Superannuation, TPD and income protection claims in Queensland.
Claims under superannuation fund insurance for total and permanent disability, terminal illness and income protection.
Many Australians have insurance within their superannuation fund. Many do not know the details of the cover they hold.
What each type of cover pays, and when, depends on the policy and the trust terms in force at the relevant date. Total and permanent disability cover generally pays a lump sum where the member meets the policy’s disability definition, which may be an own occupation, any occupation, activities of daily living or another test. Income protection cover generally pays a proportion of pre-disability earnings for a defined period while the member meets the policy’s incapacity test. Terminal illness cover can accelerate a death benefit where the member meets the policy’s terminal illness definition. These policies sit within the superannuation account, sometimes without the member being aware they are there at all.
A claim is assessed by the insurer under the policy terms, with the trustee involved because the cover is held through the fund. There is no court hearing in the first instance. If a claim is declined, a complaint is usually made to the trustee under its internal dispute resolution process, and the trustee considers the insurer’s decision. The maximum response period set by ASIC Regulatory Guide 271 is generally 45 days, or 90 days for a complaint about the distribution of a death benefit. If the complaint is not resolved, an eligible complaint may be taken to the Australian Financial Complaints Authority (AFCA), which makes binding determinations in its superannuation jurisdiction. Court is not automatically the next step; whether it is available depends on the nature of the decision and separate advice.
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.
When you can make a claim.
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. For a consumer insurance contract, s 20B imposes a duty to take reasonable care not to make a misrepresentation; the s 21 duty of disclosure applies to contracts that are not consumer insurance contracts.
- 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). Governs legal costs and costs disclosure. Disclosure is tiered: it may be unnecessary under s 307A, abbreviated under s 307B or detailed under s 308, and is required before or as soon as practicable after the firm is retained under s 310. A conditional costs agreement is governed by ss 322 to 324, and s 347 caps claim-related costs in a speculative personal injury claim.
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.
A policy may require a waiting period of continuous inability to work before a claim can be made, and the length of that period is set by the policy. Waiting longer than necessary once any qualifying period has passed can mean income protection benefits are not being claimed while they accrue. The assessment of a TPD claim can take time, and 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.
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.
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 may involve an independent medical examination arranged by the insurer and, for a TPD claim, a vocational assessment where the policy requires it. We manage the process and advise on each step.
Step 5: Review if denied
If the claim is declined, we advise on the grounds and whether to make a complaint through the trustee's internal dispute resolution process. If that process does not resolve the dispute, an eligible complaint can be taken to AFCA, which is free for the consumer.
Step 6: Resolution or proceedings
AFCA can resolve a complaint without court proceedings and makes binding determinations in its superannuation jurisdiction. Court is not automatically the next step if a complaint is unresolved; whether it is available depends on the nature of the decision and separate advice. We advise on the merits and, if proceedings are filed, we run them.
Questions we hear often.
Plain-English answers to the questions clients tend to ask. If your question is not here, call us.
Get in touchDo 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 cover generally pays a lump sum where the member meets the policy’s total and permanent disability definition, which may be an own occupation, any occupation, activities of daily living or another test. Income protection cover generally pays a proportion of pre-disability income for a defined period while the member meets the policy’s incapacity test; the percentage and benefit period are set by the policy. 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?
There is no fixed assessment period. The time taken varies with the policy terms, the medical and vocational evidence required, and the insurer’s process. The policy may impose a waiting period before a claim can be made, and a TPD claim in particular may require detailed medical and vocational evidence. We provide a written timeframe estimate at engagement once the policy terms are reviewed, rather than relying on a general figure.
What if my claim is denied?
A complaint is usually made to the trustee under its internal dispute resolution process, and the trustee considers the insurer’s decision. The maximum response period set by ASIC Regulatory Guide 271 is generally 45 days, or 90 days for a complaint about the distribution of a death benefit. If the complaint is not resolved, an eligible complaint may be taken to AFCA, which is free for the consumer and makes binding determinations in its superannuation jurisdiction. Court is not automatically the next step; whether it is available depends on the nature of the decision and requires separate advice. We advise at each stage on the merits of continuing.
Will I have to attend a medical examination?
An insurer may require a medical examination as part of its assessment, in addition to the treating medical evidence supporting the claim, depending on the policy and the issues in the claim. Where that occurs, we coordinate the medical evidence, correspond with the insurer, and 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.
Personal injury claims in Queensland run to strict time limits. Some apply within months of the injury or accident, the limits differ by claim type, and a few, such as hit-and-run claims against the Nominal Defendant, cannot be extended.
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.
Visit us in Bundall.
Five minutes from Surfers Paradise, ten from Robina. On-site parking. Talk to us about your matter; we will tell you what we think and what the next step is. More about our lawyers in Bundall. Injured in a car accident near Southport? See car accident lawyer, Southport.
- Office86 Bundall Road, Bundall QLD 4217
- Phone(07) 5554 6116
- Email[email protected]
- HoursMonday to Friday, 8:30am to 5:00pm