Total and permanent disability (TPD) claims are usually decided by reference to a specific definition in your policy, not a general sense of whether you can still work. Understanding which definition applies to you is one of the most important steps in preparing a claim.
Own occupation
An “own occupation” definition asks whether you are unable to work in your own specific occupation — the job you were actually doing, or one reasonably similar to it based on your training, education and experience. This is generally regarded as an easier test to meet, since it does not ask whether you could retrain into a completely different type of work.
Any occupation
An “any occupation” definition is generally stricter. It asks whether you are unable to work in any occupation you are reasonably suited to, based on your training, education or experience — not just the job you were doing. This broader test can mean an insurer argues you could work in a different role, even if you can no longer do your previous job.
Why this matters for your evidence
The definition that applies to your policy determines what your medical and vocational evidence actually needs to prove. Evidence that clearly shows you cannot return to your specific previous job may not, on its own, satisfy an “any occupation” test. This is why aligning your evidence to the correct policy definition — rather than simply gathering as many medical records as possible — is central to a well-prepared claim.
Checking which definition applies to you
Some people hold more than one TPD policy, potentially with different definitions in each — for example, across different superannuation funds from different periods of employment. It is worth confirming exactly which definition applies to each policy you hold before assuming your situation meets, or does not meet, the relevant test.
Frequently asked questions
Which definition is more common?
Both are used, and the applicable definition depends on your specific policy and fund, including when the cover was taken out.
What if my claim is declined under an “any occupation” test?
You can generally seek internal review, and if that does not resolve the dispute, make a complaint to the Australian Financial Complaints Authority (AFCA), which handles disputes about superannuation and insurance decisions.
See our page on TPD & Superannuation Claims for more detail, or contact WPI Lawyers to discuss your situation.