Once you lodge a TPD claim, it goes through a structured assessment process. Understanding what the insurer is looking for at each stage helps you provide the right evidence and improves your chances of approval.
Stage 1: Initial review
The insurer checks that the claim form is complete and that basic eligibility criteria are met — active cover at the time of disability, the waiting period satisfied, and the claim within any time limits.
Stage 2: Medical assessment
The insurer reviews all medical evidence you've submitted. They look for:
- A clear, established diagnosis
- Evidence of treatment and its outcomes
- A specialist opinion on prognosis and long-term work capacity
- Consistency between different treating practitioners
The insurer may also request an Independent Medical Examination (IME) — where they send you to a specialist of their choosing for an assessment.
Stage 3: Occupational and vocational assessment
For any-occupation claims, the insurer may engage a vocational assessor to identify whether there are any jobs you could realistically do given your condition and background. This stage is critical and is where many claims are contested.
Stage 4: Trustee decision
For super fund TPD claims, the insurer recommends a decision, but the super fund trustee makes the final call. The trustee may accept or reject the insurer's recommendation. Start with our free eligibility check.