TPD claims through super: how to check if you are covered

Most Australians with a super account hold total and permanent disability (TPD) insurance without ever choosing it, because funds provide default cover. If an injury or illness means you are unlikely to work again, that cover can pay a lump sum, whatever caused the injury and whoever was at fault. Many people never claim because they do not know the cover exists. This post shows how to check, what the policy definition means and how to make the claim.

The short answer

Look at every superannuation statement you have received, including from funds you have left, for an insurance section showing TPD cover. Ask each fund for the insurance certificate and the product disclosure statement. The claim succeeds if you meet the policy’s definition of total and permanent disability, usually that you are unlikely ever to work again in your own or any suited occupation. Fault is irrelevant. A declined claim can go to the fund’s complaints process and then to AFCA.

Step 1: find the cover

TPD cover can sit inside super through your fund, or outside super directly with an insurer (Moneysmart). Inside super it is often default cover you were given on joining. To check:

• Read the insurance section of each fund’s annual statement.
• Log in to each fund’s member portal and look for “insurance”.
• Ask each fund in writing whether you held TPD cover on the date you last worked, and for the policy terms.
• Check old funds. If you changed jobs, you may have cover in a fund you have not touched for years, provided the account stayed active and premiums were being paid.

The date you stopped work matters, because cover must have been in force then. Inactive or low-balance accounts can have insurance switched off, so ask when cover ended.

Step 2: read the definition

Moneysmart describes the three definitions insurers use. “Own occupation” pays if you are unlikely ever to work again in your own or a similar job. “Any occupation” pays only if you are unlikely ever to work in any job suited to your education, training or experience, a higher bar. “Activities of daily living” pays if you are permanently unable to perform basic self-care tasks without help, the highest bar (Moneysmart). Default cover in super is usually “any occupation”. The product disclosure statement also sets waiting periods, exclusions for pre-existing conditions and when cover stops.

Definition	Test	Typical use
Own occupation	Unlikely to work again in your own or a similar job	Retail policies, some professional cover
Any occupation	Unlikely to work again in any job suited to your education, training or experience	Most default super cover
Activities of daily living	Permanently unable to perform basic self-care tasks without assistance	Some default cover for older members or high-risk occupations

Step 3: make the claim

1. Notify the fund that you intend to claim. The fund refers it to the insurer.
2. Complete the claim forms: your statement, an employer statement and treating doctor reports.
3. Attend any independent medical examination the insurer arranges.
4. Respond to requests for information in writing and keep the dates.
5. Wait for the decision, often several months, while continuing treatment.

Insurers assess the claim against the definition on the evidence. Consistent treating doctor reports about your capacity for any suited work, and a clear account of your skills and training, matter more than the number of reports.

What the insurer looks for

TPD claims are decided on paper, so the paper has to say the right things. Insurers assess four areas.

Treating doctor evidence. Your GP and specialists are asked whether, in their opinion, you are unlikely ever to return to work within the policy definition. Reports that describe your diagnosis, treatment, prognosis and functional limits in detail, and that are consistent over time, carry the claim. Reports that only list appointments do not.

Work history and skills. Under an “any occupation” definition the insurer considers every job your education, training and experience suit. A short, honest account of your qualifications, the jobs you have held and what each involved lets the assessor see why a desk job, for example, is not realistic for a rigger with a spinal injury and no computer skills.

Treatment and rehabilitation. Insurers look for a stabilised condition, reasonable attempts at treatment and, where relevant, retraining. Gaps in treatment are read as capacity. If you have stopped treatment because it was not helping, ask your doctor to record why.

Independent medical examinations. The insurer may send you to its own specialist. Attend, answer accurately, do not minimise or exaggerate, and make a note afterwards of what was asked and how long it took. A support person can usually attend.

Keep a copy of every form and report you submit, respond to requests in writing and record the dates. If the insurer takes months without a decision, ask in writing for a timeframe; unreasonable delay is itself a matter AFCA can consider (AFCA).

The tax and timing trap

Moneysmart warns that a TPD payout may be taxed at up to 22% if you are under 60, so the amount you receive may not match the cover on your statement (Moneysmart). How and when you withdraw the benefit from super affects the tax, so get advice before withdrawing rather than after.

If the claim is declined

Use the fund’s internal complaints process first. If that fails, the Australian Financial Complaints Authority considers superannuation complaints, including declined disability claims and unreasonable delay; there are no monetary limits, but specific time limits apply to some superannuation complaints (AFCA). Lawyers who work in super and insurance claims are most useful when the evidence was not presented against the right definition, when a pre-existing condition exclusion is relied on or when more than one fund is involved.

TPD alongside other claims

TPD does not depend on fault, so it runs beside a workers compensation claim, a car accident claim or a negligence claim. Tell every adviser about every claim, because some benefits offset others.

Frequently asked questions

Do I have to be totally unable to do anything? No. Under an own or any occupation definition the test is about work, not self-care. Only the activities of daily living definition is that strict.

Can I claim for a mental illness? Yes, if the policy covers it and you meet the definition. Psychiatric evidence from treating specialists is central.

Is there a deadline? No single statutory limit, but policy conditions, super rules and complaint time limits apply, and the evidence of your capacity at the time you stopped work fades. Start early.

Can I claim from two funds? Yes, if you held cover in both when you stopped work. Each is assessed on its own policy.

This article is general information, not legal or financial advice, checked on 26 September 2026. An enquiry with Australian Claim Helpline does not lodge a claim or pause a time limit; the TPD guide has more.

General information published 26 September 2026. It is not legal advice and may not reflect later changes to the law or a scheme. Check your own position with a qualified adviser.

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