When can a Total and Permanent Disablement (TPD) claim be assessed?
When and how TPD must be established depends on a proper construction of the definition of “total and permanent disablement” which must be made in the context of the relevant insurance policy and trust deed. This issue can be complicated as some definitions are capable of more than one construction. The date of assessing TPD can therefore vary depending on the definition, for example:
- the date of injury;
- the last date of work;
- the date of termination of employment;
- the date after 6 months of being out of work;
- the date the claim was lodged; or
- the date on which the medical evidence was assessed by the primary decision maker.
In many cases it is too soon to assess the permanent effects of an injury or illness at the 6 month mark from the date of injury. Medical practitioners are often reluctant to make a determination that an injury has reached maximum medical improvement (MMI) or stabilised until at least 12 months from the date of injury. In some cases the time frame can be greater.
The key point for potential claimants is to seek early advice once they have sustained an injury. While it may be uncertain as to whether there will be an injury sufficient to trigger eligibility for a lump sum TPD payment, it is vital that investigations are made to determine the correct definition and therefore the eligibility criteria should a claim need to be pursued.
If an insurer has made a decision ignoring evidence after the date identified in the relevant definition you should urgently obtain legal advice to dispute that decision.
Given the technicalities involved in pursuing a TPD claim you should obtain legal advice as soon as possible following injury to maximise your prospects for a successful outcome. In many cases, injured people anticipate a full recovery and it is only after a period of time that they become aware (or accept) that they have significant injuries. It is important to pursue these claims promptly from the outset.
If you have a TPD claim, contact us on 8523 8400 (Gawler) or 8211 6500 (Adelaide) to arrange an appointment for an initial no obligation consultation with one of our Injury Lawyers. Alternatively, send an email to email@example.com and we will contact you.