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Status and seniority ruled out in TPD claims
Maintaining previous job status and standing cannot be called upon to justify being determined totally and permanently disabled (TPD), according to a recent determination by the Superannuation Complaints Tribunal (SCT).
The SCT has upheld a decision by a superannuation fund and its insurer to refuse a TPD claim by a member which, in part, was based on his claim that alternative forms of employment fell beneath his job status and experience.
The SCT panel noted that the complainant had sought to be declared TPD raising the issue that suggested alternate forms of employment identified as part of a vocational assessment were beneath the seniority he had enjoyed in his previous role.
It said he had suggested that he should not be required to have to more menial occupations such as an administrative assistant or a delivery driver.
However the SCT said the complainant's views were misguided in that the definitions of TPD in both in the relevant insurance policies required the Complainant to be:
- Policy 1 — … incapacitated to such an extent as to render the Covered Person unlikely ever to engage in or work for reward in any occupation or work for which he or she is reasonably qualified by reason of education, training or experience; or
- Policy 2 — … incapacitated to such an extent as to render the Insured Member unlikely ever to engage in any gainful profession, trade or occupation for which the Insured Member is reasonably qualified by reason of education, training or experience.
"The definitions are clear in that they require incapacity such that the person being assessed against them must be unlikely ever to engage in any occupation, profession, trade, or work for which they are reasonably qualified as a result of the person's education, training or experience," the determination said.
"Neither definition makes any mention of status, seniority, or of a requirement that the work that they are able to engage in, bares any relationship to the seniority of or contain similar duties (such as the supervision of staff) to the role or roles which the person being assessed held prior to the onset of the condition which caused the incapacity."
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