A TPD claim inside superannuation runs through three different entities with three different jobs. Understanding who does what explains why claims move slowly, and who is actually accountable when one is declined.
Most people talk about a “TPD claim against my super fund” as if it is one relationship. It is not. A claim inside superannuation runs through three separate entities, each with a different legal role, and confusing them is one of the most common reasons claimants misdirect their frustration, or miss an avenue for review that was open to them the whole time.
The three parties, and what each one actually does
The super fund is where your membership is held and where your account balance sits. For most members, this balance is built from employer contributions made over years of work, not personal savings. Most funds do not decide TPD claims themselves. Their job is to hold the insurance policy, collect premiums from member balances, and pass a claim to the insurer for assessment.
The trustee is the legal entity responsible for running the fund and for looking after members’ interests, including yours. Under the Superannuation Industry (Supervision) Act, a trustee must do everything that is reasonable to pursue an insurance claim for the benefit of a beneficiary (if the claim has a reasonable prospect of success). This stops trustees from taking a passive role, as they must turn their own mind to the insurer’s recommendation rather than simply rubber stamping it. In practice this means the trustee is the one that formally decides whether your benefit is paid, even though the insurer does almost all of the assessment work.
The insurer holds the actual TPD policy and carries the risk. It investigates the claim, requests medical evidence and reports, applies the policy’s definition of disability, and recommends an outcome to the trustee. There are relatively few insurers active in this market compared with the number of funds, so the same handful of insurers assess claims for members across dozens of different super funds.
Our glossary explains the trustee’s role and what AFCA does once an internal review is exhausted, for readers who want the short version of each term.
Why there are many funds but few insurers
Australia has a large number of APRA regulated superannuation entities, but group TPD and life cover for those funds is concentrated in a small number of specialist group insurers. For the financial year to June 2025, TAL held roughly 39 per cent of group risk premium, AIA Australia around 26 per cent, and MetLife close to 14 per cent, meaning three insurers wrote close to four in every five dollars of group risk premium in the country. Zurich and MLC Life are the other names most commonly seen.
This matters practically. Two people in completely different super funds can find their claim assessed by the same insurer, under similar policy wording, because that insurer underwrites both funds’ cover. It also means an insurer’s internal claims culture, not the fund’s brand, often has more influence over how a claim is handled.
Funds and insurers this commonly involves
The exact combination varies, and cover changes hands between insurers from time to time, but a TPD claim inside superannuation most often involves one of the following.
Super funds members most often hold TPD cover through: AustralianSuper, Australian Retirement Trust, Aware Super, CBUS, HESTA, Hostplus, Rest, UniSuper, Mercer Super Trust, Colonial First State, AMP Super, MLC Super and BT Super, alongside a large number of smaller industry and corporate funds.
Group insurers most often behind that cover: TAL, AIA Australia, MetLife, Zurich and MLC Life Insurance. Because these five insurers underwrite the large majority of default group cover in the market, the insurer’s policy wording, not the fund’s marketing material (such as a Product Disclosure Statement), is usually the document that decides how a claim is assessed.
We act for claimants across all of these funds and insurers, and for members of smaller funds not listed here. The fund and insurer named on your annual statement is the starting point for working out which policy definition applies to you.
Why this structure slows claims down
A claim has to pass through the insurer’s assessment before it reaches the trustee’s decision, and each step carries its own paperwork, its own timeframes and its own point of possible delay. ASIC’s review of the TPD claims process found that members regularly face onerous lodgement processes, repeated requests for the same information, and long delays between steps, problems it linked directly to the number of separate parties and handoffs involved in a typical claim.
Claims assessed under the stricter “activities of daily living” test, a definition mostly seen in default cover for casual, contract and seasonal workers, are declined roughly five times more often than claims assessed under the standard occupation based tests. Knowing which definition applies to your policy, which is a question about the insurer’s wording rather than the fund’s, is one of the first things worth checking early.
Where accountability actually sits
Because three parties are involved, it is worth being precise about where a complaint belongs.
| If the problem is | The accountable party is |
|---|---|
| The policy definition was applied too strictly, or medical evidence was misread | The insurer, in the first instance |
| A decision took an unreasonable time | The insurer, in the first instance, unless the delay was caused by the trustee |
| The trustee did not properly turn its mind to the insurer’s recommendation | The trustee |
| You were never told what cover you held, or premiums were deducted for cover you were not eligible to claim on | The trustee, and potentially the fund’s disclosure obligations |
A complaint through internal dispute resolution is made to the trustee, since it is the trustee’s decision being challenged, even where the underlying dispute is about the insurer’s assessment. If the internal review does not resolve the matter, a complaint can be made to the AFCA, which has the power to review the trustee’s decision and, where appropriate, direct that a benefit be paid. TPD claims make up around one in five superannuation product complaints AFCA receives each year, and complaint numbers have been rising, which reflects both growing claim volumes and the friction built into this three party structure.
What this means for your claim
Understanding who does what changes how you approach a declined or delayed claim. Chasing the fund’s call centre about a medical assessment decision usually goes nowhere, because the fund itself did not make that decision. The insurer made the assessment, and the trustee made the formal call. Directing evidence, correspondence and pressure at the right party, at the right stage, is one of the more overlooked parts of running a TPD claim well.
If your claim has stalled and you are not sure who is responsible for the delay, our guide to how long a TPD claim takes sets out the stages in more detail. If your claim has been declined, our guide to what happens next explains the internal review and AFCA process.
Sources
- ASIC, Report 633, Holes in the safety net: a review of TPD insurance claims, October 2019.
- ASIC, media release 19-281MR, ASIC calls on insurers and trustees to take action to improve consumer outcomes from TPD insurance.
- Australian Financial Complaints Authority, annual review, superannuation complaints.
- Australian Financial Complaints Authority, annual review, life insurance complaints.