Elita Gluscevic
June 11, 2024

How Consulting a Medical Specialist Can Contribute to a Successful TPD Insurance Claim

In Australia, many superannuation funds contain a Total and Permanent Disability (TPD) insurance policy. This policy protects the insured when their ability to work is affected. A successful TPD claim provides a lump sum payment if you have to stop working because of illnesses or injuries.

If a personal injury or illness has significantly impacted your ability to work, you should consider making a TPD claim. Note that each superannuation fund’s insurance company has its requirements. You should check the fine print to know if you meet the insurer’s criteria.

tpd IME

However, the essential requirement is that the applicant has been unable to work for some time and has specific evidence to prove their permanent inability to return to work. A medical specialist’s advice is essential in establishing an applicant’s failure to work.

How does a medical specialist contribute to a successful TPD claim? Why should you consult with medical specialists in the TPD insurance claims process? These are the questions we’re going to address. You will also see how Lex Medicus can help you get successful TPD claims.

Why You Need Medical Specialists for Successful TPD Claims?

Any typical TPD payout requires the input of medical specialists. Obtaining them may increase your legal expenses, but it’s essential to consult with appropriate medical specialists if you wish to access your TPD benefits. We have highlighted their contribution to your application process, whether you are making one or multiple TPD claims.

Gathering Medical Evidence

Generally, as part of your approval process, you would be examined by an independent medical examiner to determine the extent of your injuries. Your insurer and lawyer will organise this consultation. The results of this examination are significant as they are crucial evidence for your application.

The independent medical specialist submits a medico-legal report, which would be factored into the insurer’s decision about your TPD claim. This report is combined with the medical records from your treating medical practitioner to support your TPD claim.

Getting Accurate Diagnosis

You can get a medical specialist at the diagnosis stage. Getting a specialist’s opinion from the beginning of your care might be better. With cases like mental illness, a specialised psychologist or psychiatrist can provide a more comprehensive diagnosis than getting one from a general practitioner. 

The technical advice would also support your application and ensure your claim is appropriately processed when submitted to your insurance policy provider.

Having the right medical records and reports is essential to successfully claim TPD. It would be best to have medical specialists who understand the claims process and give you the best medical and legal advice. Getting a medical specialist can mean the difference between an unsuccessful or successful claim.

If you have an injury or illness that has made or will make it impossible to work for six months or more, you should talk to a suitable medical specialist. You can consult with any of our medical specialists when you make a TPD claim.

When Do You Need Medical Specialists in the TPD Claim Process?

The TPD claims process can be challenging to wade through, especially if there are complexities in your case. There might be the temptation to skip medical specialists when you think about the medical expenses, but they can do you more good than they cost.

When You Need Supporting Evidence

In scenarios where your work history is inconsistent, or you have more than one injury or illness, getting independent medico-legal reports from a specialist can help build your case. These reports can help convince your medical providers that your case fits the definition of TPD.

When You Are Not Sure that You Qualify

Sometimes, you might not be sure how your injuries fit into the Total and Permanent Disability clause of your superannuation fund. Medical specialists can provide TPD claims advice on whether you can qualify for the TPD payout or not. You can be sure of your TPD claims application before you apply, with expert advice.

A medical specialist can help clarify your illness or injuries in cases with opposing views about your medical condition. They can make it clear whether the injuries made you unable to return to work. This clarification will determine if you will get the lump sum payout of your TPD insurance policy.

When You Get Rejected Due to Insufficient Evidence

Medical specialists can also help if your TPD claims have been rejected due to insufficient medical evidence. Outdated or inadequate evidence usually affects the approval of your TPD claim. Insurance companies need a valid proof of the claimant’s medical condition to determine their eligibility for TPD benefits.

Having the right medical specialists diagnose and treat your illness or injury can save you time in the application process. With up-to-date medical evidence from qualified medical practitioners, you can get your TPD lump sum approved within the time frame.

What Can Be Considered A Total and Permanent Disability?

If you have TPD insurance included in your superannuation policy when you stop working or when your disability starts, you can get TPD payouts. However, you must know what qualifies as a TPD under your superannuation fund to apply.

Total and Permanent Disability

Generally, if an injury or illness stops you from working for six or more months with an inability to go back to work, and you have a superannuation account, you most likely qualify to make a TPD claim. 

But you will have to check the fine print of your policy to know you are eligible. Different policies have their various definitions and provisions for a claim TPD. You can ask expert TPD lawyers for TPD claims advice if anything is unclear to you.

Some TPD claims don’t require you to be completely unable to work in order to make a claim. Some claims cover being unlikely to return to work in your occupation, while others only cover being unable to return to work in any occupation.

Getting the Best Medical Specialists for A Successful TPD Claim

Knowing you need a medical specialist for a successful TPD payout is not enough. You also need to understand that getting the best specialist for your case is essential. The medical specialist must be experienced, qualified, and knowledgeable about writing medico-legal reports.

At Lex Medicus, we have over 200 medical experts spanning across 45 specialities. Our specialists have extensive knowledge of the peculiarities of your illness or injury and can provide accurate medico-legal reports. We can also process express reports within two business days after an appointment.

Book an appointment with one of our medical specialists today!

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