TPD Claim Process in Australia: Steps, Timing and Appeals

A TPD claim starts with a call to your super fund or insurer, not with a form. You tell them you intend to claim, they send a claim kit, you and your doctors complete it, and the insurer assesses whether you meet the policy's definition of total and permanent disability. Under current AFCA guidance, insurers are expected to decide within 6 months of the claim starting, unless an exception applies. The step that most often decides the outcome is the policy definition, so this guide starts there.

TL;DR

• TPD cover pays a lump sum if illness or injury leaves you permanently unable to work. Most people hold it inside super, so the claim usually runs through your fund.
• Your result depends on your policy's definition (own occupation, any occupation or daily living activities), not on how unwell you feel.
• Expect a waiting period (often three consecutive months off work), medical evidence and possibly an examination by a doctor the insurer chooses.
• AFCA expects a decision within 6 months, progress updates every 20 business days and written notice within 15 business days of receiving all assessment information.
• A decline is not always final: ask for written reasons, use the fund's internal review, then take it to AFCA.

Table of Contents

• What a TPD claim actually is
• Step 1: Check whether you have TPD cover
• Step 2: Understand the conditions you must meet
• Step 3: Notify your fund or insurer
• Step 4: Complete the claim forms and gather evidence
• Step 5: Submit and respond to requests
• How long does a TPD claim take?
• What happens after assessment
• If your claim is declined or delayed
• Our perspective: claim well by preparing early
• Getting help with your TPD insurance and claim
• FAQ
• Sources

What a TPD claim actually is

Total and permanent disability (TPD) insurance pays a lump sum if an illness or injury leaves you permanently unable to work. It is different from income protection, which replaces part of your income while you recover, and different from workers' compensation or Centrelink payments.

A claim is the formal request to your insurer, usually through your super trustee, to pay that lump sum. The insurer does not simply accept your word or your doctor's. It tests your circumstances against the wording of the policy.

That is why two people with the same condition can get different outcomes. One may be covered under a policy that asks whether they can return to their own job. Another may be under a stricter policy that asks whether they could do any work suited to their education, training and experience.

Step 1: Check whether you have TPD cover

Before anything else, find out what you hold. Moneysmart says to check the product disclosure statement (PDS) or contact your insurer or super fund if you have questions about the policy. It also notes that default cover in super may be cheaper but might not match your needs.

Look for:

• Where the cover sits. Inside one or more super funds, or a policy held outside super.
• The definition. Own occupation, any occupation, or activities of daily living (ADL). Moneysmart notes definitions vary between insurers.
• The amount of cover and any conditions on it.
• Multiple funds. If you have had several jobs, you may have cover in more than one account. Ask each fund.

If you are still working and reading this as a precaution, our guide to TPD insurance in super explains how the cover works before you ever need to claim.

Step 2: Understand the conditions you must meet

Requirements differ by policy, but common threads appear in fund claim kits. According to the Super SA TPD claim kit, you generally need to satisfy the policy's definition and be under the care of a medical practitioner. You typically must have been unable to work for a consecutive waiting period, often three months, because of injury or illness. The insurer must also be satisfied you are unlikely to ever work again in suited employment.

Two details that surprise people:

• The date of claim matters. MLC, for example, defines the date of claim for its Any Occupation TPD as the first day of the three consecutive months you were absent from your occupation due to injury or illness. The date can determine which policy terms apply.
• Not having worked recently changes the test. From 1 October 2025, MLC states that members who have not been in paid employment in the 16 months before the date of claim are assessed under the Any Occupation definition. That is one insurer's rule, not a universal one, but it shows why gaps in work history deserve a conversation before you lodge.

Catholic Super's handbook notes that the fund works out which policy and definitions apply based on the date of disablement. You do not have to work this out alone, and you should not guess.

Step 3: Notify your fund or insurer

Contact your super fund (or insurer, if the policy is held outside super) as soon as it looks likely you will claim. Most funds have a claims team and a dedicated phone line, and many have an online notification form. Give them:

• Your name, member number and contact details.
• A short description of your illness or injury.
• The date you last worked, or the date you stopped working in your usual capacity.
• Your last occupation and employer.

Ask them to confirm in writing which cover you hold, which definition applies and whether the waiting period has been met. Keep a log of every call: date, time, who you spoke with and what was said. It becomes useful if there is a delay later.

Notifying early does not commit you to anything. It starts the clock on paperwork and lets the fund tell you what it will need. Late notification can cause problems, because policies often contain time limits for giving notice, which your PDS will set out.

Step 4: Complete the claim forms and gather evidence

The fund sends a claim kit. It generally has a member section, a section for your treating doctor and an employer section. Complete your part honestly and in full, and make sure the details match what your doctors and employer will say. Inconsistencies slow claims down.

What insurers typically ask for:

• Medical records. Mercer Super says it typically requires records from around the time you stopped working or became unable to work, plus documents on ongoing treatment.
• Reports from your treating doctors and specialists. These should address not just the diagnosis but what you cannot do and why recovery is unlikely.
• Employer information. Catholic Super says it may seek details from employers about your employment status and role.
• Independent examinations. The same handbook says the fund may require additional tests or opinions from doctors of its choice.

Practical tips from our experience of how these claims go wrong at the paperwork stage:

1. Ask your doctor to describe your functional limits in plain terms (sitting, standing, concentrating, lifting), not just the diagnosis.
2. Make sure the treatment history is complete. Gaps invite questions about whether you have exhausted options.
3. Keep copies of everything you lodge.
4. Answer every question in the kit, even if the answer is "not applicable".

Step 5: Submit and respond to requests

Lodge the completed kit with the fund by the method it specifies, whether online, by post or through your adviser. After that, the trustee typically gathers information from your doctors and employer and passes the file to the insurer for assessment. Respond to requests quickly. AFCA's approach to delay looks at who caused it, so a claimant's late reply can weigh against an otherwise fair complaint about speed.

If you are asked to attend an examination, go, and take a list of your symptoms and medications. If you cannot attend, tell the insurer and rebook rather than ignoring it.

How long does a TPD claim take?

There is no fixed timeframe in the policy itself, but there is a regulatory benchmark. AFCA's approach to delayed claims (published May 2025) sets these expectations:

Complex claims, such as those needing several specialist reports, can run to the long end. Slow responses from doctors or employers are a common cause, and AFCA considers whether the delay was caused by the firm, the claimant or third parties like medical practitioners.

If you are approaching the 6-month mark without a decision, write to the trustee asking for a status update and the reason for the delay. Keep that letter. It is the basis of any complaint.

What happens after assessment

There are three outcomes: approved, declined, or approved on different terms (for example, under a different definition than you expected).

If approved, the lump sum is paid to your super account or, where you meet a condition of release, may be paid out to you. Because tax and Centrelink treatment can depend on how the payment is made and your circumstances, speak with a licensed financial adviser and tax professional before you decide what to do with it.

If declined, do not accept it as final without understanding why. ASIC's review of TPD claims, Report 633 (October 2019), found that decline rates under specific Any Occupation definitions varied significantly, with some groups declined more often than others. That is a reason to scrutinise a decision, not proof yours is wrong.

If your claim is declined or delayed

1. Ask for the decision and reasons in writing, along with the definition the insurer applied and the evidence it relied on.
2. Compare the reasons with your policy wording. Was the right definition used? Did the insurer rely on an outdated medical report?
3. Use the fund's internal dispute process. Your fund must have one and the decision letter should explain it.
4. Lodge a complaint with AFCA if you remain unsatisfied or the claim is delayed. AFCA assesses whether a delay is unreasonable or unfair. It may also review a later decision to decline even if it excluded a delay complaint.
5. Get specialist help. A claims lawyer, a financial adviser who understands your policy, or your fund's own claims officer can each play a role. Check any fee arrangement before you sign.

Our perspective: claim well by preparing early

Most people meet TPD insurance for the first time on their worst day, and that is when the definition they never read becomes the most important sentence in their financial life. In our work with pre-retirees, professionals and business owners, three patterns come up repeatedly.

First, default cover in super is rarely a deliberate decision. Members often hold it in several accounts, with different definitions and no idea what each pays. A review while you are well is cheap. A discovery during a claim is not.

Second, the definition matters more than the sum insured. A large benefit with a narrow definition can be harder to collect than a smaller one with a friendlier definition. If you work in a specialised occupation, such as medicine, dentistry or a trade, an own-occupation style definition may suit your situation better, though availability inside super is limited and depends on the policy.

Third, a claim sits inside a wider plan. A lump sum affects your super balance, your retirement timeline and, in some cases, Age Pension entitlements. We would rather talk to you about that before a claim than after a payout arrives.

We also encourage clients not to carry a claim alone. Help is available from the fund, an adviser and, when needed, AFCA. Leaning on it is sensible, not a sign of weakness.

— Adam

Getting help with your TPD insurance and claim

We are a Melbourne-based financial planning firm and we work with clients across Australia. If you want to understand what TPD cover you hold, whether it suits you, or how a claim sits within your retirement plans, we can review your policies and explain your options. See our TPD insurance claims support or our wider personal insurance advice. If you are weighing up life cover inside super at the same time, our piece on whether to keep, top up or move life cover from super is a good starting point.

FAQ

How long does it take to get a TPD payout?

AFCA's guidance expects insurers to decide a claim within 6 months unless an exception applies. It also expects written notice within 15 business days of the insurer receiving all the information it needs. Delays in medical or employer reports can extend this.

What are the conditions for a TPD claim?

You generally need to meet your policy's TPD definition and be under the care of a medical practitioner. You typically must also have been unable to work for a waiting period, often three consecutive months. The insurer must be satisfied you are unlikely to work again in suited employment.

Do I need a lawyer to make a TPD claim?

Not necessarily. The claim starts with your super fund or insurer, and the fund's claims team can explain the forms. Some people seek legal or adviser help for complex or declined claims. Check any fee terms carefully before agreeing.

Can I claim if I have not worked for a while?

It depends on your policy. MLC states that from 1 October 2025, members who have not worked in paid employment for 16 months before the date of claim are assessed under its Any Occupation definition. Other insurers have their own rules, so check your PDS or ask your fund.

What can I do if my TPD claim is declined?

Ask for the reasons in writing, review them against your policy wording and use your fund's internal dispute process. If that does not resolve it, you can complain to AFCA, which can review both delays and decline decisions.

Sources

• Total and permanent disability (TPD) insurance, Moneysmart
• The AFCA approach to delayed insurance claims in superannuation
• Making a TPD claim, Super SA claim kit
• TPD definition changes from 1 October 2025, MLC
• Making a total and permanent disablement (TPD) claim, Catholic Super
• Claiming TPD insurance FAQs, Mercer Super
• ASIC Report 633: Holes in the safety net

Recommended

• TPD insurance in super: how it works and how to claim
• Tpd Insurance Claims
• Tpd Insurance
• Life, TPD, Trauma & Income Protection Insurance

This article is general information, not a substitute for advice from a qualified financial advisor. Consult a qualified financial professional about your own circumstances before acting on anything here. General Advice Warning Disclaimer: The information on this website is general information only and is not intended to be a recommendation. We strongly recommend you seek advice from your financial adviser as to whether this information is appropriate to your needs & financial situation.