Most Common TPD Claims in Australia

At a glance:

• Common TPD claims in Australia involve mental health conditions, cardiovascular events, cancer, sensory loss, limb loss, physical injuries and severe pregnancy-related complications.
• The overall TPD claim acceptance rate is approximately 86%, with outcomes varying depending on the policy’s disability definition.
• Successful claims typically require clear medical documentation, accurate completion of forms and an understanding of policy terms.

 

 

Total and Permanent Disability (TPD) cover is commonly included in Australian superannuation arrangements, yet many individuals are unsure which conditions may lead to a claim.

When an illness or injury affects a person’s ability to work, TPD cover can provide financial support. Understanding how TPD claims are typically assessed can help set clearer expectations about eligibility, claiming procedure and receiving payouts.

This article outlines the conditions most frequently associated with TPD claims in Australia and provides a brief context on overall claim trends, the general process for lodging a claim, and the common reasons claims may be declined.

 

 

The Most Common TPD Claims in Australia

 

Some medical conditions are more commonly linked to TPD claims than others. Below is an overview of the conditions most frequently associated with TPD assessments in Australia.

 

Mental Health Conditions

Mental health conditions are among the most common bases for TPD claims. Disorders such as anxiety, depression, Post Traumatic Stress Disorder (PTSD), and other psychological conditions can have a significant impact on work capacity, leading to claims.

Increasing awareness of mental health and broader acknowledgement of its effect on functional capacity have contributed to a higher visibility of these conditions within TPD assessments.

These conditions may affect concentration, decision-making, workplace interaction and the ability to sustain regular duties, which are key considerations when insurers evaluate long-term work incapacity under TPD policy terms.

 

Stroke or Heart Attack

Cardiovascular events such as strokes and heart attacks are frequently associated with TPD claims due to their potential to cause long-term functional impairment. The National Heart Foundation of Australia reports that more than 150 people are hospitalised due to a heart attack each day. These conditions can affect mobility, cognition and overall work capacity, which may lead individuals to lodge a TPD claim.

Eligibility for a TPD claim following a stroke or heart attack depends on the extent and duration of the impairment. Some individuals recover sufficiently to resume employment, while others experience long-term limitations that may prevent a return to their previous occupation or any suitable work.

 

Cancer

Cancer is another common TPD claim in Australia due to the significant impact the condition and its treatment can have on a person’s long-term work capacity. Individuals may experience fatigue, cognitive effects, and reduced physical endurance, which can limit their ability to perform their usual duties. Treatments, including surgery, chemotherapy, or radiation, may also contribute to extended periods away from work.

Many cases involving terminal or advanced-stage cancer may meet the criteria for TPD benefits, depending on the policy definition and supporting medical evidence. In TPD assessments, insurers consider the condition’s functional impact and the medical information provided.

 

Loss of Sight or Hearing

Loss of sight or hearing is a common basis for TPD claims in Australia due to the substantial impact these impairments can have on functional capacity and the ability to perform work-related tasks. They can affect a wide range of occupational duties, particularly in roles that rely heavily on sensory function, and may prevent an individual from continuing in their previous line of work.

These limitations are key considerations in TPD assessments, where insurers evaluate medical evidence and the long-term effect of the impairment on work capacity. Access to rehabilitation, adaptive technology and appropriate workplace support can assist individuals in managing the functional changes associated with vision or hearing loss.

 

Loss of Limb

Loss of limb caused by traumatic incidents is a recognised basis for TPD claims in Australia, as it can create substantial limitations in mobility, strength and functional independence. These changes may reduce a person’s capacity to perform tasks requiring mobility, strength or coordinated physical effort, which can impact employability across many occupations.

The claim outcome depends on whether the documented impairment satisfies the policy’s definition of total and permanent disability, based on medical and occupational evidence.

 

Physical Injuries

Physical injuries that result in permanent impairment are a recognised basis for TPD claims in Australia. Conditions such as spinal injuries, severe fractures, and other long-term musculoskeletal damage are commonly claimed for TPD benefits. These injuries may reduce functional capacity, limit a person’s ability to perform work-related tasks and affect suitability for certain occupations. 

For most TPD policies, the cause of the injury is less relevant than its long-term impact on work capacity. The key consideration is whether the injury limits the person’s capacity to work in occupations aligned with their skills and experience, as defined by the policy.

 

Pregnancy Complications

Severe pregnancy-related complications may be considered under a TPD policy if they result in a permanent impairment that meets the policy’s definition.

Conditions such as preeclampsia or complications arising from gestational diabetes can, in rare cases, lead to long-term health effects that limit a person’s capacity to return to their usual job or any other work they are reasonably suited for. These claims are assessed using medical reports, evidence that the condition is permanent, and the criteria outlined in the TPD policy.

 

Although the conditions listed above are among the most common reasons for TPD claims in Australia, a wide range of other injuries and illnesses may also be considered depending on their severity and permanence. These can include neurological disorders, chronic diseases and respiratory conditions such as multiple sclerosis, rheumatoid arthritis, and chronic obstructive pulmonary disease.

 

 

Success Rate of TPD Claims In Australia

 

Industry data published by the Australian Securities and Investments Commission (ASIC) indicates that the overall acceptance rate for TPD claims in Australia is approximately 86%. However, acceptance rates vary depending on the type of Total and Permanent Disability definition applied under the policy.

TPD policies generally assess claims under one of three definitions:

• Own occupation – the person is unable to return to the specific job they held before their illness or injury.
• Any occupation – the person is unable to work in any role reasonably suited to their skills, education or experience.
• Activities of daily living (ADL) – eligibility applies when a person cannot independently perform certain basic personal care tasks.

Policies using own-occupation or any-occupation definitions generally allow broader eligibility, while ADL-based definitions apply more restrictive functional criteria.

 

Read More: Own Occupation vs Any Occupation – Which TPD Insurance is Better for you?

 

 

How to Successfully Claim TPD

 

To improve the likelihood of a successful TPD claim, it is important to follow a structured process:

• Document medical evidence: Collect all relevant medical records, specialist assessments, and test results to support the disability claim.
• Understand your policy terms: Review your insurance policy carefully to know how “total and permanent disability” is defined.
• Complete claim documentation accurately: Fill out all forms correctly, sign required authorisations, and attach all supporting documents to avoid delays.
• Provide comprehensive supporting evidence: Include employment history, job descriptions, and relevant financial or work-capacity documentation along with medical reports.
• Maintain communication: Stay in contact with your insurer and provide additional information promptly if requested. This helps prevent unnecessary delays.

For a detailed, step-by-step walkthrough of the claim process, read our full guide on How to Claim TPD Successfully.

 

 

Why Do TPD Claims Get Rejected?

 

TPD claims may be declined for several reasons, often relating to gaps in evidence or the claimant not meeting the policy definition of total and permanent disability. Common reasons include:

• Insufficient medical evidence: The documentation does not clearly demonstrate a permanent impairment affecting long-term work capacity.
• Policy exclusions: The condition or circumstance falls within an exclusion clause outlined in the policy terms.
• Returning to work (even partially): Resuming work duties can indicate functional capacity inconsistent with the policy’s disability definition.
• Inaccurate or incomplete information: Missing forms, conflicting details, or administrative errors can impact the assessment.
• Late claim submission: Significant delays in lodging a claim may affect eligibility where timeframes are specified in the policy.
• Unclear inability to work: Evidence does not sufficiently show that the person cannot perform their usual role or other suitable employment.
• Occupation-related factors: Certain job classifications have specific assessment criteria, which may influence how disability definitions are applied.

For a detailed explanation of each factor and how assessment criteria operate in practice, see our full guide on Common Reasons for TPD Claim Denials.

 

Understanding the types of conditions, how claims are assessed, and the reasons for claim rejection can help set clearer expectations when considering a claim. Each policy defines total and permanent disability differently, and eligibility ultimately depends on the medical evidence provided and how the insurer applies those definitions.

Aspect Underwriting provides TPD cover within its Accident & Health portfolio, with defined policy terms and defined disability criteria to support consistent assessment outcomes. Individuals reviewing their TPD insurance arrangements may find it useful to refer to Aspect’s product information when considering whether this type of cover aligns with their requirements.

 

 

FAQs

 

What Is the Average Payout for TPD in Australia?

The benefit amount depends on the level of cover selected under the policy. Many TPD lump-sum payments typically fall within the range of $60,000 to $500,000. Higher insured amounts are also available, and some policies may provide benefits of $1.5–2 million or more, where greater cover has been maintained.

 

How long does a TPD claim take to be assessed?

Assessment timeframes vary between insurers, but many TPD claims take several months to complete. Additional time may be required if further medical information is needed, the condition is still stabilising, or multiple parties (such as superannuation funds, employers, or medical specialists) are involved in providing supporting documentation.

 

Can you receive TPD and continue to work in some capacity?

Whether a person can work after receiving a TPD benefit depends on the policy definition applied and the type of work performed. Some policies assess disability based on the inability to return to the person’s usual occupation, while others require an inability to work in any role suited to the person’s skills, experience or education. Policies using functional or ADL-based definitions have different assessment criteria. Individuals should review their policy wording to understand how post-claim work is handled.