Why Should I Use a Lawyer for My TPD (Total and Permanent Disability) Claim?

There are plenty of misconceptions when it comes to hiring a lawyer. The chief among these are that hiring a lawyer is both expensive and unnecessary. In reality, however, hiring a lawyer often saves time and money. This is definitely the case if you are trying to make a total permanent disability (TPD) claim for a serious injury or illness.

There are several reasons why it is difficult to make this type of claim without proper legal advice or representation. One of them is that various super funds and insurance providers have their own definitions of TPD.  Among other things, this means there may be different requirements.  Under one policy, for example, you may need to prove that you are unable to work to make a successful claim. Under another, you may be required to prove that it is “unlikely” you will ever be able to work again.

Additional considerations, such as how your employment is legally classified, whether you are currently employed and how many hours you work, can also affect your case. Depending on your situation, you may have to prove that your illness or injury rendered you incapable of performing simple tasks that are essential to daily life. Specifically, you may be required to submit evidence showing that you can no longer feed yourself, bathe, use the toilet, do household chores and errands, or get around without assistance in order to make a successful claim.

A qualified lawyer can quickly and easily assess your situation to determine whether you have a viable claim. If so, he or she can also can help you identify and gather the evidence you need to support your case. Just as importantly, your lawyer will have the experience and skills necessary to help you complete all of the paperwork associated with making a TPD claim. This is critical due to the length and complexity of TPD claim forms, some of which can top 20 pages.

Even if you are capable of completing the TPD application form(s) on your own, you should consult an experienced lawyer first. This is because some insurance providers have been known to use an applicant’s ability to do so as evidence that he or she does not have a total permanent disability. If this has already happened, a lawyer can help you challenge the insurer.

Legal representation is also essential if an insurer has rejected your claim based on “non-disclosure” of a previous medical condition or stipulations which exclude “preexisting illnesses”.  In most cases, the insurer that denies a claim based on the former argues that the applicant for TPD failed to provide information about an existing illness or injury when he or she obtained the policy. This allows the insurer to disregard or ‘avoid’ the policy. Super funds or insurers that deny TPD claims based on the second ground do so by demonstrating that the applicant is seeking cover for an illness or injury that happened before you were insured. While insurers count on the fact that most applicants lack the knowledge and ability to challenge these decisions, lawyers have the expertise necessary to do so.

By hiring a lawyer to help you understand your rights as you go through the TPD claim process, you’ll ensure that you have recourse if the insurer sends you to the wrong doctor or specialist. You’ll also know what to do if you think the insurer is engaging in an activity called “doctor shopping”. This is a process in which the insurer tries to send you to the same type of doctors or specialists over and over until one provides the information the insurer needs to deny your claim.

Ideally, your case will be resolved and your TPD claim will be approved without going to court. However, if your super fund insurance provider declines your claim, it may be necessary to seek court intervention. In that case, it is essential to have a good lawyer on your side.

Coping with a serious injury or illness is never easy, especially when medical bills are piling up and you are unable to work. The last thing you should have to worry about is getting the compensation to which you are legally entitled. If you’re considering pursuing a TPD claim through your superannuation fund, securing the best possible legal advice and representation is critical, so contact us today.

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