EligibilityTPD Claims Are Assessed Against Your Policy
TPD claims are assessed against the particular definition contained in your insurance policy. The relevant circumstances can include your condition, its impact on your ability to work, your occupation and the evidence available to support your claim. That's something that can be difficult to determine without properly reviewing the circumstances of your claim — see Can I Claim TPD? for the fuller picture of how eligibility actually works. The real question isn't “Am I sick or injured?” — it's “Does my current situation meet the definition of TPD under my insurance policy?”
AssessmentWhat Is Considered When Assessing TPD Eligibility?
There isn't one simple test that applies to every TPD policy. Depending on the policy and your circumstances, relevant considerations can include:
Your Illness or InjuryThe nature and severity of your condition can be important, but the diagnosis itself is only part of the picture.
Your Ability to WorkThe insurer may need to consider how your condition affects your ability to perform work.
Your OccupationThe type of TPD definition contained in your policy can affect what work capacity is relevant.
Your PrognosisThe expected duration and permanence of your restrictions may be relevant to the claim.
Your Medical EvidenceYour treating doctors and specialists may provide evidence about your condition, restrictions and capacity.
Your PolicyThis is critical — TPD policies contain different definitions and requirements, which is why no online checklist can reliably tell you if you'll qualify.
ImportantImportant
Eligibility cannot be determined from your diagnosis alone. The relevant policy wording, your occupation, work capacity, medical evidence and individual circumstances all need to be considered together.
Does a Serious Diagnosis Mean I Qualify?
Not necessarily. A serious diagnosis can be relevant to a TPD claim, but insurers generally need to consider how the condition affects your capacity, rather than simply the name of the diagnosis. Two people with the same condition can have very different circumstances. One may remain capable of working, while another may have significant restrictions that prevent them from continuing their occupation — that's why the circumstances of each claim need to be considered individually.
Can I Qualify If I'm Still Working?
Possibly. Working doesn't automatically mean you cannot have a TPD claim. For example, a person may be working significantly reduced hours, performing different duties, unable to maintain their previous workload, taking substantial sick leave, or attempting a return to work in circumstances that are no longer sustainable. However, whether these circumstances satisfy your particular policy is a separate question. See Can I Claim TPD While Working? →
What If I Have More Than One Condition?
A TPD claim doesn't necessarily depend on having one particular illness or injury — in some circumstances, multiple conditions may affect a person's overall capacity. For example, someone may experience a combination of chronic pain and depression, PTSD and anxiety, multiple physical conditions, or neurological and psychological symptoms together. The important issue is the overall effect of the circumstances in relation to the policy. See TPD Claims With Multiple Conditions →
Understanding eligibilityWhy TPD Eligibility Can Be Difficult to Determine
This is where many people misunderstand TPD claims. You may look at your circumstances and think “I obviously can't work anymore, so I must qualify.” Or, just as commonly, “I'm still working, so I can't qualify.” Neither assumption is necessarily correct. The answer can depend on the policy wording, your individual circumstances and the evidence available — which is exactly why an initial assessment can be so valuable.