TPD lump sum insurance benefit

What do I need to do?

If you believe that your patient is unlikely to return to their full duties in their normal job for medical reasons or incapacity, you should advise them to seek legal advice about lodging a potential TPD claim with their superannuation fund.  Whilst your patient can lodge their own claim, it is recommended that they seek legal advice before lodging a claim owing to the complex legal issues involved.

As part of the claims process, the superannuation fund is likely to require the treating doctor to provide a medical opinion about their patient’s capacity for work. Generally, the superannuation fund will prefer the opinion of the doctor who was treating the patient at the time they ceased work. If this doctor is unable to provide an opinion, another treating doctor may be acceptable.

The doctor will be required to provide a retrospective medical opinion, based on past clinical notes, about their patient’s condition at the time the patient ceased work rather than an opinion based on the patient’s current medical condition/s.

The medical opinion can be based on the balance of probabilities, or what is ‘likely’. It need not be an opinion based on what will definitely happen.

If your patient has a terminal condition and applies to the superannuation fund for early release of their superannuation, the doctor’s view about their patient’s prognosis will be sought from the fund. The fund will make a decision based on the information available to it at the time it assesses the claim.  If the prognosis was ultimately incorrect and the patient was paid the benefit as a result, the doctor will not be held accountable for this and the patient will not be required to repay the benefit.