Total and Permanent Disability Insurance

**[TPD insurance](/glossary/insurance-types/tpd-insurance) pays a single tax-free lump sum if illness or injury makes returning to work unlikely.** It is not a monthly income, and it pays only once. Every retail TPD policy on IMFL's panel uses the same three-month qualifying test. You stop work, treatment runs for three months, and at the end the insurer applies a permanence test against your policy's definition. The panel is AIA, Zurich, TAL, OnePath, ClearView, NEOS, Encompass, Acenda and Futura. ## What TPD pays for The lump sum is capital, not income replacement. On the claim file it typically funds: - Mortgage payout and personal debt. - Home and vehicle modifications (ramps, bathroom changes, wheelchair-accessible car). - Care, therapy and rehabilitation not covered by Medicare, NDIS or private health. - Lost future earnings to planned retirement. - A capital reserve for longer-term cost of living with a permanent impairment. The Zurich Cost of Care research is the most commonly cited Australian benchmark for sizing these figures. For a fuller framework on sizing cover, see [how much TPD insurance coverage do I need](/faqs/tpd-insurance/how-much-tpd-insurance-coverage-do-i-need). ## How TPD is sold in Australia Three channels, structurally different: - **Retail.** Sold by a broker under one of the nine panel insurers' PDSs. Medically underwritten at application. Definitions locked. [Guaranteed renewable](/glossary/policy-terms/guaranteed-renewable) for the life of the policy. - **Inside super (retail).** The same retail PDS, owned by a super trustee. Premiums come out of your super balance. The benefit is taxed under super rules on payout. - **Group inside super (default).** Bulk cover that a super fund's chosen insurer writes for all members. The trustee, not the member, owns the contract. Definitions and sum insured can change at master-policy renewal. - **Direct.** Sold without a broker by insurer-owned consumer brands (NobleOak, Real, AAMI, others). Shorter PDS definitions. NOT on IMFL's retail panel. For more on the channel split see [how TPD insurance differs across the panel](/faqs/tpd-insurance/how-does-tpd-insurance-differ-across-the-panel-of-australian-insurers) and [how TPD insurance works with superannuation](/faqs/tpd-insurance/how-does-tpd-insurance-work-with-superannuation). ## The three-limb claim test Every panel PDS uses the same three limbs for an Own Occupation or Any Occupation TPD claim. The life insured must: 1. Be absent from work for three consecutive months. 2. Have undergone all reasonable and appropriate treatment and rehabilitation. 3. At the end of those three months, be unlikely ever again to engage in the relevant occupation. The first limb is a hard gate. The second prevents claims that refuse standard treatment. The third is the forward-looking medical opinion the assessor must reach. See [what does 'total' and 'permanent' actually mean in TPD claims](/faqs/tpd-insurance/what-does-total-and-permanent-actually-mean-in-tpd-claims) for the full breakdown of the three limbs and the supplementary branches that bypass the three-month wait (loss of limbs, loss of sight, 25% whole-person impairment, paralysis, Activities of Daily Living). ## Where each panel insurer defines TPD The core wording is substantially equivalent across the panel. PDS source citations: - **TAL Accelerated Protection**: PDS 12 December 2024, Section 9 Definitions, page 88. - **AIA Priority Protection**: PDS 9 November 2025, Section 12.1, page 221. - **Zurich Wealth Protection**: PDS 1 November 2025, Definitions section. - **OnePath OneCare**: PDS 1 October 2025, pages 32 to 33. - **NEOS Protection**: PDS 6 December 2024, page 67. - **ClearView ClearChoice**: PDS May 2024 (update effective 5 June 2025), pages 40 to 41. - **Encompass Protection**: PDS 26 September 2025, pages 16 to 17. - **Acenda Insurance**: PDS 27 September 2025, page 19. - **Futura Protection**: PDS 1 October 2025, pages 21 to 24. ## Why TPD usually sits next to Life cover Most retail TPD is sold attached to [Life cover](/glossary/insurance-types/life-insurance). Two structures: - **Linked.** A TPD claim reduces the Life cover by the same amount. Lower premium, but a TPD payout leaves less for the family if the life insured later dies. - **Standalone.** Separate sums insured for TPD and Life. Higher premium, but the Life cover survives a TPD claim. See [the difference between linked and standalone TPD insurance](/faqs/tpd-insurance/what-is-the-difference-between-linked-and-standalone-tpd-insurance). TPD does not replace [income protection](/glossary/insurance-types/income-protection-insurance) or [trauma insurance](/glossary/insurance-types/trauma-insurance). The three covers solve different problems. The comparison sits in [how TPD insurance differs from other types of insurance cover](/faqs/tpd-insurance/how-does-tpd-insurance-differ-from-other-types-of-insurance-cover).

**[Own Occupation TPD](/glossary/insurance-types/own-occupation-tpd) pays if you can never return to your specific job. [Any Occupation TPD](/glossary/insurance-types/any-occupation-tpd) pays only if you can never return to any job you are reasonably suited to.** Own Occupation is the easier test and costs more. Both definitions are available on retail TPD across IMFL's panel of nine insurers. One structural caveat: the Own Occupation component must sit outside super. ## The two definitions in plain words Worked example: a surveyor injures their back and can no longer do site work, but could retrain into a desk role. - **Own Occupation.** The surveyor meets the test. The insurer asks whether you are unlikely ever again to engage in the trade, profession or type of work you were doing immediately before disability. - **Any Occupation.** The surveyor generally fails the test. The insurer asks whether you are unlikely ever again to engage in any occupation for which you are reasonably suited by education, training or experience. ## Why Own Occupation must sit outside super The constraint is regulatory, not pricing. Under Superannuation Industry (Supervision) Regulation 4.07D (SIS Reg 4.07D), insurance held inside a super fund (acquired on or after 1 July 2014) must align with a super condition of release. The release condition that lines up with TPD is **Permanent Incapacity** under SIS Regulation 6.01(2). It uses the "any occupation" test. The trustee must be reasonably satisfied that the member is unlikely, because of ill-health, ever to engage in gainful employment for which they are reasonably qualified by education, training or experience. In practice: - TPD held inside super is ordinarily Any Occupation only. - You can still buy an Own Occupation upgrade with super money, using a split policy. The shorthand is correct: "Own Occupation through a retail policy is structured outside super as a split rider funded personally". It is NOT correct to say "Own Occupation is not available with super money". ## How the split policy works The Any Occupation TPD component sits inside super. The trustee owns it. Premiums are paid from super. The benefit releases through the trustee under SIS 6.01(2). The Own Occupation uplift sits as a smaller separate rider outside super. You pay for it personally. The Own Occ component is generally the smaller portion of total premium. Panel insurers each name the split design differently: - **Acenda**: TPD Optimiser (Acenda Insurance PDS 27 September 2025, page 19). - **ClearView**: TPD Super Solutions / flexi-linked TPD (ClearView ClearChoice PDS, page 40). - **OnePath**: SuperLink arrangements (OnePath OneCare PDS 1 October 2025, page 33). - **AIA, Zurich, TAL, NEOS, Encompass, Futura**: equivalent split designs on their retail products. ## Where each panel insurer defines the two tests The core wording is consistent across the panel. PDS source citations: - **TAL Accelerated Protection**: PDS 12 December 2024, Section 9 Definitions, page 88. Own Occupation requires three consecutive months not working in Own Occupation, then incapacity unlikely to ever permit return. Any Occupation uses the same three-month absence, with incapacity unlikely to ever permit work paying more than 25% of last 12 months' earnings. - **AIA Priority Protection**: PDS 9 November 2025, Section 12.1, page 221. Identical structure. Own Occupation references the trades, professions or types of work the life insured was last engaged in. Any Occupation references occupations reasonably suited by education, training or experience. - **OnePath OneCare**: PDS 1 October 2025, pages 32 to 33. Identical three-month qualifying absence and reasonable treatment requirement. Includes a Non-working TPD conversion at the policy anniversary when the life insured is 65 (subject to a continuation request for white-collar occupations). - **ClearView ClearChoice**: PDS May 2024 (with update effective 5 June 2025), pages 40 to 41. If the life insured has been unemployed or on parental or sabbatical leave for more than 12 months at the time the sickness or injury occurs, the assessment defaults to Any Occupation. - **NEOS Protection**: PDS 6 December 2024, page 67. - **Encompass Protection**: PDS 26 September 2025, pages 16 to 17. - **Acenda Insurance**: PDS 27 September 2025, page 19. - **Futura Protection**: PDS 1 October 2025, pages 21 to 24. The last four use substantially equivalent definitions. ## Premium impact Own Occupation premiums are higher than Any Occupation for the same sum insured, age and occupation category. The lower claim threshold produces a higher expected payout. The Acenda PDS states plainly that "you'll be charged a higher premium if you choose Own Occupation". The exact uplift varies by occupation category. Own Occupation is also restricted to certain categories. The AIA Priority Protection Adviser Guide (10 November 2025) restricts Own Occupation to specific professional and white-collar codes (A1 to A4, C1, plus medical category M). ## How to decide The trade-off is cost against claim probability. Common factors that lead clients to discuss Own Occupation: - A highly specialised occupation where retraining into any other role would represent a major income loss. - A long planned working life ahead, where the cumulative claim-probability uplift is meaningful. - Sufficient outside-super income to fund the Own Occ rider personally. For the broader cost picture see [how TPD premiums are calculated](/faqs/tpd-insurance/how-are-tpd-insurance-premiums-calculated). For the structural rules on holding cover in both places see [can I have TPD insurance both inside and outside superannuation](/faqs/tpd-insurance/can-i-have-tpd-insurance-both-inside-and-outside-superannuation). For the broader retail-vs-super choice see the [retail vs super life insurance guide](/guides/retail-vs-super-life-insurance).

**[TPD insurance](/glossary/insurance-types/tpd-insurance) pays a one-off lump sum if illness or injury makes returning to work unlikely.** It is one of four covers Australians commonly hold, and the four are designed to stack rather than substitute. [Life cover](/glossary/insurance-types/life-insurance) pays on death or terminal illness. [Income protection](/glossary/insurance-types/income-protection-insurance) pays a monthly income while you are off work. [Trauma cover](/glossary/insurance-types/trauma-insurance) pays a lump sum on diagnosis of a defined critical condition. Workers' compensation pays only for workplace injuries. ## Side-by-side: what triggers a payout | Cover | Trigger | Payment shape | Test | |---|---|---|---| | Life | Death of the life insured, or terminal illness with life expectancy of 24 months (12 months on some products and 12 for super-released terminal benefit) | One lump sum | Death certificate or specialist certification of terminal illness | | TPD | Three months continuously off work plus permanent incapacity finding | One lump sum | Own Occupation, Any Occupation, ADL, Home Duties or Non-Occupational definition in the PDS | | Income Protection | Total or partial disability for the waiting period | Monthly benefit for a fixed [benefit period](/glossary/policy-terms/benefit-period) (typically 2 years, 5 years or to age 65) | "Unable to perform the important income-producing duties" of the occupation | | Trauma | Diagnosis of a listed critical condition (cancer, heart attack, stroke and similar) | One lump sum | Defined-condition test in the PDS | | Workers' Compensation (state-based) | Work-related injury or illness | Weekly payments plus medical plus lump sum, depending on state | Causally linked to work | ## TPD vs Life cover Life cover triggers on death. TPD triggers while you are alive but permanently unable to work. The two are usually sold together because the financial gap they fill is the same: replace lost income and clear debt. Only the trigger differs. Most retail TPD on IMFL's panel is sold in one of two structures: - **Linked.** A TPD claim reduces the Life cover by the same amount. Lower premium. - **Standalone.** Separate sums insured for TPD and Life. Higher premium. See [the difference between linked and standalone TPD insurance](/faqs/tpd-insurance/what-is-the-difference-between-linked-and-standalone-tpd-insurance). ## TPD vs Income Protection Income Protection is the income-replacement layer for the months and years after you stop working. TPD is the capital-event layer that clears the long-term gap if you never return to work. They solve different timing problems. - **IP** pays roughly 70% of pre-disability income, monthly, after a [waiting period](/glossary/policy-terms/waiting-period) of typically 30, 60 or 90 days. The benefit ends at the end of the benefit period (commonly to age 65 across the panel; see the TAL Accelerated Protection PDS Section 1.1.6, the AIA Priority Protection PDS Section 5.1, and the OnePath OneCare PDS, Income Secure Cover). - **TPD** pays once, in full, after a three-month qualifying period plus a permanent-incapacity finding. Claim coexistence matters. A successful TPD claim does NOT automatically stop an in-force IP claim, because the definitions are different. But IP benefit calculations typically offset other income. ### Note on IP structure changes APRA's Individual Disability Income Insurance (IDII) measures issued in 2020 to 2022 reshaped IP product design. Changes included 2-year occupational tests on long-benefit policies, income at risk versus indemnity, and restrictions on Agreed Value. The retail panel rebuilt the IP products in 2022 to 2024 to meet those measures. TPD product design was not directly affected by those measures. ## TPD vs Trauma Trauma cover pays on **diagnosis** of a listed condition. Common examples include cancer of specified criteria, heart attack of specified severity, stroke with neurological deficit, and organ transplant. The number of covered conditions varies across the panel: | Insurer | Conditions listed | |---|---| | OnePath OneCare | 47 | | AIA Priority Protection (PDS 9 November 2025, Section 4.1.2) | 44 | | Zurich Wealth Protection | 43 | | ClearView ClearChoice | 42 | | Encompass Protection | 42 | | NEOS Protection | 40 | | Acenda Insurance | 40+ | | TAL Accelerated Protection | 39 | | Futura Protection | 39 | The key difference: a trauma claim does NOT require you to be off work. Someone diagnosed with stage-2 breast cancer who returns to work after treatment can still claim trauma. They cannot claim TPD unless and until the permanent-incapacity test is met. Trauma is the right cover for the short-term shock cost of a major diagnosis. TPD is the right cover for the long-term cost of never returning to work. ## TPD vs Workers' Compensation Workers' comp is statutory cover. Scheme rules vary by state, and the payout addresses work-related injury or illness only. Several common claim scenarios fall outside workers' comp: - A back injury at a weekend football game. - A stroke. - A chronic illness diagnosed unrelated to work. TPD pays regardless of where or how the disability arose, subject to the PDS exclusions (see [what exclusions apply to TPD insurance policies](/faqs/tpd-insurance/what-exclusions-apply-to-tpd-insurance-policies)). ## TPD vs Total Disability (in income protection) The terminology overlaps but the tests are different. - **"Total disability"** in an IP context is a monthly-benefit test that resets each month. Are you unable to perform the important income-producing duties this month? - **"Total and permanent disability"** is a one-off finding. Are you unlikely ever again to work? IP can be paying out at the same time as a TPD claim is being assessed. A TPD claim payout typically does not end IP payments automatically, depending on the policy's offset clauses. ## Retail vs group-super vs direct: same name, different cover The word "TPD" covers three structurally different products in Australia: 1. **Retail TPD.** Sold via brokers under the nine panel PDSs (AIA, Zurich, TAL, OnePath, ClearView, NEOS, Encompass, Acenda, Futura). [Guaranteed renewable](/glossary/policy-terms/guaranteed-renewable), definitions locked, medically underwritten at application. 2. **Group TPD inside super.** A master policy a super fund's chosen insurer writes for all members. The trustee can change cover terms at master-policy renewal. 3. **Direct TPD.** Sold without underwriting by insurer-owned consumer brands. Simpler product, simpler claims test, weaker definitions, often annually renewable. NOT on IMFL's broker panel. See [retail vs direct vs group super life insurance](/guides/retail-vs-super-life-insurance) for the full comparison. See [how TPD insurance works with superannuation](/faqs/tpd-insurance/how-does-tpd-insurance-work-with-superannuation) for the super-specific rules.

'Total' and 'permanent' are not abstract phrases. Every Australian retail PDS defines them as a specific multi-part legal test, and the structure is consistent across the nine retail insurers on IMFL's panel: AIA, Zurich, TAL, OnePath, ClearView, NEOS, Encompass, Acenda and Futura. The core ['any occupation' or 'own occupation'](/faqs/tpd-insurance/whats-the-difference-between-own-occupation-and-any-occupation-tpd-definitions) test in every panel PDS has three limbs that must all be met: 1. Three consecutive months absent from work because of sickness or injury. The clock starts when you stop working, not when you lodge the claim. ([See how waiting periods vary between insurers.](/faqs/tpd-insurance/what-is-the-typical-waiting-period-for-tpd-insurance)) 2. Actively undergoing all reasonable and appropriate treatment, including rehabilitation, for the condition. Refusing recommended treatment can defeat the claim. 3. At the end of the three months, in the insurer's opinion after consideration of [medical evidence](/faqs/tpd-insurance/what-medical-evidence-is-required-for-a-tpd-claim), you are unlikely ever again to engage in your own occupation (under Own Occupation cover) or any occupation reasonably suited to your education, training or experience (under Any Occupation cover). ## How long does a TPD claim take? Plan for [six to twelve months from first notification to payout](/faqs/tpd-insurance/how-long-does-a-tpd-claim-take-to-be-processed-and-paid), and longer is not unusual. The timeline runs sequentially, not in parallel: **Stage 1: Three-month qualifying period.** You must be absent from work and continuously unable to work. Lodgement only opens at the end of this period. **Stage 2: Two to four months of medical-evidence collection and assessment.** Treating GP report, relevant specialist reports, functional capacity assessment, occupational duties statement from your employer, and (for accident-based claims) accident and treatment records. The insurer may request independent medical examinations. See [what medical evidence is required for a TPD claim](/faqs/tpd-insurance/what-medical-evidence-is-required-for-a-tpd-claim) for the specific documentation expected, and [the full claims process](/faqs/tpd-insurance/what-is-the-claims-process-for-tpd-insurance) for what to expect end to end. **Stage 3: For TPD cover held inside super,** an additional one to three months for the super fund trustee to make a separate 'permanent incapacity' finding under Superannuation Industry (Supervision) Regulations r.6.01(2). The trustee must be reasonably satisfied that your ill-health makes it unlikely you will ever again engage in gainful employment for which you are reasonably qualified. Meeting the PDS definition alone does not release the super benefit until the trustee makes that finding. See [how TPD insurance works with superannuation](/faqs/tpd-insurance/how-does-tpd-insurance-work-with-superannuation) for the broader super interaction and [the difference between holding cover inside and outside super](/faqs/tpd-insurance/can-i-have-tpd-insurance-both-inside-and-outside-superannuation). Faster outcomes are possible when a supplementary branch applies (loss of limbs, sight, paralysis, 25% whole-person impairment), because those bypass the three-month qualifying period. Slower outcomes are common where the medical evidence is contested, where occupational duties are disputed, or where [pre-existing condition disclosure is reviewed](/faqs/tpd-insurance/how-does-tpd-insurance-handle-pre-existing-conditions). See [why so many TPD claims are rejected](/faqs/tpd-insurance/why-are-so-many-tpd-claims-rejected) for the most common failure modes. ## Where each panel insurer defines TPD Verbatim from TAL Accelerated Protection (PDS 12 December 2024, Section 9 Definitions, page 88): the life insured must be 'incapacitated to such an extent as to render the Life Insured unlikely ever to be able to' work in the relevant occupation. The wording across the other eight panel insurers is substantially identical. PDS source citations: - **TAL Accelerated Protection:** PDS 12 December 2024, Section 9, page 88 - **AIA Priority Protection:** PDS 9 November 2025, Section 12.1, page 221 - **Zurich Wealth Protection:** PDS 1 November 2025, Definitions section - **OnePath OneCare:** PDS 1 October 2025, pages 35 to 36 - **NEOS Protection:** PDS 6 December 2024, page 71 - **ClearView ClearChoice:** PDS May 2024 (with update effective 5 June 2025), pages 40 to 41 - **Encompass Protection:** PDS 26 September 2025, pages 16 to 17 - **Acenda Insurance:** PDS 27 September 2025, page 20 - **Futura Protection:** PDS 1 October 2025, pages 21 to 23 ## Supplementary branches that bypass the three-month wait Most PDS also list alternative paths that do not require the three-month absence. Common branches: - **Loss of limbs or sight, total and irrecoverable.** AIA pays on 'total and irrecoverable loss of the sight of both eyes, use of two limbs, or sight of one eye and use of one limb' (PDS s.12.1). Encompass, Futura, ClearView and NEOS contain equivalent language. TAL lists Activities of Daily Living (ADL) as a third named TPD definition alongside Own and Any Occupation. - **25% permanent whole-person impairment,** measured against the American Medical Association Guides to the Evaluation of Permanent Impairment. NEOS, OnePath OneCare and Encompass each include this as an alternative path. - **Loss of independent existence or cognitive loss.** OnePath OneCare provides a separate cognitive-loss branch with a six-month assessment period rather than three. ClearView ClearChoice and Futura Protection switch automatically to a Non-Occupational definition (loss of independent existence, loss of use of limbs, or blindness in both eyes) from the policy anniversary after age 65. [Mental health conditions](/faqs/tpd-insurance/can-tpd-insurance-cover-mental-health-conditions) are typically assessed under the same Own/Any Occupation tests, with insurer-specific limitations. - **Home Duties.** Acenda, NEOS, Encompass and Futura assess clients who were performing full-time domestic duties at application (and for the 12 months prior) under a Home Duties definition instead of Any Occupation. ## What 'total' and 'permanent' mean in practice 'Total' does not mean fully incapacitated. It means you cannot perform the duties of the relevant occupation. 'Permanent' is the harder limb of the test: the insurer needs medical evidence that you have reached maximum medical improvement and are unlikely to recover enough to return to work. Which definition you hold (Own Occupation, Any Occupation, Super, ADL, Home Duties) is shown on your policy schedule, and the precise wording of every test sits in the Definitions section of the PDS your policy was issued under. Always read that section for your specific cover before relying on a general summary. For the broader context on what TPD insurance is and how it sits alongside life and income protection cover, see [What is TPD (Total and Permanent Disability) insurance?](/faqs/tpd-insurance/what-is-tpd-total-and-permanent-disability-insurance) and [how TPD differs from other types of cover](/faqs/tpd-insurance/how-does-tpd-insurance-differ-from-other-types-of-insurance-cover).

**Every retail TPD product on IMFL's panel uses the same core qualifying period: three consecutive months absent from work because of sickness or injury, before the [Total and Permanent Disability](/glossary/coverage-claims/total-permanent-disability) test even opens for assessment.** The three-month wait is NOT the same as an [income protection waiting period](/glossary/policy-terms/waiting-period), and it is NOT the same as a survival period (covered in a [separate FAQ](/faqs/tpd-insurance/what-is-a-survival-period-in-tpd-insurance)). ## When the clock starts The three months begin when the insured stops working because of the sickness or injury, not when the claim is notified. That is why notifying the insurer early matters. The qualifying period can run in parallel with claim documentation and the [evidence-gathering process](/faqs/tpd-insurance/what-medical-evidence-is-required-for-a-tpd-claim), so the assessment is ready to start the moment the three months elapse. ## Branches that bypass the three-month wait Each panel PDS lists alternative paths that do not require the three-month absence. The most common: - **Loss of limbs, sight, or paralysis.** AIA Priority Protection pays on "total and irrecoverable loss of the sight of both eyes, use of two limbs, or sight of one eye and use of one limb" (PDS s.12.1). OnePath OneCare, NEOS, ClearView, Encompass, Futura and Zurich contain equivalent language. See [does TPD insurance pay out for catastrophic events](/faqs/tpd-insurance/does-tpd-insurance-pay-out-for-catastrophic-events-like-loss-of-limbs-or-paralysis) for the full list. - **Loss of independent existence or cognitive loss.** OnePath OneCare requires a six-month assessment of continuous care for cognitive loss (PDS, page 34), not a three-month absence. - **25% whole-person impairment.** TAL Section 9, page 88, treats this as a separate path. ## How the qualifying period differs from a survival period The survival period (where one applies) is a short window the insured must outlive after meeting the definition. It is separate from the three-month qualifying absence. Some products impose a survival period and some do not. The 14-day survival rule is more typical for [Trauma cover](/glossary/insurance-types/trauma-insurance) than for TPD. Rules differ across the panel. See the dedicated FAQ on [survival periods in TPD insurance](/faqs/tpd-insurance/what-is-a-survival-period-in-tpd-insurance). ## Rare 6-month variants The three-month qualifying period is the panel standard. Some legacy or non-panel products in the Australian market use a six-month qualifying period. A small number of panel definitions impose a six-month confirmation window for specific branches (e.g. OnePath OneCare's cognitive loss path). For your specific cover, the Definitions section of the PDS issued under your policy is the source of truth. See also [how TPD insurance differs across the panel](/faqs/tpd-insurance/how-does-tpd-insurance-differ-across-the-panel-of-australian-insurers) for product-level variations across the nine retail insurers. ## Where each panel insurer documents the three-month qualifying absence The phrase varies but the rule does not. Three months absent from work, continuously, before the permanence test is applied: - **TAL Accelerated Protection** (PDS 12 December 2024, Section 9 Definitions, page 88): the Life Insured "has not been working in their Own Occupation for three consecutive months" before the unlikely-ever test runs. - **AIA Priority Protection** (PDS 9 November 2025, Section 12.1, page 221): "absent from work in your Own Occupation and have not worked for an uninterrupted period of at least three consecutive months from the Date of Disablement". - **Zurich Wealth Protection** (PDS 1 November 2025, Definitions): the life insured "must have stopped work for three consecutive months due to sickness or injury". - **OnePath OneCare** (PDS 1 October 2025, pages 32 to 33): the life insured "has been absent from work for three consecutive months" and has undergone reasonable treatment. - **NEOS Protection** (PDS 6 December 2024, page 67): the insured has "been continuously unable to work for at least three consecutive months" (i.e. continuously totally disabled for at least the initial three months). - **ClearView ClearChoice** (PDS May 2024 with update effective 5 June 2025, pages 40 to 41): "absent from, and unable to work, for three consecutive months". - **Encompass Protection** (PDS 26 September 2025, pages 16 to 17): "completely unable to work for a continuous three month period at any occupation they are reasonably suited to". - **Acenda Insurance** (PDS 27 September 2025, page 19): aligned with the Encompass wording. Three-month continuous inability. - **Futura Protection** (PDS 1 October 2025, pages 21 to 24): three-month absence test under both Own and Any Occupation definitions.

**Yes. The structure most clients ask about is a single retail policy split across two ownership wrappers.** The [Any Occupation TPD](/glossary/insurance-types/any-occupation-tpd) component sits inside super (the super trustee owns it, premiums come from your super balance). The [Own Occupation TPD](/glossary/insurance-types/own-occupation-tpd) uplift sits outside super as a smaller non-super rider paid for personally. The split design is standard across all 9 insurers on IMFL's panel: AIA, Zurich, TAL, OnePath, ClearView, NEOS, Encompass, Acenda, and Futura. ## Why the split design exists Insurance held inside super must align with a super release condition. The Superannuation Industry (Supervision) Regulations 1994 r.4.07D (added 1 July 2014) restrict super-funded insurance to definitions that match a release condition. The Permanent Incapacity release condition in [SIS Reg 6.01(2)](https://www.legislation.gov.au/F1996B02609/latest/text) uses the "any occupation" test. The trustee must be reasonably satisfied the member is unlikely ever to engage in gainful employment for which they are reasonably qualified by education, training or experience. That rule means a pure [Own Occupation TPD](/faqs/tpd-insurance/whats-the-difference-between-own-occupation-and-any-occupation-tpd-definitions) definition cannot be funded entirely from super contributions. To preserve the broader Own Occupation definition while keeping most of the premium tax-effective, panel insurers built a two-policy design. ## How the split structure works A typical [retail](/glossary/insurance-types/retail-insurance) split TPD has two layers: 1. **Inside super (the larger component).** Any Occupation TPD owned by the super trustee. Premiums deducted from the super balance. Claim proceeds release via SIS r.6.01(2) once the trustee makes a permanent-incapacity finding. 2. **Outside super (the smaller uplift).** Own Occupation TPD rider, personally owned. Premiums paid from after-tax personal cashflow. Claim proceeds paid tax-free under [ITAA 1997 s.118-37](https://www.austlii.edu.au/cgi-bin/viewdoc/au/legis/cth/consol_act/itaa1997240/s118.37.html). The split allows you to claim under the easier Own Occupation test (you cannot perform your own job) even when the Any Occupation test inside super has not yet been met. The Own Occ rider is usually the smaller portion of the total sum insured, so the personally-funded premium stays modest. ## Where each panel insurer documents the split The naming varies across the panel: - **TAL Accelerated Protection**: Section 9.2 Superannuation PLUS / 9.3 Maximiser (PDS 12 December 2024). The Own Occupation TPD definition inside a Superannuation Plan "is only available if you also select a Linked Benefit (Superannuation PLUS or Maximiser)". - **AIA Priority Protection**: Maximiser structure (PDS 9 November 2025). TPD Own Occupation is offered as a Rider Benefit to a Superannuation TPD policy. - **OnePath OneCare**: SuperLink TPD structure (PDS 1 October 2025). - **NEOS Protection**: "Plan ownership" combinations table (PDS 6 December 2024, page 38). - **Zurich, ClearView, Encompass, Acenda, Futura**: each supports an equivalent split-policy design under their retail products. The PDS for your specific cover defines the exact mechanics. Read the Definitions section and the policy schedule before relying on a general summary. ## Holding multiple separate policies You can also hold completely separate policies. For example, a workplace [group inside super](/glossary/insurance-types/group-insurance) default cover plus a [retail](/glossary/insurance-types/retail-insurance) policy outside super. See: - [How TPD insurance works with superannuation](/faqs/tpd-insurance/how-does-tpd-insurance-work-with-superannuation) for the broader interaction. - [How multiple TPD policies pay out](/faqs/tpd-insurance/can-i-have-multiple-tpd-insurance-policies-and-claim-on-all-of-them) for the stacking and offset rules. - [Retail vs super life insurance guide](/guides/retail-vs-super-life-insurance) for a structural comparison of channels.

**[TPD premiums](/glossary/policy-terms/premium) paid by an individual outside super are NOT tax-deductible to the individual. TPD premiums paid by a complying super fund inside super are deductible to the fund (for the proportion that corresponds to a liability to provide a "disability superannuation benefit").** Concessional contributions used to fund inside-super TPD premiums are taxed at 15% in the fund rather than at the member's marginal rate. That is the primary source of the apparent tax saving for cover held in super. References below are to the Income Tax Assessment Act 1997 (Cth) (ITAA 1997). ## TPD held outside super: not deductible A TPD premium paid by an individual policyholder for personal cover is a capital outlay of a private nature. ATO Taxation Ruling TR 95/25 (and the broader ATO guidance on personal life insurance) treats personal TPD premiums as non-deductible. The trade-off is that the lump-sum benefit, when paid, is generally not assessable income under [ITAA 1997 s.118-37](https://www.ato.gov.au/) (capital gains tax exemption for compensation or damages received for personal injury). For a self-employed person trading through a company or trust, the company or trust may pay the premium, but it does not change the deductibility outcome for a personal TPD policy. A narrow business-purpose exception applies for key-person TPD held by an employer (where the employer is the policyholder, the benefit is for the employer, and the cover is for a revenue purpose). That sits outside the scope of this answer. ## TPD held inside super: deductible to the fund Where a complying super fund holds the policy and pays the premium, the fund can claim a deduction for the premium under [ITAA 1997 s.295-465](https://www.ato.gov.au/), to the extent the policy provides for a "disability superannuation benefit". The definition of "disability superannuation benefit" in ITAA 1997 s.995-1 requires two medical practitioners to certify that, because of ill-health, it is unlikely the member can ever be gainfully employed in a capacity for which they are reasonably qualified. The practical effect: - **Any Occupation TPD held inside super.** The fund typically claims 100% of the premium as a deduction, on the basis that the policy aligns to the disability super benefit definition. - **Own Occupation TPD held inside super (pre-1 July 2014).** The fund can claim only the proportion that aligns to the "disability superannuation benefit" definition. The Commissioner accepts a 67% default proportion under PCG 2017/D11 / TR 2012/6 where the policy is composite. The non-deductible portion has effectively been priced out of post-2014 retail super TPD because Own Occupation can no longer be acquired through super under SIS Reg 4.07D. - **Member contribution route.** A member who funds the inside-super premium via a concessional (pre-tax) contribution pays 15% contributions tax inside the fund (instead of the marginal rate outside), and the fund then claims the premium deduction. The combined effect is that, for a member on a 32.5% or 37% or 45% marginal rate, holding TPD inside super reduces the after-tax cost of cover. ATO Taxation Determination TD 2018/2 and the ATO Self-Managed Super Fund guidance describe the mechanics. ## Concessional contributions caps Concessional super contributions are capped at $30,000 per financial year for 2025-26 (Australian Taxation Office concessional cap, indexed). Premiums funded by salary sacrifice or personal deductible contributions consume the cap before they reach the insurance policy. The cap forces a real-cash trade-off for high earners with already-large contribution flows. ## Insurance-only super funds and the 15% upfront rebate Some insurance-only super funds (and some retail master trusts) offer an upfront 15% rebate or credit on premiums funded by rollover or contribution. The rebate represents the tax deduction the trustee receives when claiming the premium against fund earnings, passed back to the member at the point of premium debit rather than spread across the year through investment performance. It is a cash-flow improvement, not a separate concession. ## Worked illustrative comparison **Setup**: a member on the 39% marginal rate (including Medicare) with a $1,000 nominal annual TPD premium. ### Path A: outside super, personal funds **Calculation**: 1. The member must end up with $1,000 of after-tax income to fund the premium. 2. Pre-tax salary required: $1,000 / (1 - 0.39). 3. Result: approximately $1,640 of pre-tax salary. **Pre-tax cost: $1,640.** ### Path B: inside super, funded by salary sacrifice **Calculation**: 1. The member redirects $1,176 of pre-tax salary to super. 2. The fund deducts 15% contributions tax: $1,176 x 15% = $176. 3. Remaining inside the fund: $1,000. 4. The fund pays the $1,000 premium. 5. The fund then claims a deduction for the $1,000 premium, which offsets fund earnings tax. **Pre-tax cost: $1,176.** The pre-tax saving is $1,640 - $1,176 = $464 per year, before any payout-tax considerations. ## Tax on the payout, not just the premium Deductibility of premiums is one half of the cover-tax decision. Tax on the payout is the other. Summary: - **Outside super, paid to the life insured.** Lump sum is tax-free (capital, not income). - **Inside super, member 60+.** Lump sum is tax-free on withdrawal. - **Inside super, member preservation age to 59.** Taxable component up to the low-rate cap ($245,000 for 2025-26, indexed) is tax-free. Excess is taxed at 15% plus Medicare. - **Inside super, member under preservation age.** The "disability super benefit" tax-free uplift applies under ITAA 1997 s.307-145, increasing the tax-free component using the days-to-retirement formula. The remaining taxable component is taxed at 22% (20% plus Medicare). The full payout-tax breakdown sits in [how TPD insurance payouts are taxed](/faqs/tpd-insurance/how-are-tpd-insurance-payouts-taxed). ## What this means in practice The inside-super premium discount is real for higher-marginal-rate earners. The payout-tax cost partially offsets it for members under 60, and fully offsets it for members under preservation age unless the taxable component is small. For a personalised structure, get advice from a registered tax agent or financial adviser. This answer is general information about how the tax rules apply, not personal financial advice. Cross-references: - [How TPD insurance works with superannuation](/faqs/tpd-insurance/how-does-tpd-insurance-work-with-superannuation). - [Can I have TPD insurance both inside and outside superannuation](/faqs/tpd-insurance/can-i-have-tpd-insurance-both-inside-and-outside-superannuation). - [Retail vs super life insurance guide](/guides/retail-vs-super-life-insurance).

**Tax on a TPD lump sum depends on whether the cover is held inside or outside [superannuation](/glossary/insurance-types/group-insurance), and (if inside super) the member's age at the time of payment.** The rules sit in the Income Tax Assessment Act 1997 (ITAA 1997) and the Income Tax Assessment Act 1936. ## The four cases | Ownership | Member age | Tax treatment | |---|---|---| | Outside super | Any | Lump sum is non-assessable (tax-free). ITAA 1997 s.118-37. | | Inside super | Age 60 or older | Tax-free withdrawal. ITAA 1997 div 301. | | Inside super | Preservation age to 59 | Taxable component up to the low-rate cap ($245,000 for 2025-26) is tax-free; excess taxed at 15% plus Medicare. Tax-free component is tax-free. | | Inside super | Under preservation age | Disability super benefit uplift under ITAA 1997 s.307-145 increases the tax-free component. Remaining taxable component taxed at 20% plus Medicare (max 22%). | Preservation age is **60** for everyone born on or after 1 July 1964. ## Worked examples Each example assumes a $500,000 TPD sum insured. The examples are illustrative only. The [ATO super lump sum tax pages](https://www.ato.gov.au/individuals-and-families/super-for-individuals-and-families/super/withdrawing-and-using-your-super/withdrawing-your-super-and-paying-tax) and your accountant are the authoritative reference for your specific circumstances. ### Example 1: outside super, any age **Setup**: you hold a standalone retail TPD policy outside super. A $500,000 TPD benefit is paid. **Calculation**: 1. ITAA 1997 s.118-37 excludes the receipt from assessable income. 2. Tax payable: $0. **Net payout: $500,000.** ### Example 2: inside super, member is 62 **Setup**: $500,000 TPD inside super. Member is age 62. The trustee has made a permanent-incapacity finding under [SIS Reg 6.01(2)](https://www.legislation.gov.au/F1996B02609/latest/text). The benefit is paid into the super account and then withdrawn as a lump sum. **Calculation**: 1. The member is 60 or older. 2. ITAA 1997 div 301 makes the entire withdrawal tax-free. **Net payout: $500,000.** ### Example 3: inside super, member is 58 **Setup**: $500,000 TPD inside super. Member has reached preservation age (60 for anyone born on or after 1 July 1964; assume preservation age is reached for the worked case). The trustee has made a permanent-incapacity finding. **Assumptions** (illustrative; your actual split depends on your contribution history): - Taxable component: 90% = $450,000. - Tax-free component: 10% = $50,000. - 2025-26 low-rate cap: $245,000. **Calculation**: 1. Tax-free component is always tax-free: $50,000 untaxed. 2. First $245,000 of the taxable component is tax-free under the low-rate cap. 3. Remaining taxable: $450,000 - $245,000 = $205,000. 4. Tax on the remainder: 15% plus 2% Medicare = 17%. 5. Tax payable: $205,000 x 17% = $34,850. **Net payout: $500,000 - $34,850 = $465,150.** ### Example 4: inside super, member is 40 (under preservation age) **Setup**: $500,000 TPD inside super. Member became disabled at age 40 and is paid the lump sum at age 40. Same trustee finding as Example 2. **Assumptions** (illustrative; uplift formula based on disability super benefit rules under ITAA 1997 s.307-145): - Taxable component before uplift: 90% = $450,000. - Tax-free component before uplift: 10% = $50,000. - Member started super at age 22 (days served = 18 years x 365 = 6,570). - Days to age 65 = 25 years x 365 = 9,125. **Uplift formula**: tax-free uplift = original taxable component x (days to age 65 / (days served plus days to age 65)). **Calculation**: 1. Uplift fraction = 9,125 / (6,570 + 9,125) = 9,125 / 15,695 = 0.5814. 2. New tax-free amount from uplift = $450,000 x 0.5814 = $261,630. 3. Reduced taxable component = $450,000 - $261,630 = $188,370. 4. Under preservation age, the remaining taxable component is taxed at 20% plus Medicare (effective max 22%). 5. Tax payable: $188,370 x 22% = $41,441. 6. Tax-free component (10% of $500,000) = $50,000 (untaxed). **Net payout: $500,000 - $41,441 = $458,559.** The uplift mechanic is generous for under-preservation-age claimants. The longer the future service period to age 65, the bigger the tax-free uplift. A 30-year-old gets a much larger uplift than a 55-year-old under the same formula. ## The trustee-release gate Inside super, satisfying the policy's TPD definition is not enough on its own. The trustee must separately determine that the member meets the Permanent Incapacity release condition in [SIS Reg 6.01(2)](https://www.legislation.gov.au/F1996B02609/latest/text). Until the trustee makes that finding, the money cannot leave the super system. See [how TPD insurance works with superannuation](/faqs/tpd-insurance/how-does-tpd-insurance-work-with-superannuation) for the broader interaction. ## Other practical points - **Medicare levy** is 2% (plus Medicare Levy Surcharge if applicable). The "plus Medicare" rates above are the headline rate plus 2%. - **Tax components** (taxable vs tax-free) are set by your contribution history. Your super fund can produce a benefit statement showing the split. - **Consolidating accounts** before a claim can change the taxable/tax-free split and increase tax payable. Get accounting advice before merging accounts when a TPD claim is on the horizon. - **TPD inside vs outside super** decisions interact with the [premium tax deductibility](/faqs/tpd-insurance/are-tpd-insurance-premiums-tax-deductible) question. Super premiums are not personally tax-deductible but are paid pre-tax inside the fund. An interactive calculator with adjustable inputs (age, sum insured, taxable/tax-free split, ownership) is on the roadmap. For now, the four worked examples above cover the dominant cases. For tax matters specific to your situation, consult a registered tax agent.

**[TPD insurance](/glossary/insurance-types/tpd-insurance) is definition-based, not condition-based.** The PDS does not list specific diseases that "qualify" for a TPD claim. Any sickness or injury can support a claim if it meets the relevant Own Occupation, Any Occupation, ADL, or Home Duties test in the policy's Definitions section. The nine retail insurers on IMFL's panel use substantially identical core wording: AIA, Zurich, TAL, OnePath, ClearView, NEOS, Encompass, Acenda, and Futura. ## The test is the gate, not the diagnosis The core PDS test has three limbs that must all be met: 1. Three consecutive months absent from work because of sickness or injury. 2. Actively undergoing all reasonable treatment and rehabilitation. 3. At the end of the three months, in the insurer's opinion after medical evidence, unlikely ever again to engage in the relevant occupation. The "relevant occupation" depends on which definition you hold. See [Own Occupation and Any Occupation TPD](/faqs/tpd-insurance/whats-the-difference-between-own-occupation-and-any-occupation-tpd-definitions) for the difference. The TAL Accelerated Protection PDS (12 December 2024, Section 9 Definitions, page 88) and the AIA Priority Protection PDS (9 November 2025, Section 12.1, page 221) both frame the test in this "incapacitated to such an extent as to render unlikely ever to work" language. The eight other panel PDS use substantially identical wording. See [what "total" and "permanent" actually mean in TPD claims](/faqs/tpd-insurance/what-does-total-and-permanent-actually-mean-in-tpd-claims) for the full per-insurer citations. ## What conditions actually drive claims The policy is definition-based, but the conditions that most commonly cause people to meet a TPD definition cluster into five categories. The Australian Prudential Regulation Authority (APRA) Life Insurance Claims and Disputes Statistics publication reports TPD-finalised acceptance rates of 82.88% in the advised channel for the rolling 12 months to 30 June 2025. APRA does not break down accepted claims by cause. The cause-of-claim breakdown comes from insurer cost-of-care research and large in-force books: - **Musculoskeletal failure.** Chronic back, neck, shoulder, and joint conditions are among the most-claimed disability causes in Australia. Zurich's Cost of Care Volume 2 (2023) identifies musculoskeletal conditions, particularly back pain, as one of the top three claim drivers across its in-force book. - **Mental health.** Severe depression, post-traumatic stress disorder, and bipolar disorder can meet the test where treating practitioners certify the impairment as permanent. See [whether TPD covers mental health conditions](/faqs/tpd-insurance/can-tpd-insurance-cover-mental-health-conditions) for how panel insurers handle this. - **Cancer.** A cancer diagnosis itself does not trigger a TPD claim; the test is incapacity, not diagnosis. A cancer that leaves residual impairment preventing return to work can meet the test. - **Cardiovascular events.** Heart attack, stroke, or cardiac surgery with residual functional impairment may support a claim. The 25% whole-person impairment branch often applies where the relevant Own/Any Occupation test is borderline. - **Neurological conditions.** Multiple sclerosis, motor neurone disease, Parkinson's, and acquired brain injury feature regularly in advised claim books. ## The supplementary branches Most panel PDS include alternative paths that do not require the three-month qualifying absence. These deliver faster, more certain outcomes for specific conditions. ### Loss of limbs, sight, or the ability to live without assistance AIA, Encompass, Futura, ClearView, NEOS, and OnePath all pay on total and irrecoverable loss of two limbs, sight in both eyes, or one limb and sight in one eye. TAL lists this under its ADL definition (PDS 12 December 2024, page 88). ### 25% permanent whole-person impairment Three panel insurers include this as an alternative path, measured against the AMA Guides to the Evaluation of Permanent Impairment: - **NEOS Protection**: PDS 6 December 2024, page 71. - **OnePath OneCare**: PDS 1 October 2025. - **Encompass Protection**: PDS 26 September 2025. ### Activities of Daily Living (ADL) Inability to perform certain activities (bathing, dressing, eating, toileting, transferring) is the fallback test for clients without an active occupation. See [what an ADL TPD definition is and when it applies](/faqs/tpd-insurance/what-is-an-activities-of-daily-living-adl-tpd-definition-and-when-does-it-apply). ### Home Duties Acenda, NEOS, Encompass, and Futura assess clients performing full-time domestic duties at application under a Home Duties test rather than Any Occupation. For catastrophic-event payouts that bypass the three-month wait, see [whether TPD insurance pays out for events like loss of limbs or paralysis](/faqs/tpd-insurance/does-tpd-insurance-pay-out-for-catastrophic-events-like-loss-of-limbs-or-paralysis). ## What is not covered A narrow set of conditions and circumstances are specifically excluded across the panel: - Intentional self-inflicted injury. - Anything specifically excluded on your plan schedule (commonly a pre-existing condition endorsement from underwriting). - In some cases war or criminal acts. See [what exclusions apply to TPD policies](/faqs/tpd-insurance/what-exclusions-apply-to-tpd-insurance-policies) for the per-insurer detail. See [how TPD insurance handles pre-existing conditions](/faqs/tpd-insurance/how-does-tpd-insurance-handle-pre-existing-conditions) for how prior medical history affects what your specific policy will cover. The PDS for your specific cover defines exactly which test applies and any individual exclusions. Always read the Definitions and Exclusions sections before relying on a general summary.

**Pre-existing conditions are handled in two structurally different ways.** Retail [TPD cover](/glossary/insurance-types/tpd-insurance) is individually underwritten at application, so each condition is assessed and reflected in your offer terms. Default group [TPD cover inside super](/faqs/tpd-insurance/how-does-tpd-insurance-work-with-superannuation) instead applies blanket 'pre-existing condition' or 'limited cover' clauses for an initial period. The IMFL retail panel is AIA, Zurich, TAL, OnePath, ClearView, NEOS, Encompass, Acenda and Futura. The legal anchor for the application duty is the [Insurance Contracts Act 1984 (Cth)](https://www.legislation.gov.au/Details/C2017C00073). ## Retail TPD: full disclosure, four possible outcomes When you apply for retail TPD you complete a personal statement covering medical history, occupation, pastimes, family history and income. Under section 20B of the Insurance Contracts Act 1984 (Cth), inserted by the Insurance Contracts Amendment Act 2013, you have a duty to 'take reasonable care not to make a misrepresentation' to the insurer before the contract is entered. Based on what you disclose, the underwriter returns one of four outcomes: 1. **Standard rates.** The condition either does not affect underwriting risk, or its impact is too small to price for. 2. **Premium loading.** The premium is increased above standard to reflect higher expected claim risk. Loadings are usually expressed as a percentage uplift (for example, +50%) and can be permanent or time-limited. 3. **Exclusion endorsement.** A specific exclusion is written on your policy schedule (for example, 'no cover for any claim arising from or contributed to by lower back conditions'). This is the most common way for an existing musculoskeletal or mental-health history to be handled. 4. **Decline.** Where the risk is too high to price or exclude usefully, the insurer declines to offer cover. Brokers do not hold any underwriting authority; the decision is the insurer's. A disclosed condition that is loaded or excluded is on the schedule for the life of the policy. It is the gate that determines whether a future claim is paid. ### Where each panel insurer states the duty and the exclusion mechanic - **Zurich Wealth Protection**: 'legal duty to take reasonable care not to make a misrepresentation' (PDS 1 November 2025, page 68). - **AIA Priority Protection**: equivalent duty language (PDS 9 November 2025). - **Futura Protection**: equivalent duty language (PDS 1 October 2025). - **NEOS Protection**: schedule exclusion mechanic (PDS 6 December 2024). - **ClearView ClearChoice**: schedule exclusion mechanic (PDS May 2024 with update effective 5 June 2025, page 25). - **TAL Accelerated Protection**: same four-outcome framework (PDS 12 December 2024). - **OnePath OneCare**: same four-outcome framework (PDS 1 October 2025). - **Encompass Protection**: same four-outcome framework (PDS 26 September 2025). See [what should I do before applying for TPD insurance](/faqs/tpd-insurance/what-should-i-do-before-applying-for-tpd-insurance-to-ensure-the-best-coverage) for the disclosure process and [why so many TPD claims are rejected](/faqs/tpd-insurance/why-are-so-many-tpd-claims-rejected) for what happens when prior disclosure does not match the claim history. ## Default group TPD inside super: blanket pre-existing rules Most super funds offer default group [TPD cover](/glossary/insurance-types/group-insurance) without individual underwriting, up to an Automatic Acceptance Limit (AAL). The trade-off is a 'limited cover' or 'pre-existing condition exclusion' clause that runs for an initial period (commonly 12 to 24 months; read your fund's insurance booklet). During that period the policy only pays claims arising from new events, not conditions that existed before cover commenced. Once you have been in active employment for the prescribed period without medical absence, the policy converts to full cover. Members who voluntarily increase default cover above the AAL get underwritten by the fund's group insurer at that point. The retail four-outcome model then applies to the increase. ## What 'pre-existing' means A pre-existing condition is a sickness, injury, symptom or condition that you were aware of, or that a reasonable person in your circumstances could be expected to have been aware of, before cover started or was reinstated. Acenda Insurance (PDS 27 September 2025, page 59) captures it as: 'sickness or injury that first appeared, happened or was diagnosed, and which you were aware of or a reasonable person in your circumstances could be expected to have been aware of, before your Total and Permanent Disability insurance or Critical Illness insurances started or was last reinstated (unless disclosed to, and accepted by, us as a part of the application or reinstatement process).' ## The practical test at claim time At claim time the insurer requests: - Treating doctor reports. - Hospital records. - Medicare and PBS history. - Any prior insurance applications. If the medical record shows the condition existed and was not disclosed, the insurer may rely on its Insurance Contracts Act remedies. Remedies range from varying cover to the terms that would have applied had the duty been met, through to avoiding the contract from inception in cases of fraudulent misrepresentation. ## Disclosure trumps assumption The rule is the same across the nine retail PDS: if in doubt, disclose. The underwriter decides whether the disclosure is material. APRA's Life Insurance Claims and Disputes Statistics (reporting period ending 30 June 2025) show advised TPD acceptance at 82.88%, materially higher than the 69.88% non-advised rate. Meaningful disclosure at application is one of the biggest reasons. See [how TPD differs across the panel of Australian insurers](/faqs/tpd-insurance/how-does-tpd-insurance-differ-across-the-panel-of-australian-insurers) for how appetite for specific conditions varies, and [what is TPD insurance](/guides/what-is-tpd-insurance) for the broader product context. The PDS for your specific cover defines exactly how pre-existing conditions are treated on your policy. If there is any conflict between the PDS, the policy schedule and the application, the contract documents prevail.