Claim Story: $34,000 TPD Payout – Approved Over a Decade After Ceasing Work

Client Profile

Name: Mr MM

Occupation prior to disability: Full-time Boilermaker

Superannuation Fund: Oasis Superannuation Master Trust – Personal Division

Insurance Provider: Zurich

Insurance Type: Total and Permanent Disablement (TPD) under Group Life Plan

Claim Amount Paid: $34,000

Case Background

Mr. MM joined the Oasis Superannuation Master Trust Employer Division on 30 August 2002 through his employer ABC and held one unit of life insurance cover. In March 2003, he transitioned into the Personal Division after ceasing employment with the sponsoring employer. His insurance cover officially ceased on 29 March 2014 when his superannuation balance was transferred to the Australian Taxation Office (ATO).

He ceased working on or around 13 March 2013 due to a traumatic brain injury sustained during a violent home invasion. At the time, Mr. MM was working full-time and earning approximately $56,000 per year, confirming his status in gainful employment.

Medical Evidence

Following the incident, Mr. MM suffered a gunshot wound to the left parietal region of the brain. This resulted in:

• Traumatic Brain Injury (TBI)

• Post-Traumatic Stress Disorder (PTSD)

• Cognitive impairment

• Memory loss and concentration difficulties

• Social withdrawal

• Permanent physical disability (wheelchair-bound)

Two general practitioners supported the claim:

• Dr. EL confirmed MM’s inability to walk and diagnosed both TBI and PTSD. He stated MM could not return to work due to cognitive deficits and psychological trauma and was unsuitable for retraining based on his background.

• Dr. M provided an Invalidity Statement, reiterating the diagnoses and describing a poor long-term prognosis.

  
  

Medical Assessment

Zurich reviewed the claim under the TPD definition in the Oasis Superannuation Master Trust – Personal Division policy, which requires that:

A member is considered totally and permanently disabled if they are: Unable to engage in any gainful employment for six consecutive months due to illness or injury; and Unlikely to ever return to any occupation for which they are reasonably suited by education, training, or experience.

Taking into account Mr. MM’s long-term cognitive and functional impairments, and his background in heavy manual work with no scope for retraining, Zurich concluded that he met the criteria under the TPD definition.

Claim Resolution

Zurich accepted the claim and paid the full insured TPD benefit of $34,000, which was deposited into the client’s nominated bank account. The payment reflected the insured value as of the date of disablement: 13 March 2013.

Key Insights

• TPD benefits can still be paid even if your superannuation account has been transferred to the ATO.

• You may qualify for a TPD claim if you are permanently unable to work in any field related to your education, training, or experience.

• Accurate income history is essential to confirm you were in gainful employment at the time of the event.

• Detailed and consistent medical evidence is crucial for a successful TPD assessment.