What qualifies as total and permanent disability

You qualify for total and permanent disability (TPD) cover when your illness or injury meets the definition written in your own policy. In most policies that means you have been off work for a set period and the evidence shows you are unlikely ever to work again in the way the policy describes.

There is no single national definition. Each super fund and insurer writes its own, so two people with the same condition can be assessed under different policies. This article explains the tests insurers commonly apply, so you can see where you might fit. It is general information, not advice on your policy.

The policy wording decides

TPD cover is usually held through a superannuation fund, with the benefit provided by an insurer under a group policy. The fund trustee decides the claim, relying on the recommendations made by the insurer. The question is never whether you feel disabled in general terms. It is whether you meet the specific words of the definition that applied to you when your disability began.

For that reason, the first practical step is to get the actual policy document or product disclosure statement, not a summary. Our FAQ on what a TPD claim is gives the wider picture, and our explanation of who actually pays a TPD claim shows how the fund and insurer fit together.

The main tests insurers apply

Most definitions fall into a few families. Some policies use one, others use different tests depending on whether you were working when your disability began.

Test	What it asks	Who it usually applies to
Own occupation	Can you ever return to your usual job?	People with some retail or personally held policies
Any occupation	Can you ever return to any job suited to your education, training or experience?	Most super fund policies
Activities of daily living	Can you perform basic daily tasks without help?	People who were not working, over the age of 65 and still held cover, held a specific occupational category, or not working regularly, when the disability began

The own occupation and any occupation entry in our glossary explains the first two. The any occupation test is usually harder to meet, because the insurer looks beyond your current job to work you could be realistically retrained for. The activities of daily living test looks at tasks such as dressing, bathing and moving about, and is generally a demanding standard.

If you were not working when your disability began, see our article on whether you can claim TPD if you are not working.

The waiting period

Many policies require you to have been away from work for a continuous period before the definition can be assessed. This is the waiting period. The length is set by the policy and varies between funds, so read your own wording rather than relying on a figure you have heard elsewhere.

Some policies let you work a little or try a return to work without restarting the clock. Others are stricter. Our FAQ on TPD while still working covers that situation.

What unlikely ever to work again means

Most definitions are built around a phrase like unlikely ever to work again, or unlikely to be able to work in a suitable occupation. Three points are worth knowing.

• It looks forward. The insurer asks about your future capacity, not only how you are today.
• It is about suitable work. Suitable usually means work reasonably matched to your education, training and experience, which can include work you may not have done before.
• It is evidence based. Insurers weigh treating doctor reports, specialist opinions, your work history and any attempts to return to work.

A condition that is serious but expected to improve with treatment can be hard to fit within the word permanent. A condition that has stabilised, where treatment options are exhausted, is usually easier to document. Neither is automatic. Some policies also set a minimum time after the date of disablement before permanence can be judged. Our article on TPD claims for multiple sclerosis explains how this works for a condition that relapses and remits.

Evidence that tends to matter

Insurers read the paperwork closely. Evidence that often carries weight includes:

• consistent notes from your treating doctors about your symptoms and limits
• specialist reports on diagnosis, treatment and outlook
• records of your jobs and why you could not continue
• records of any return to work attempts and what happened
• your own account of your day to day function, which should match the medical records

Gaps and inconsistencies are a common reason for delay or refusal. If a claim is refused, our article on why a TPD claim is rejected explains the review options.

Other points that affect eligibility

Meeting the definition is only part of it. Your cover must also have been in force on the relevant date, and there are conditions such as exclusions for pre existing conditions and lapses in cover in some policies. The policy may also set timeframes for giving notice of a claim, so prompt advice is wise if you think you may qualify.

If a TPD payment raises questions about tax, Centrelink or accessing your super, those depend on your own circumstances and belong with your accountant or financial adviser. The firm gives legal advice, not tax or financial advice.

What to do next

If you are off work, or cutting back, because of a condition you think may be permanent, a sensible start is to collect your policy documents and the details of every super fund you have held. If you have more than one, see our FAQ on multiple super funds.

Then you can check your position with our claim check or contact us to talk it through. Time limits can apply, as explained in our FAQ on time limits for personal injury claims, so do not leave it long. No outcome or amount can be promised, because every claim depends on its own wording and evidence.