What a TPD claim actually requires
A Total and Permanent Disability (TPD) claim asks your insurer to pay out a lump sum because you cannot work again in any capacity. The insurer does not decide this based on your diagnosis alone. They decide it based on medical evidence, work history, age, and whether you have genuinely exhausted retraining options. Winning means building a file that answers the question: "Why can this person not do any work, ever?"
The threshold is high because the payout is permanent and large. You are not claiming temporary disability or income support. You are claiming that your condition is so severe that no reasonable employer would hire you for any job, and that you cannot retrain into something different. The insurer will scrutinize this claim, which is why the structure of your evidence matters as much as the evidence itself.
Key Takeaways
- TPD claims turn on medical evidence that shows your condition prevents you from working in any occupation, not just your old job.
- Your own doctor's opinion matters, but an independent medical examination (IME) ordered by the insurer will carry equal or greater weight.
- You must show you have tried work, retraining, or rehabilitation and that these attempts failed because of your condition, not lack of effort.
- A disability lawyer can organize your evidence, anticipate the insurer's objections, and negotiate or dispute a denial.
- The insurer has a legal duty to investigate fairly, but they are also looking for reasons to deny the claim, so your file must be airtight.
Gather medical evidence that addresses the insurer's questions
Start by collecting records from every doctor who has treated you since your condition began. This includes your GP, specialists, hospital admissions, mental health providers, and rehabilitation professionals. The insurer will request these anyway, but gathering them yourself first lets you spot gaps and organize them in a way that tells a coherent story.
The insurer is looking for answers to specific questions: What is your diagnosis? How severe is it? Is it stable or worsening? What treatment have you had? What is your functional capacity—that is, what can your body or mind actually do? A single letter from your GP saying "this person is disabled" will not answer these questions. Medical records that show test results, imaging, specialist assessments, and detailed notes about your limitations will.
Ask your treating doctors to write a report specifically addressing your work capacity. Do not ask them to say you are disabled; ask them to describe what you can and cannot do. Can you sit for eight hours? Can you concentrate? Can you lift? Can you work around other people? Can you follow instructions? The more concrete and specific the answer, the harder it is for the insurer to argue that you could do some other job.
Document your work history and attempts to return to work
The insurer will want to know: What did you do before? Why did you stop? Have you tried to work since? If you have not tried to work, they will argue you have not proven you cannot. If you have tried and failed, that failure must be clearly linked to your condition, not to other factors like job market conditions or lack of motivation.
Keep a detailed record of any work you have attempted since becoming ill or injured. Include dates, the type of work, how long you lasted, and specifically what symptoms or limitations forced you to stop. If you worked part-time or in a reduced capacity, document that too—it shows you tried to accommodate your condition and still could not sustain it. If you have not worked, be prepared to explain why: Are you housebound? Do you have severe pain that makes sitting impossible? Does your condition make it unsafe for you to be around others?
If you have attended rehabilitation, retraining programs, or vocational assessments, collect those records as well. The insurer wants to see that you have genuinely explored other options. If a retraining program told you that you could not complete it because of your condition, that is powerful evidence. If you completed a program but could not find work because employers would not hire you due to your disability, that also matters.
Understand what the insurer's independent medical examination will test
Once you lodge a claim, the insurer will almost certainly order an independent medical examination (IME). This is a doctor they choose, not your doctor. The IME doctor will review your medical records, examine you, and report to the insurer on whether you meet the TPD definition in your policy.
The IME is not your opportunity to convince the doctor you are disabled. It is a formal assessment. You should attend, answer questions honestly, and do not exaggerate or minimize your symptoms. The doctor will note inconsistencies between what you say and what your medical records show, and the insurer will use those inconsistencies to deny your claim. If you say you cannot walk but your records show you walked a mile last week, the IME report will flag that contradiction.
Before the IME, review your medical records and be clear in your own mind about what you can and cannot do on a typical day. If your condition fluctuates, explain that to the IME doctor. If you have good days and bad days, say so. If you can do something for five minutes but not for five hours, say that. The IME doctor is trained to spot malingering, but they are also trained to recognize genuine disability. Consistency and honesty serve you better than any strategy.
Organize your claim file in the order the insurer will review it
Do not send the insurer a box of loose documents. Organize your file in a logical order that tells the story of your condition and your inability to work. A typical structure is:
- A cover letter summarizing your claim and the documents enclosed
- Your policy document, with the TPD definition highlighted
- A chronological medical summary: diagnosis, treatment, current status
- Medical records in date order, starting with the earliest
- Specialist reports and assessments
- Your work history and attempts to return to work
- Rehabilitation or retraining records
- A statement from you describing your daily life and why you cannot work
The insurer will have a claims officer assigned to your file. That officer will read your documents in order. If your evidence is scattered and hard to follow, the officer may miss important details or conclude that you have not provided enough information. If your evidence is organized and clear, the officer can see the full picture.
Anticipate and address the insurer's likely objections
Insurers deny TPD claims for predictable reasons. Knowing these reasons lets you build a file that preempts them. Common objections include: your condition is not as severe as you claim; you have not tried hard enough to work; your medical evidence is inconsistent; you could do sedentary work even if you cannot do physical work; your condition may improve; or you are not following medical information.
If your medical records show you have not seen a doctor in two years, the insurer will argue your condition is not as serious as you claim. If you have seen a doctor regularly, that strengthens your file. If your records show you have tried work multiple times and failed each time, that addresses the "you haven't tried" objection. If your doctors have assessed your functional capacity and concluded you cannot work in any occupation, that addresses the "you could do sedentary work" objection.
A disability lawyer can review your file and identify gaps before you send it to the insurer. They can ask you to obtain additional medical evidence, clarify your work history, or provide a detailed statement addressing specific objections. This preparation often makes the difference between a claim that is denied on first review and one that is approved.
Know when to dispute a denial or negotiate a settlement
If the insurer denies your claim, you have options. You can request an internal review, where a different officer at the same insurer examines the decision. You can lodge a complaint with the Australian Financial Complaints Authority (AFCA) if you are in Australia, or the equivalent body in your jurisdiction. You can also pursue a legal dispute, either through negotiation or court.
A lawyer can review the insurer's reasons for denial and tell you whether those reasons are sound or whether the insurer has misapplied the policy or the law. Sometimes a denial is based on a misunderstanding that a lawyer's letter can correct. Sometimes the insurer has straightforward ignored medical evidence that supports your claim. In other cases, the denial is defensible but negotiable—the insurer might agree to a partial payout or a staged settlement rather than fight the claim in court.
The cost of disputing a denial varies. Some lawyers work on a no-win-no-fee basis for TPD claims, meaning they take a percentage of the payout if you win and nothing if you lose. Others charge hourly or fixed fees. Understanding the cost structure before you hire a lawyer helps you decide whether to pursue a dispute.
Frequently Asked Questions
Can I win a TPD claim if I have not tried to work since becoming disabled?
It is harder, but not impossible. If your condition is so severe that attempting work would be dangerous or would cause serious harm, you do not have to prove you tried. Your medical evidence must show this clearly. If your condition is severe but work might be possible, the insurer will expect you to have tried, and your failure to try will weigh against your claim.
What if my doctor says I am disabled but the insurer's doctor says I am not?
This disagreement is common and does not automatically mean you lose. The insurer will weigh both opinions, but they will also consider the detail and reasoning behind each. If your doctor has treated you for years and the insurer's doctor saw you once, your doctor's opinion may carry more weight. A lawyer can argue this point and, if necessary, obtain a third medical opinion from a specialist.
How long does a TPD claim take to decide?
The insurer must investigate and make a decision within a timeframe set by law or by the policy. This is typically 90 days, but can be extended. If the insurer delays unreasonably, a lawyer can pressure them to decide or lodge a complaint with the regulator. Once denied, an internal review or AFCA complaint can take several months.
Do I have to disclose information that might hurt my claim?
Yes. You have a legal duty to disclose all material information to the insurer, even information that weakens your claim. If you hide information and the insurer later discovers it, they can deny your claim or cancel your policy. Honesty, even when it is uncomfortable, is the only safe strategy.
What should I tell the insurer's doctor during the IME?
Tell the truth. Describe your condition as it actually is, on an average day. If you have symptoms that come and go, say so. If you can do something for a short time but not for long, say that. Do not exaggerate or minimize. The IME doctor will compare what you say to your medical records, and consistency will help your claim more than any attempt to persuade.