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TPD Eligibility

Am I Eligible for a TPD Claim? The 4-Question Test

If you answer yes to all four questions below, you almost certainly have a TPD claim worth lodging. The whole test takes under a minute.

TPD eligibility in Australia comes down to four questions. We've ordered them by how often they're the reason a claim fails, so the easiest disqualifiers come first.

Question 1: Did you have super when you stopped work?

Almost every Australian who has had a job since 1992 has held super, and most super funds attach default TPD insurance to member accounts. If you were an active fund member at the time you stopped work due to illness or injury, you almost certainly held some level of TPD cover.

How to check:

  • Log into your super fund's member portal — TPD cover is shown under "Insurance"
  • Check your annual super statement (the row labelled "TPD" or "Total & Permanent Disablement")
  • Search MyGov > ATO > Super to see all funds you've held

If you held more than one fund, each one is a separate potential claim. Don't consolidate or roll over funds before checking — doing so usually cancels the insurance.

Question 2: Did you stop work because of illness or injury?

TPD pays when illness or injury caused you to stop work — not when you stopped work for other reasons (redundancy, retirement, parental leave) and later became unwell. The order matters.

Most policies require you to have been "engaged in gainful employment" immediately before you stopped, and many require you to have been working a minimum number of hours per week (usually 15 or 20). Casual workers, contractors, and gig-economy workers can usually still qualify if they meet the hours test, but the wording in your specific PDS matters.

Watch out: If you took voluntary redundancy or resigned, then became unwell weeks or months later, the order of events can be contested by the insurer. Get specialist advice before lodging.

Question 3: Is the condition permanent (or expected to be)?

Most super-linked TPD policies don't require absolute permanence — they require that you are "unlikely ever to engage in any occupation for which you are reasonably suited by education, training or experience." That's a clinical opinion question, not a guarantee.

Conditions that commonly meet the permanence test:

  • Major depression / anxiety / PTSD that has not responded to evidence-based treatment over 12+ months
  • Chronic pain conditions (fibromyalgia, complex regional pain syndrome, non-resolving back injuries)
  • Cancer with ongoing treatment or significant residual impairment
  • Stroke and other neurological conditions with permanent deficit
  • Cardiovascular conditions imposing permanent work restrictions
  • Progressive conditions: MS, Parkinson's, motor neurone disease
  • Significant orthopaedic injuries with failed surgical outcomes

Question 4: Can your treating doctors document the disability?

TPD claims live and die on medical evidence. The minimum evidence pack typically includes:

  • GP letter setting out the diagnosis, treatment history, and prognosis
  • Specialist report(s) from the treating clinician(s) — psychiatrist, oncologist, orthopaedic surgeon, neurologist, depending on condition
  • Functional capacity evidence — work restrictions, what you can and cannot do

If you have a long-standing treating relationship with a GP and at least one specialist, and they support the view that you cannot return to suitable work, your evidence base is strong. If you've only seen doctors sporadically, the insurer will likely request an Independent Medical Examination (IME) which adds 2 to 4 months to the timeline.

Policy definitions explained

Two terms drive most TPD eligibility disputes:

"Any Occupation" definition

The standard for super-linked TPD. You must be unable to ever again work in any job for which you're reasonably suited by your education, training or experience. A 50-year-old former carpenter with a back injury who could theoretically work in a call centre may fail an "Any Occupation" test if no realistic role is open to them in their region — but the assessment is genuinely fact-specific.

"Own Occupation" definition

Easier to satisfy. You must be unable to do your usual job. More common in retail (non-super) policies, occupational specialist policies, and some industry funds for specific trades. If you have an "Own Occupation" policy as a tradesperson or surgeon, your eligibility threshold is materially lower.

Common edge cases

Returning to work briefly, then stopping again

Many people attempt a return to work after illness, find they can't sustain it, and stop again. The "date you stopped work" for TPD purposes is usually the final date, not the original date — but some policies look at the original cessation. Specialist advice matters here.

Working through a chronic condition then deteriorating

If you worked through a chronic condition for years before it became unmanageable, the date of TPD eligibility is usually when the condition became disabling — not the original diagnosis date.

Mental health conditions with periods of recovery

Mental health TPD claims face the most scrutiny. Insurers commonly argue that recurrent depression with periods of stable function doesn't meet the permanence test. Detailed treating-psychiatrist reports addressing function across time are critical.

Get an expert assessment for free A specialist TPD lawyer in your state will review your situation in a 15-minute call →

Eligibility FAQs

The eligibility questions we answer most often.

I had super but cancelled my insurance — can I still claim?
If you cancelled the TPD insurance attached to your super before you stopped work, you usually cannot claim. If you cancelled after you stopped work, you may still have a claim against the cover that was in place at the time you stopped. Check the date you cancelled cover against the date your treating doctor first certified you unfit for work.
I have never worked full-time — does the 'Any Occupation' test apply differently?
The 'Any Occupation' test asks whether you can perform any work for which you are reasonably suited by education, training or experience. If your work history is part-time or casual, the suitability assessment is based on the jobs you actually have the qualifications and experience to do — it does not penalise you for never having worked full-time.
My doctor says I might recover in a few years — does that disqualify me?
Most TPD policies define 'permanent' as 'never likely to engage in any occupation again' — not absolute mathematical permanence. If multiple specialists agree your condition is unlikely to materially improve to the point where you could return to suitable work, you can usually meet the definition even if a small chance of partial recovery exists. The wording in your specific PDS controls.
I'm working part-time after the injury — am I disqualified?
Limited part-time work that is unsustainable, modified-duty work created specifically to accommodate you, or unpaid voluntary work generally do not disqualify you. The test is whether you can sustain suitable paid employment in the open labour market. If you're working 4 hours a week in a role designed around your limitations, that's typically not enough to defeat an 'Any Occupation' claim.
I have multiple super funds — do I need to pass the test for each?
Yes. Each fund is a separate insurance contract. You need to meet the TPD definition in each policy, and definitions can vary between funds. In practice, if you meet the definition for one major fund, you likely meet it for the others — but each must be assessed and lodged independently.

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