Category: Claims
Plan for six to twelve months from first notification to payment on a retail TPD claim. Longer durations are common where medical evidence is contested or where cover is held inside super and the trustee must make a separate finding.
The Australian Prudential Regulation Authority (APRA) publishes Life Insurance Claims and Disputes Statistics half-yearly. Across the industry, TPD consistently shows one of the longer average assessment durations of any cover type.
The timeline runs sequentially, not in parallel.
Every panel TPD definition requires the insured to be continuously absent from work for three consecutive months before the permanence test opens for assessment.
You can notify the insurer immediately. Notification triggers the claim pack and starts evidence gathering in parallel with the qualifying period.
The three-month structure sits in every panel PDS:
Following the qualifying period the insurer collects:
Duration depends on specialist availability. Single-specialist claims (clear orthopaedic injury, terminal oncology diagnosis) move faster than multi-specialist claims (psychiatric conditions, chronic pain, multisystem disease).
See what medical evidence is required.
The claims assessor reviews the evidence against the definition shown on the policy schedule. Incomplete evidence triggers follow-up requests rather than an outright decline.
If the insurer wishes to test the medical record, an independent medical examination may be arranged. That adds four to eight weeks for booking, attendance and report production.
If the cover is held inside super, the insurer's admission only releases the funds to the super account. The trustee then independently considers whether the SIS Reg r.6.01(2) permanent incapacity release condition is met. Meeting the PDS definition does not automatically satisfy the trustee.
See how TPD insurance works with superannuation and holding cover inside and outside super.
For cover outside super, payment goes to the policy owner.
For cover inside super, the benefit is allocated to the member's super account. A withdrawal request under the SIS release condition then follows, with tax depending on age and components. See how TPD payouts are taxed.
The insurer is required to keep you updated. If a claim has been outstanding without an outcome for longer than the PDS-specified service standard, the next step is internal dispute resolution.
Under ASIC Regulatory Guide 271, life insurance complaints must receive a final IDR response within 45 calendar days. If the outcome is unsatisfactory, the matter can escalate to the Australian Financial Complaints Authority (AFCA).
See what happens if my TPD claim is rejected for the full IDR-to-AFCA pathway, and the TPD claims process for the documentation workflow itself.
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