Medical Evidence to Help With Your TPD Claim

If you are seeking Total and Permanent Disability (TPD) benefits, having the right medical evidence can make all the difference. TPD insurers, superannuation funds, and other relevant bodies rely on comprehensive documentation of your medical condition to determine your eligibility for a claim.

1300 679 222

Below, we explain the types of evidence you may need, from medical imaging reports to letters from your treating doctor or health professional, and how to make sure you present strong, relevant medical evidence when lodging your TPD claim.

Fill in the details and we’ll call you back

What Is the Medical Evidence for a TPD Claim?

Medical evidence for a TPD claim includes all supporting information documenting your diagnosis, treatment, and prognosis from qualified medical practitioners. This typically involves:

Medical certificate: A signed statement from your general practitioner or treating doctor confirming your medical condition, dates of treatment, and ability to work.
Medical imaging reports: X-rays, MRIs, CT scans, or other forms of evidence confirming an injury or illness.
Specialist assessments: Psychiatrists, ophthalmologists, or other treating health professionals may provide further information about specific eye conditions, ear conditions, or psychological injuries.
Occupational therapist reports: Evaluate your functional capacity and how your circumstances affect daily tasks.

When medical evidence shows that you have been reasonably treated and stabilised, it means you have followed planned treatment and your condition is unlikely to improve significantly within the next two years. This is often required for TPD insurers to consider your condition permanently incapacitated.

What Is an Independent Medical Examination?

An independent medical examination (IME) involves a medical practitioner or health professional, not directly involved in your ongoing treatment, conducting a fresh assessment of your condition. They may:

Review your medical information and reports (including those from your treating doctor, general practitioner, or other treating health professionals).
Conduct a physical or psychological examination to assess your symptoms and ability to perform work-related tasks.
Provide a medical report detailing your diagnosis, treatment history, and prognosis.

1300 679 222

The insurer or superannuation fund uses this IME as other evidence in addition to your treating doctor’s documentation, helping them determine if you meet their definition of disability and are eligible for TPD payment. If there is any discrepancy between your treating doctor’s findings and the IME, the insurer considers both sets of reports before making a decision.

What Is Included in a Medical Report for a TPD Claims Process?

A comprehensive medical report for TPD must typically address:

Diagnosis and Date Diagnosed: The doctor specifies when your condition first appeared or was officially recognised.
Treatment History: Records of any procedures, therapies, or further treatment you have undergone, including medical imaging reports, prescription medications, and consultations with specialists such as a treating ophthalmologist or psychologist.
Symptoms and Impact on Daily Life: Details about how your condition affects your ability to perform occupational tasks or even daily activities—especially relevant if you have eye conditions, ear conditions, or require assistance for an intellectual disability.
Prognosis: Whether your condition is expected to improve, remain stable, or worsen, consider all planned treatments.

Supporting Information from Other Health Professionals: Letters, reports, or additional evidence from your psychiatrist, occupational therapist, or any health professional involved.

Insurers will often request contact details of your treating doctor or specialist, in addition to any letter summarising your condition’s severity. Being thorough can expedite the process and prevent repeated requests for further information.

1300 679 222

What Medical Evidence Do You Need for a TPD Claim?

Relevant medical evidence for a TPD claim should confirm that you are permanently incapacitated and unable to work in your usual or any other occupation for which you are reasonably qualified. This could include:

Completed forms and questionnaires requested by the insurer or superannuation fund.
Special rate or DSP claim evidence if you have also applied for Centrelink benefits.
Statements from your treating health professionals, such as an occupational therapist or psychologist, outlining specific functional limitations.
Other evidence like diaries of symptoms, records of workplace adjustments attempted, or contact with a vocational assessor, if relevant to your ability to work.

If you have a child with special needs or you have a unique medical condition (e.g., requiring a treating ophthalmologist for eye conditions), your insurer may request additional supporting information about your circumstances.

How to Make a Successful TPD Claim With Medical Evidence Support

Start by requesting a copy of your medical certificate, medical imaging reports, and detailed medical information from each health professional treating you.

Ensure that all reports clearly outline your diagnosis, treatment, prognosis, and how your condition is treated.

Ensure Consistency

Discrepancies between one doctor’s report and another’s can slow or derail your claim. Make sure all health professionals have up-to-date details about your symptoms and any new planned treatment.

Lodge the Correct Forms

Provide evidence of your condition by completing all required TPD forms from your superannuation fund or insurer.

Keep contact details of your doctor, general practitioner, and any representative assisting you to facilitate efficient communication.

Follow Through on Further Treatment

If more procedures or therapies could improve your condition, insurers may want proof you have pursued them. Demonstrating you are reasonably treated and stabilised is crucial to show that no further treatment is expected to restore your ability to return to work.

Seek Professional Support

Consult a TPD-focused health professional, psychiatrist, or occupational therapist for targeted assessment.

An expert representative, like a TPD claims adviser or lawyer, can help you assemble a clear, cohesive file of relevant evidence.

TPD Helpline Can Refer You to Medical Practices If Further Treatment Is Required to Help Support Your TPD Claims Process

At TPD Helpline, we know collecting relevant medical evidence can seem daunting. Our services include guiding you through each stage of your TPD claim, clarifying the type of medical documentation you need, and suggesting treating health professionals, be it a psychiatrist, occupational therapist, or ophthalmologist, for additional assessment if required.

If your treating doctor believes you need to be seen by a new specialist or require updated medical imaging reports, we can help you find the right health providers. Our goal is to ensure you’re fully treated and that your claim has every chance of being paid.

Get in touch

Let us know know about your requirements

Phone

1300 679 222

Email

info@tpdhelpline.com.au

If you have any questions about your TPD claim, need guidance on gathering medical evidence, or simply want to talk through your concerns, we’re here to help. Our goal is to support you at every stage of your TPD journey—from understanding eligibility requirements to referring you to qualified medical practitioners if needed.

TPD Helpline Australia can be contacted on 1300 679 222. Our helpline reps are well-versed in all things related to TPD claims, injury compensation claims, health conditions, illnesses and injuries whether sustained at work or not. If there is an issue we can’t answer over the phone, we have access to a mountain of resources so that we can call you back within the day to provide answers.

Final Considerations

Date your documents and label each piece of medical evidence for easy reference.
Keep a record of any payment or reimbursements you receive, and note the contact details of any representative handling your claim.
If your condition changes, update your records with further treatment or assessment results.
For an example of how these requirements apply to specific circumstances, don’t hesitate to seek further information directly from TPD Helpline.