Super, TPD and income protection

Superannuation, TPD and income protection claims in Queensland.

Claims under superannuation fund insurance for total and permanent disability, terminal illness and income protection.

Most Australians have insurance within their superannuation fund. Most do not know the details of the cover they hold.

Total and permanent disability cover pays a lump sum where the member is permanently disabled and cannot return to work. Income protection cover pays a proportion of pre-disability earnings for a defined period while the member is unable to work. Terminal illness cover accelerates a death benefit where the member has a limited life expectancy. These policies sit within the superannuation account, sometimes without the member being aware they are there at all.

The claim is made against the insurer under the policy terms. There is no court hearing in the first instance. Where a claim is denied, as many initially are, internal review through the trustee is the first step, followed, if needed, by the Australian Financial Complaints Authority (AFCA), and then, in some cases, court proceedings.

Fraser Lawyers acts for individuals across Queensland in these claims. The principal is Blake Fraser, admitted as a solicitor of the Supreme Court of Queensland in 2013.

Process

What happens after you are charged.

The framework that applies to superannuation insurance claims:

Superannuation Industry (Supervision) Act 1993 (Cth). The principal Commonwealth statute governing superannuation funds. Establishes the trustee duties that govern how a fund processes a claim.
Insurance Contracts Act 1984 (Cth). Sets the rules for insurance contracts in Australia, including the duty of utmost good faith and disclosure obligations.
Corporations Act 2001 (Cth). Governs the conduct of financial services providers (including superannuation trustees) and the dispute resolution framework, including access to AFCA.
Australian Securities and Investments Commission Act 2001 (Cth). Consumer protection rules that apply to financial services and products, including unconscionable conduct and misleading representations.
Limitation of Actions Act 1974 (Qld). Time limits for actions against insurers depend on the contract terms; we explain the position on the first call.
Legal Profession Act 2007 (Qld). Section 308 requires written costs disclosure before any work begins.

Time limits

Deadlines and risks.

Superannuation insurance claims do not have a single notice deadline in the way CTP and public liability claims do. But delay creates its own risks.

Most TPD policies require a specified waiting period, often three to six months of continuous inability to work, before the claim can be made. Waiting longer than necessary once the qualifying period has passed means income protection benefits are not being claimed while they accrue. TPD claims can take six to twelve months or longer to assess; the earlier the claim is lodged, the earlier the assessment begins.

Where a cover is attached to a superannuation account that has been inactive for some time, the cover may have lapsed. Establishing that the cover was in force at the relevant time is a question that needs to be answered early. We do this on the first call.

What we do

How Fraser Lawyers acts in these matters.

We do not make extravagant promises about outcomes. No competent lawyer should.

We establish what cover is held across all superannuation accounts. We review the policy terms, including the definition of total and permanent disability or the income protection benefit structure, and advise on whether the circumstances satisfy the test. We prepare the claim documentation, coordinate the medical evidence, and correspond with the insurer through the assessment process.

If a claim is denied, we advise on the grounds, assess whether internal review is viable, and, where warranted, run the AFCA process or court proceedings against the trustee or insurer.

Pathway

The likely path.

Step 1 — Initial call

You call or send a short enquiry. We establish the nature of the injury or illness, the period of incapacity, and any superannuation funds or insurance policies that may be relevant.

Step 2 — Cover identification

We identify what insurance cover is held across all superannuation accounts, including accounts from previous employment that may have been overlooked. Each policy is reviewed for the relevant definitions and conditions.

Step 3 — Claim preparation

We prepare the claim documentation: the claim form, the medical evidence, the vocational evidence where the policy requires it, and any other material the insurer requires under the policy terms.

Step 4 — Insurer assessment

The insurer assesses the claim. This typically involves independent medical examinations arranged by the insurer and, for TPD claims, a vocational assessment. We manage the process and advise on each step.

Step 5 — Review if denied

If the claim is denied, we advise on the grounds and whether internal review is appropriate. If the internal review does not resolve the dispute, the claim can be taken to AFCA, which is free for the consumer.

Step 6 — Resolution or proceedings

Most disputes resolve at AFCA. If the matter is not resolved at that stage, court proceedings against the trustee or insurer are the next step. We advise on the merits and, if proceedings are filed, we run them.

Frequently asked

Questions we hear often.

Plain-English answers to the questions clients tend to ask. If your question is not here, call us.

Get in touch

Do I know what insurance my super fund provides?

Often not. Many people do not know they have TPD, terminal illness or income protection cover through superannuation, and many have multiple policies across different accounts from different periods of employment. Establishing what cover is held is the first step in any claim. We do this with you on the first call. If you are unsure what accounts you hold, the ATO’s myGov service can identify accounts linked to your tax file number.

What is the difference between TPD and income protection?

TPD pays a lump sum where the member is permanently disabled and cannot return to work. Income protection pays an ongoing benefit, typically up to 75% of pre-disability income, for a defined period while the member is unable to work. Both are claimed through the policy held within or alongside superannuation; the eligibility tests differ, and the policy terms vary between funds.

How long does a claim take to be assessed?

TPD claims typically take six to twelve months to assess, sometimes longer. The policy usually requires a specified waiting period before the claim can be made and extensive medical and vocational evidence. Income protection claims can be assessed faster but pay over time. We provide a written timeframe estimate at engagement once the policy terms are reviewed.

What if my claim is denied?

Internal review through the trustee is the first step. If the claim remains unresolved, it can be taken to AFCA, which is free for the consumer. If AFCA does not resolve the dispute, court proceedings against the trustee or insurer are possible. We run files through this sequence as required and advise at each stage on the merits of continuing.

Will I have to attend a medical examination?

Most TPD and income protection claims involve a medical examination arranged by the insurer, in addition to the treating medical evidence supporting the claim. We coordinate the medical evidence on your side. You do not chase doctors or the insurer. We explain what each report says and what it means for the claim.

Can I claim TPD or income protection if I am also receiving WorkCover benefits?

Yes. TPD and income protection claims through superannuation insurance are separate from workers’ compensation claims under the Workers’ Compensation and Rehabilitation Act 2003 (Qld). The two systems run in parallel. WorkCover provides statutory benefits and a possible common-law pathway against the employer; superannuation insurance pays under the policy terms based on the medical evidence. Some policies contain set-off clauses that reduce the superannuation benefit where workers’ compensation is also being received. Establishing the position on set-off is worth doing early. We do this on the first call.

Talk to Fraser Lawyers about your super, TPD or income protection claim.

An initial call or email is the fastest way to know whether we can help and what the next step looks like. Fraser Lawyers is based at 86 Bundall Road, Bundall QLD 4217. We answer the phone Monday to Friday, 8:30 to 5:00.

Send a brief Call (07) 5554 6116