Total Permanent Disability Contact Form

1300 300 457

Mon-Fri 7:30AM - 6:00PM

Total Permanent Disability Contact Form

Welcome to our Total Permanent Disability Contact Form!

Please complete the information feels below so that we can respond to your information requests. The more accurate you are in completing the form, the more useful our response is likely to be.

Please note that our response to your information request is necessarily limited in its efficacy and accuracy.

The response should not be relied on as advice specific to your particular circumstances the full and complete details of which we remain unaware.

Do not make any decisions or take any action is reliant solely upon our response.

For detailed information specific to your circumstances you should request a phone contact or phone us now on1300 300 457. One of our expert lawyers will respond promptly.

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Total Permanent Disability Contact Form

Step 1. Your situation

Please fill out all information as accurately as you can.

Do you have an active Superannuation Fund TPD or Income Protection policy?

Yes

What is your current age?

How did your injury or illness occur?

Occurred in a vehicle

Occurred at work

Occurred in a public area

Occurred due to a medical negligence

Occured in other circumstances

Total Permanent Disability Contact Form

Please note strict time limits apply and it is in your interests not to delay making contact with us. Otherwise, you may be out of time and lose all your rights.

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Step 1. Your situation (continued)

Please fill out all information as accurately as you can.

Do you have a copy or able to access your last quarterly Super Fund statement?

Yes

Did you select TPD insurance cover from your superfund or is it default cover?

Please input your super fund details in the table below.

#	Super fund	Member #	Super balance
1	Super fund		Member #		Super balance	$

Total Permanent Disability Contact Form

Please note strict time limits apply and it is in your interests not to delay making contact with us. Otherwise, you may be out of time and lose all your rights.

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Step 1. Your situation (continued)

Please fill out all information as accurately as you can.

Have you lodged a claim?

Total Permanent Disability Contact Form

Please note strict time limits apply and it is in your interests not to delay making contact with us. Otherwise, you may be out of time and lose all your rights.

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Step 1. Your situation (continued)

Please fill out all information as accurately as you can.

What benefit(s) did you claim through your super fund?

Total Permanent Disability Contact Form

Please note strict time limits apply and it is in your interests not to delay making contact with us. Otherwise, you may be out of time and lose all your rights.

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Step 1. Your situation (continued)

Please fill out all information as accurately as you can.

What is the status of your claim with your super fund?

Total Permanent Disability Contact Form

Please note strict time limits apply and it is in your interests not to delay making contact with us. Otherwise, you may be out of time and lose all your rights.

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Step 1. Your situation (continued)

Please fill out all information as accurately as you can.

What was the date your super fund made their decision on the claim?

Total Permanent Disability Contact Form

Please note strict time limits apply and it is in your interests not to delay making contact with us. Otherwise, you may be out of time and lose all your rights.

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Step 2. Your details

Please fill out all information as accurately as you can.

As a result of your injury or illness, what treatment did you have?

General Practitioner (GP)

Physiotherapy

Surgery

Other treatments

None of the above

As a result of your injury or illness, where have you had treatment?

When did your injury occur or your illness begin?

I don't know / un-sure of date

Total Permanent Disability Contact Form

Please note strict time limits apply and it is in your interests not to delay making contact with us. Otherwise, you may be out of time and lose all your rights.

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Step 2. Your details (continued)

Please fill out all information as accurately as you can.

Are you currently working?

Yes

Total Permanent Disability Contact Form

Please note strict time limits apply and it is in your interests not to delay making contact with us. Otherwise, you may be out of time and lose all your rights.

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Step 2. Your details (continued)

Please fill out all information as accurately as you can.

Total Permanent Disability Contact Form

Please note strict time limits apply and it is in your interests not to delay making contact with us. Otherwise, you may be out of time and lose all your rights.

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Step 3. Your results

Please fill out all information as accurately as you can.

First name *

Last name *

Email address *

Phone *

Postal address *

Date of birth *

Additional message

Total Permanent Disability Contact Form

Please note strict time limits apply and it is in your interests not to delay making contact with us. Otherwise, you may be out of time and lose all your rights.

Return to main page

Total Permanent Disability Contact Form

Total Permanent Disability Contact Form

Step 1. Your situation

Total Permanent Disability Contact Form

Step 1. Your situation (continued)

Total Permanent Disability Contact Form

Step 1. Your situation (continued)

Total Permanent Disability Contact Form

Step 1. Your situation (continued)

Total Permanent Disability Contact Form

Step 1. Your situation (continued)

Total Permanent Disability Contact Form

Step 1. Your situation (continued)

Total Permanent Disability Contact Form

Step 2. Your details

Total Permanent Disability Contact Form

Step 2. Your details (continued)

Total Permanent Disability Contact Form

Step 2. Your details (continued)

Total Permanent Disability Contact Form

Step 3. Your results

Total Permanent Disability Contact Form

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