Preparing your TPD Claim

Investigating the Claim:  

1. Superannuation Statement – provide a copy to Garling and Co
2. File opened – on receiving your statement Garling and Co will open your file.
3. Sign authority – Garling and Co to obtain documents from your TPD fund and perform an ATO Lost Superannuation Search. You may have more than 1 TPD insurer, and by searching, we can ensure that we have exhausted all available options that you might have for TPD insurance.
4. Contact fund – Garling and Co will contact your fund for copies of all policy documents, claim forms and clarification of the amount payable according to your date of disablement. We need your signed authority to do this. The date of disablement referred to in a TPD claim is generally when you last worked due to your injuries, plus the necessary waiting period, which may be three (3) or six (6) months.
5. Document review – we focus on the definition of Total and Permanent Disablement. Your impairment must satisfy the criteria of this definition, and this definition will be considered throughout the preparation of your claim.
6. Policy Definition and Other Documents – We will provide the written policy definition you must meet for your claim and the documents you need to provide for us to commence your claim. Below are examples of the documents you may need to provide:

• • Identification documents that may need to be certified.
  • Medical statements which need to be completed by one (1) if not two (2) treating practitioners certifying you meet the definition.
  • A copy of your resume to assist with determining your education, training and experience.
  • Relevant authorities that the Insurer has requested to be completed as part of the claims assessment process.
  • An employer’s statement confirms your employment until you stopped working.

7. Client to contact medical providers – We then ask that you contact your treatment providers and request that they complete the necessary medical statements. You must do this because your claim cannot proceed without these medical statements.

Claim Preparation:  

1. Schedule an appointment to review the draft claim.
2. Finalise the claim form and draft letter of claim. Your legal specialist will review all your medical evidence to determine whether enough medical evidence already obtained on file would allow us to lodge your claim.
3. Additional evidence – If you do not have insurance claims, such as workers’ compensation or motor accident claims that generate many medical documents, we will consider getting medico-legal evidence supporting your claim. This may include referral to an Occupational Physician who is a specialist in determining injuries and capacity for future work.
4. Final review – Garling and Co will collate the claim and supporting documents. You will then complete a final review, and your claim is lodged with the necessary fund.

Assessment and Decision:  

1. The claim is now pending. Garling and Co will regularly contact the fund while the claim is being processed. The Insurer will take some time to assess your claim as they need to carry out due diligence and check if you meet the necessary definition by liaising with your treatment providers, looking into your workers’ compensation or motor accident records and determining how your injuries comply with the required total and permanent disablement definition.
2. Timeframe – This can take weeks to months and, unfortunately, is totally at the Insurer’s discretion.
3. Decision Made – whether you are approved or denied your TPD benefits, they will then issue a decision to your legal provider.
4. Successfully approved – you will need financial advice about the taxation implications for the payment of the benefit and complete forms for your fund indicating what you wish to do with the TPD amount. You can choose to:

1. • Take the TPD amount from your fund.

• • Take the TPD amount and your account balance under the provisions of permanent incapacity.

• • Have the TPD amount transferred to your account balance.

5. Claim rejected – your legal specialist will review the decision and discuss with you the options available to obtain further evidence, provide submissions or dispute the decision of the Insurer.

We hope the above assists in your understanding of the processing

We hope the above assists in your understanding of the processing of a TPD claim. If you would like further assistance, please contact Garling and Co at (02) 9329 9500 or email us at info@garlingandco.com.au.