When it comes to TPD claims, you need all the evidence on your side: your story, your employer’s statement, your super fund’s policy wording.
But if there’s one thing that matters more than anything else, it’s your medical evidence.
At the centre of every TPD claim is one critical document: your doctor’s report. This is the piece of evidence insurers rely on most heavily when deciding whether your disability is permanent and whether it truly prevents you from working again.
The problem is many people don’t understand the medical assessment process. They provide evidence that is too vague, missing key information, or that doesn’t answer the questions insurers are actually trying to decide.
This guide explains why your medical evidence is the foundation of your claim, what your doctor’s report needs to say, common traps to avoid, and how to work with your doctor to strengthen your case.
Why Medical Evidence Matters
Insurers only have to assess your claim against the strict definition of TPD in the insurance policy. No matter how genuine your illness or injury is, if your doctor’s report doesn’t demonstrate that you meet that definition, your claim can be declined.
Medical evidence matters because:
- It proves permanency. Insurers must be satisfied that your condition will not improve enough for you to return to work.
- It defines capacity. The report should clearly state what you can and cannot do.
- It corroborates consistency. Reports from your GP and specialists need to align.
- It closes gaps. Missing or unclear evidence gives insurers room to delay or reject.
Tip: Most funds require at least two medical reports — one from your GP and one from a relevant specialist. Both must support the claim clearly.
How Insurers Scrutinise Medical Evidence
Insurers don’t just glance at your report. They scrutinise it for ways to reject or delay:
- Consistency across doctors – even small contradictions are seized upon.
- Compliance with treatment – if you stopped medication or therapy, they may argue you haven’t maximised recovery.
- Alternative work capacity – insurers often suggest you could retrain, take a “light duties” role, or work part-time.
- Detailed prognosis – they want a clear statement of permanency, not vague references.
- Gaps in treatment history – long periods without seeing doctors can be interpreted as “not serious.”
Some insurers also arrange Independent Medical Examinations (IMEs) with their chosen doctors. These reports are often less favourable, which is why your own treating doctors’ reports are so important to counterbalance them.
What Your Doctor’s Report Needs to Say
1. Clear Diagnosis
- Exact condition(s) (not just “back pain” but “lumbar disc degeneration”).
- Supporting test results (MRI, CT, pathology).
- History of when symptoms began and how they progressed.
2. Treatment History
- Medications prescribed and their effects.
- Surgeries or interventions attempted.
- Physiotherapy, counselling, rehabilitation outcomes.
- Clear evidence of compliance.
3. Symptoms and Daily Limitations
- Explanation of how your illness/injury limits work and daily activities.
- Examples:
- Physical: “Unable to stand longer than 15 minutes.”
- Mental: “Severe anxiety prevents sustained concentration.”
4. Prognosis and Permanency
- Whether further improvement is likely.
- Clear statement: condition is chronic and permanent.
5. Work Capacity
- Can you return to your own occupation?
- Can you return to any occupation suited to your skills/education?
- Explanation of why alternative or part-time work is not realistic.
6. Functional Assessments
- Lifting, sitting, standing tolerances.
- Psychological and cognitive restrictions.
- Stress tolerance and ability to interact socially.
7. Consistency Across Reports
- All treating doctors should provide reports that tell the same story.
Common Mistakes in Medical Reports
- Vague language: “Patient is unfit for work at present.”
- Short-term focus: Describes current symptoms but not permanency.
- Contradictions: GP says unfit, specialist suggests “light duties.”
- No link to work capacity: Lists conditions without connecting them to inability to work.
- Incomplete records: Missing hospital reports or diagnostic results.
Example Reports: Strong vs Weak
Physical Injury
- Weak: “Back pain, patient cannot work for now.”
- Strong: “Lumbar disc degeneration confirmed via MRI. Tried physio, injections, surgery without improvement. Cannot sit or stand longer than 20 minutes. Prognosis: permanent. Unfit for manual labour or sedentary office work.”
Mental Health
- Weak: “Patient has depression. On medication.”
- Strong: “Major depressive disorder diagnosed. Treatment since 2018. Experiences severe fatigue, panic attacks, and impaired concentration. Unable to sustain employment in any role. Condition is chronic and permanent.”
Progressive Illness
- Weak: “MS diagnosis, patient has fatigue.”
- Strong: “Multiple sclerosis confirmed by neurologist. Progressive deterioration over 5 years. Symptoms include loss of balance, double vision, severe fatigue. Unable to continue any occupation requiring mobility or concentration. Prognosis: irreversible.”
Special Considerations for Mental Health Claims
Mental health conditions are among the most common reasons for TPD claims, but they are scrutinised more closely than almost any other.
Insurers may argue:
- Symptoms are “subjective.”
- Treatment hasn’t been “maximised.”
- Claimant could work in a “low-stress” role.
To strengthen a mental health claim, reports should:
- Give specific examples of failed work attempts or breakdowns.
- Explain why even part-time or low-pressure roles aren’t viable.
- Provide evidence of ongoing therapy and compliance with medication.
Preparing Before You See Your Doctor
To help your doctor produce a stronger report:
- Bring your PDS – show them the policy definition of TPD.
- Provide your job description – so they can link symptoms to job duties.
- Keep a symptom diary – daily notes of pain, fatigue, or episodes.
- List all treatments – medications, side effects, therapies tried.
- Be honest – don’t exaggerate or minimise.
Checklist for a Strong Doctor’s Report
- Clear diagnosis with test results.
- Timeline of symptoms and treatment.
- Compliance with treatment plans.
- Specific work restrictions.
- Explanation of why you cannot return to work permanently.
- Clear statement on permanency.
- Aligned with policy definition (“own” vs “any” occupation).
- Functional limits (physical/psychological).
- Consistent with other doctors’ reports.
Real-Life Example
Case: Emma, 44, teacher with PTSD
- Initial GP report: “Patient is off work due to stress. Prognosis uncertain.” Claim rejected.
- With legal guidance, GP and psychiatrist rewrote reports: “Patient suffers chronic PTSD with flashbacks, avoidance behaviours, inability to supervise children. Prognosis: permanent. No realistic work prospects.” Claim then approved.
FAQs
How long should the report be?
Detailed enough to cover diagnosis, history, restrictions, and prognosis. One-page reports are rarely enough.
Do doctors charge for reports?
Yes. Many charge $200–$500. It’s usually worth the investment.
Can I change doctors?
Yes, but continuity is better. If you switch, ensure the new doctor has full records.
Do insurers keep asking for more reports?
They can. Often they’ll request updates or independent exams. Legal help can push back if it’s excessive.
Do I get to see the report?
Often yes, but some insurers request reports directly. Ask for a copy.
What if my GP and specialist disagree?
This weakens the claim. Sometimes clarification or a third opinion is needed.
Can insurers ignore my doctor’s report?
They must consider it, but they may weigh their own independent exam more heavily. That’s why consistency and detail matter.
Conclusion
Your doctor’s report is the single most powerful document in your TPD claim. It must do more than say you’re unwell — it must clearly explain why your condition is permanent and why you cannot return to work.
A vague, one-line report can doom your claim. A detailed, consistent, evidence-based report can secure a life-changing payout.
By preparing carefully, guiding your doctors, and seeking expert advice, you can ensure your medical evidence is strong and targeted to what insurers require.
At TPD Claims Lawyers, we help Australians every day strengthen their medical evidence and challenge insurer pushback. If you’re unsure whether your doctor’s report is strong enough, contact us for no-obligation advice.
Last updated: 29 August 2025