury or illness means you are unlikely to work again.

It pays as a lump sum. Importantly, it is paid on top of your super balance, not out of it. Your retirement savings stay where they are.

What “total and permanent disability” actually means

The phrase sounds absolute, and it frightens people off claiming. It should not.

You usually do not have to be incapable of all work. Most policies ask whether you are unlikely to return to work you are suited to by your education, training or experience.

That distinction matters enormously. A concreter with a destroyed back may well have a valid claim even though they could, in theory, answer phones. They have no background in office work, so it is not work they are suited to.

Policy wording varies. Some policies use an “own occupation” definition, which is easier to satisfy. Others use “activities of daily living”, which is considerably harder. Some include retraining clauses that require you to show you could not reasonably be retrained. We read the actual policy before advising you, because the wording decides the claim.

Who can claim in South Australia

To make a TPD claim you generally need to show:

• an injury or illness stops you returning to your usual job, or any job suited to your background
• you held TPD cover that was active at the time you stopped work

Your injury does not have to be work related. It can have happened at home, on the road, playing sport, or been an illness with no accident at all.

What injuries and illnesses are covered

TPD cover is broader than most people assume. Claims we see commonly involve:

• back, neck and spinal injuries
• shoulder and knee injuries that end manual work
• heart disease and stroke
• cancer
• chronic illness such as multiple sclerosis or Parkinson’s disease
• traumatic brain injury
• depression, anxiety and PTSD

Mental health conditions are a significant and growing part of TPD claiming.

Nationally, the rate of TPD insurance claims rose by 38% from 2019 to 2025, largely due to the increasing rate of mental health concerns causing Australians to leave the workforce for good.

Most super fund policies cover pre-existing conditions. Some direct policies exclude them, or exclude mental health. Again, it comes down to the wording.

What your superannuation insurance may cover

TPD is often only part of what you hold. Many people have several benefits sitting in the one fund, and claim only one of them.

Total and Permanent Disability

A lump sum if you are unlikely to return to suitable work. Usually the largest benefit.

Income protection

Monthly payments, commonly 70 to 80 per cent of your income, while you are unable to work. This is a separate claim from TPD and can often run at the same time.

Death and terminal illness benefits

Paid to your dependants on death, or to you directly if you are diagnosed with a terminal illness.

Early access to superannuation

In limited circumstances, including permanent incapacity and severe financial hardship, you may be able to access your super early. We cover this in more detail in our guide to early access to superannuation.

Multiple funds, multiple claims

If you have worked across several employers, you may hold cover in more than one fund. You can often claim on each of them for the same injury, which can multiply what you receive substantially.

Some policies restrict this, so it is worth having the policies checked before you lodge anything. We do that check for free.

How much is a TPD claim worth?

There is no standard figure. The amount depends on your policy, your age, and the level of cover you held.

One thing catches people out repeatedly: the benefit is usually calculated at the date you stopped work, not the date you claim. Default cover generally reduces as you age, so a delay of a year or two can cost you real money.

The TPD claim process in South Australia

Step 1: We check what cover you have, free

Many people do not know whether they are insured, or across how many funds. We find out before you commit to anything.

Step 2: We prepare and lodge the claim

This is where claims are won or lost. The insurer decides on the evidence in front of them, so the medical reports, work history and supporting statements need to address the exact definition in your policy.

Step 3: We deal with the insurer

We handle the correspondence, the requests for further information, and the deadlines, so you can focus on your health.

Step 4: Payment

If the claim succeeds, the benefit is paid through your super fund, and we help you get it released.

How long does a TPD claim take?

Insurers who subscribe to the Life Insurance Code of Practice are expected to decide lump sum claims, including TPD, within six months of receiving the first information for your claim, or the end of any waiting period, whichever is later. Income protection decisions are expected within two months.

The Code also requires insurers to make a decision within 10 business days of receiving all information necessary to assess the claim, provide updates on the claim process every 20 business days, and reply to update requests within 10 business days.

In practice, TPD claims take longer than other insurance claims. Compared to 91% of life insurance claims coming back approved within the month of submission, only 65% of TPD claims come back approved that quickly.

If your claim has passed six months without a decision and without a genuine explanation, the delay itself is something you can complain about.

What if your TPD claim has been denied?

A denial is not the end. It is very often the middle.

How often claims are declined

In the 2025 APRA dataset, advised TPD cover had an acceptance rate of 82.9%, meaning roughly one in six of those claims was declined. Group cover held through super performs better, but declines still happen in significant numbers.

You can compare individual insurers yourself using ASIC’s MoneySmart life insurance claims comparison tool, which draws on APRA’s published claims and disputes statistics.

Common reasons insurers reject claims

• the medical evidence does not squarely address the policy definition
• the insurer says you could work in some other occupation
• a retraining clause is applied
• alleged non-disclosure when the policy was taken out
• an exclusion the claimant did not know existed
• the insurer says cover had lapsed before you stopped work

Several of these are arguable. Some are simply wrong.

Disputing the decision

The first step is an internal review with the insurer or fund. If that does not resolve it, you can lodge a complaint with the Australian Financial Complaints Authority (AFCA), the free, independent ombudsman service that replaced the Superannuation Complaints Tribunal in 2018.

Disputes are worth pursuing. Across resolved disputes lodged in December 2025 on life insurance decisions, only 35% had the original decision maintained. That means that in 65% of resolved disputes, either the decision was entirely reversed, or the person making the dispute was able to reach another outcome with the insurer.

Complaints about these claims are rising sharply. In 2024-25, denial of claim complaints remained the biggest life insurance issue, rising 40% over 2023-24, and TPD complaints rose 43%. Over the same year, AFCA received 6,164 superannuation complaints.

Time limits apply to AFCA complaints, and they are strict. Different rules apply to superannuation complaints than to other financial complaints. If you have received a decision you disagree with, get advice promptly rather than waiting.

If AFCA cannot resolve the matter, or the benefit exceeds what AFCA can award, court proceedings may be the right route. We can advise on both.