How to talk to your doctor about your TPD Claim
For many people considering a Total and Permanent Disability (TPD) claim, one of the most difficult steps is asking their doctor or specialist for assistance.
You may have been seeing your doctor for months or years for treatment, but discussing your future capacity for work can feel very different.
A common concern I hear is:
“How do I ask my doctor if they will support my TPD claim?”
The first thing to understand is that you are not asking your doctor to approve your TPD claim.
Your doctor’s role is to provide an independent medical opinion about your condition, treatment, functional limitations, prognosis and capacity for work. The insurer or superannuation fund ultimately determines whether you satisfy the TPD definition under your policy.
How do I start the conversation?
Rather than simply asking, “Will you support my TPD claim?”, you may feel more comfortable explaining why you are considering a claim and what assistance may be required from your treating doctors.
For example:
“I am looking at making a TPD claim through my superannuation because my health has prevented me from returning to work. The insurer will need information from my treating doctors about my condition, treatment, prognosis and capacity for work. Would you be comfortable assisting me with this?”
This allows your doctor to understand what you are asking without placing pressure on them to reach a particular conclusion.
Before Your Appointment
Your doctor may know your diagnosis and treatment history extremely well, but they may not fully appreciate how your condition affects you outside the consulting room.
Going into your appointment prepared can help your doctor understand the full picture.
Think about how your condition affects you in practical, day-to-day terms, including:
- your pain, fatigue or other symptoms;
- sitting, standing, walking or physical activity;
- concentration, memory or “brain fog”;
- sleep and medication side effects;
- flare-ups and recovery following activity;
- your ability to complete normal household and personal activities;
- what prevents you from performing your previous job; and
- whether you could realistically sustain another job on a regular and reliable basis.
Most importantly, explain why these limitations prevent you from returning to your previous occupation or sustaining other employment.
For a TPD claim, a diagnosis alone is generally not enough. The functional consequences of your condition and the resulting impact on your capacity for work are extremely important.
What Does Your Doctor Need To Consider?
Depending on your TPD policy, your doctor may be asked to provide an opinion about:
- Diagnosis – What medical conditions are affecting you?
- Treatment – What treatment has been undertaken and what treatment is continuing?
- Functional capacity – How do your conditions affect your ability to function physically, cognitively or psychologically?
- Prognosis – Are your limitations expected to improve sufficiently for you to return to work?
- Work capacity – Are you realistically capable of returning to your previous occupation or other suitable employment?
The functional impact of your condition is particularly important. A diagnosis alone does not explain why you cannot work.
Preparation Can Make a Difficult Conversation Easier
If you are nervous about the appointment, write down the important points you want to discuss beforehand.
Where relevant, it may also be helpful to take copies of:
- the TPD medical form;
- relevant medical or specialist reports;
- independent medical assessments or work capacity reports;
- your position description; and
- any information provided by your Claims Advocate.
If another treating doctor has already completed a TPD medical form, taking a copy may also help your specialist understand the information being requested.
The purpose of the conversation is not to convince your doctor to say something they do not believe.
It is to make sure your doctor has enough information to provide an informed and independent medical opinion about your health, functional limitations, prognosis and future capacity for work.
What If My Doctor Is Unsure?
Don’t assume that hesitation means your doctor does not support you.
Your doctor may need to review your medical records, consider your prognosis, obtain information from another treating practitioner or better understand what the insurer is asking them to address.
Doctors are medical professionals — they are not expected to be experts in insurance policy definitions. Their role is to provide their independent medical opinion.
If your doctor is uncertain, ask what additional information they need.
Your Claims Advocate can assist with explaining the insurance requirements and ensuring the relevant medical evidence is presented appropriately.
Most Importantly
This conversation is about your health and the genuine impact your condition has had on your life and ability to work.
Be open and accurate about the difficulties you are experiencing. Don’t minimise your limitations, but don’t exaggerate them either.
If you are nervous, write down your key points before your appointment and take them with you.
You are not asking your doctor to decide your TPD claim. You are asking for their assistance in providing an honest medical opinion about your condition and your future capacity for work.
Getting help with the TPD process
TPD claims can involve detailed medical evidence and policy-specific requirements, and it can be difficult to know what information will be important before approaching your treating practitioners.
At CM Claims Advocacy, I assist clients throughout the TPD claims process, including preparing for discussions with their treating doctors and helping ensure the relevant medical evidence addresses the requirements of their particular claim.
If you are considering a TPD claim and are unsure where to start, you are welcome to contact me for an initial discussion.
This article provides general information only. Every TPD policy and claim is different. The applicable TPD definition and evidence required will depend on the terms of your policy and your individual circumstances.
