Delivering outstanding TPD and income protection insurance claims results

Trauma / Critical Illness Claims

If you’ve been diagnosed with a serious illness or medical condition such as cancer, heart attack, or stroke, you may be entitled to a lump sum payout under a trauma insurance policy. Our legal team helps you confirm eligibility, collect medical evidence, and secure the benefits you and your family need.
Start Your Trauma Claim

Are you eligible to make a Trauma / Critical Illness claim?

We’ll guide you from start to finish — preparing the paperwork, gathering medical evidence, and simplifying the process so you know exactly what to expect.
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Our Process

Making the Trauma / Critical Illness Claim Process Clear and Supportive

We guide you through every stage — from assessing eligibility to finalising your claim — with clarity, care, and expertise, ensuring you feel supported and informed throughout.

Confirm Your Full Entitlement

01. Eligibility Review
We check if you qualify for trauma or critical illness benefits by assessing your diagnosis, medical evidence, and policy definitions to confirm you meet the required criteria.
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Gather Policy & Evidence

02. Document Collection
We obtain your trauma or critical illness policy and gather essential evidence, including medical reports, diagnostic records, and specialist assessments, to support your claim.
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Prepare a Claim Submission

03. Claim Preparation
We prepare a detailed submission with medical assessments, diagnostic reports, and supporting records to demonstrate the severity of your condition and entitlement to benefits.
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Lodge & Finalise Claim

04. Claim Management
We lodge your trauma claim with the insurer, prepare submissions, and manage communication. Our team follows up until your benefit is approved and paid, keeping you informed.
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We provide legal services to help individuals access permanent impairment benefits when injury or illness causes lasting loss of function. Our team ensures the process is clear, supportive, and well-managed from start to finish.

Our experienced lawyers guide you through every stage of the claim — from confirming eligibility to securing payment — tailoring our approach to your circumstances and working to achieve the compensation you deserve.

Eligibility for Permanent Impairment Claims

Trauma (critical illness) insurance pays a lump sum when you are diagnosed with a specified medical condition (e.g. cancer, heart attack, stroke) as defined in your policy. We assess your diagnosis and medical evidence against the policy wording to confirm eligibility under Australian standards.

What Is Eligibility for Trauma Claims?

Eligibility typically depends on: a covered diagnosis, meeting the policy’s clinical definition and severity criteria, and satisfying any waiting or survival periods. Policies may be standalone or linked to superannuation, each with different rules and evidence requirements.

Why Is Eligibility Important?

Trauma policies use precise medical definitions (not general descriptions). Confirming that your diagnosis matches the required tests, markers, and severity thresholds avoids rejection and speeds up payment.

Common Eligibility Challenges

  • Definition mismatch: Medical records don’t map neatly to the policy’s clinical criteria (e.g. biomarker levels, imaging, histopathology).
  • Waiting/survival periods: Policies often require a set period after diagnosis or event (e.g. 14 days) before a claim is valid.
  • Partial-benefit tiers: Some policies pay reduced benefits for “early” or “minor” conditions.
  • Exclusions/pre-existing: Certain pre-existing conditions or symptoms before cover may be excluded.
  • Linked covers: Interaction between trauma, life, and TPD benefits can affect entitlements.

Why Choose TPD Claims Lawyers?

  • Policy mapping: We translate clinical findings into the policy’s exact definition and severity thresholds.
  • Evidence alignment: We work with your specialists so reports address the insurer’s criteria clearly.
  • Australian focus: Experience with local insurer wordings and super-linked policy requirements.

Our Services Include:

  • Reviewing policy wording (standalone vs super-linked) and covered conditions.
  • Checking diagnostic evidence (e.g. histology, imaging, biomarker/troponin results) against policy thresholds.
  • Confirming waiting/survival periods and relevant dates of diagnosis or event.
  • Advising on partial vs full benefit eligibility and any exclusions.
  • Outlining next steps to prepare a compliant, evidence-based claim.

By confirming eligibility up front, TPD Claims Lawyers ensures your trauma claim matches the policy’s clinical definitions and is positioned for timely approval.

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Policy Definitions & Exclusions

Trauma and critical illness policies differ significantly between insurers, with each setting precise definitions for covered conditions and exclusions. Understanding these definitions is vital to ensure your diagnosis meets the exact wording required for a payout.

What Are Policy Definitions & Exclusions?

Each trauma policy includes a list of covered medical events (e.g. cancer, heart attack, stroke, major organ transplant) with strict clinical definitions. Exclusions may apply for pre-existing conditions, self-inflicted injuries, or conditions that don’t meet the policy’s diagnostic thresholds.

Why Is This Important?

Even if your doctor has diagnosed you with a serious illness, your insurer may deny the claim if the medical evidence does not align precisely with the policy’s definition. Reviewing policy wording upfront prevents delays and rejection.

Common Issues in Trauma Policy Terms

  • Technical definitions: Conditions like heart attacks may require specific enzyme levels or ECG changes, not just a clinical diagnosis.
  • Exclusions: Some policies exclude pre-existing conditions, lifestyle factors, or “early stage” illnesses.
  • Ambiguity: Complex or outdated medical language can make it difficult to confirm coverage.
  • Linked policies: Combined trauma/TPD covers may reduce or cancel benefits once one claim is paid.

Why Choose TPD Claims Lawyers?

  • Policy expertise: We interpret complex insurer definitions and explain them in plain English.
  • Exclusion analysis: We identify hidden exclusions or restrictions that could impact your claim.
  • Strategic advice: We help prepare medical evidence to fit the policy’s criteria and maximise your chances of success.

Our Services Include:

  • Reviewing the specific definitions of covered trauma conditions in your policy.
  • Advising on exclusions, waiting periods, and survival requirements.
  • Explaining how linked policies (e.g. trauma + TPD) interact.
  • Recommending evidence and medical reports that address insurer criteria directly.
  • Providing clear advice on eligibility and next steps before a claim is lodged.

By clarifying your policy’s definitions and exclusions early, TPD Claims Lawyers ensures your trauma claim is positioned for success and avoids unnecessary disputes.

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Medical Evidence & Specialist Reports

Trauma claims rely heavily on medical evidence. Insurers require detailed reports from your treating doctors and, in many cases, specialist assessments that align directly with the policy’s definitions. Getting this evidence right is essential for a successful claim.

What Is Medical Evidence for Trauma Claims?

Medical evidence typically includes hospital records, diagnostic imaging, pathology results, and reports from treating specialists. Insurers may also request independent assessments to confirm diagnosis and severity against policy criteria.

Why Is Specialist Input Important?

Most trauma policies specify medical thresholds for conditions like heart attack, cancer, or stroke. Specialist reports are critical to confirming these thresholds have been met. Without precise evidence, claims can be delayed or denied.

Common Challenges in Medical Evidence

  • Incomplete records: Missing diagnostic results or treatment notes can stall claims.
  • Conflicting opinions: Differences between treating doctors and insurer-appointed specialists may weaken your case.
  • Technical language: Reports may not address the insurer’s definitions directly, leading to disputes.
  • Independent assessments: Insurer-nominated specialists may not fully understand your history or ongoing condition.

Why Choose TPD Claims Lawyers?

  • Evidence coordination: We liaise with your treating doctors to ensure reports cover the insurer’s definitions in detail.
  • Specialist network: We connect clients with experienced medical specialists who provide clear, comprehensive reports.
  • Dispute handling: If the insurer’s specialist report conflicts with yours, we challenge inconsistencies and advocate strongly on your behalf.

Our Services Include:

  • Reviewing your existing medical records and identifying gaps in evidence.
  • Requesting detailed reports from treating doctors tailored to insurer requirements.
  • Coordinating independent specialist reports that strengthen your case.
  • Clarifying medical definitions to ensure evidence matches the policy wording.
  • Preparing a comprehensive medical evidence bundle to support your claim.

With the right medical evidence and specialist reports, TPD Claims Lawyers ensure your trauma claim is properly supported and positioned for approval.

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Benefit Calculation & Lump Sum Payments

One of the key features of trauma and critical illness insurance is the payment of a lump sum upon diagnosis of a covered condition. Understanding how this payout is calculated is essential to know what you’re entitled to receive.

What Are Lump Sum Trauma Benefits?

Unlike income protection, trauma claims are usually paid as a single lump sum rather than ongoing payments. The amount is typically set at the time you take out the policy and may vary depending on the level of cover purchased.

Why Is Benefit Calculation Important?

Insurers may reduce or deny payouts if the medical evidence does not match the policy’s definitions or if exclusions apply. Clear knowledge of the insured sum and how partial payments may work is vital to avoid surprises.

Common Challenges in Benefit Calculations

  • Partial benefits: Some policies pay only a portion of the insured sum for less severe conditions.
  • Linked covers: If trauma is combined with TPD or life insurance, one payout may reduce or cancel the others.
  • Policy limits: Maximum payout caps and waiting periods can affect the amount received.
  • Tax treatment: Depending on whether the policy is held inside or outside superannuation, tax obligations may differ.

Why Choose TPD Claims Lawyers?

  • Policy review: We explain exactly how much you are entitled to under your specific policy.
  • Clear advice: We help you understand whether you’ll receive a full lump sum or partial benefit.
  • Dispute resolution: If the insurer miscalculates or underpays, we act quickly to challenge the decision.

Our Services Include:

  • Reviewing policy terms to confirm the insured lump sum and any partial benefit clauses.
  • Advising on the interaction between trauma, TPD, and life insurance covers.
  • Explaining tax implications of trauma payouts held inside vs. outside superannuation.
  • Ensuring the insurer’s benefit calculation matches the terms of your policy.
  • Challenging underpayments or incorrect benefit assessments.

With expert advice from TPD Claims Lawyers, you’ll know exactly what your trauma benefit is worth and have support to secure the full amount you’re entitled to.

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Preparing & Lodging Your Claim

A trauma or critical illness claim must be supported by strong medical and financial documentation. Our team ensures your claim is prepared thoroughly and lodged correctly to give you the best chance of approval without unnecessary delays.

What Does Claim Preparation Involve?

We compile all relevant documents, including medical reports, diagnostic results, and financial records. This comprehensive submission is tailored to meet your insurer’s policy requirements and definitions.

Why Is Proper Lodgement Important?

Incomplete or inconsistent claim forms are one of the most common reasons insurers delay or reject claims. Ensuring your submission addresses all policy terms upfront significantly increases the likelihood of a smooth process.

Common Challenges in Lodging Claims

  • Missing evidence: Claims often fail when medical or financial documents are incomplete.
  • Complex forms: Insurer paperwork can be lengthy and confusing.
  • Additional requests: Insurers may demand further evidence if the initial submission is unclear.
  • Delays: Even small errors in documentation can result in significant time lost.

Why Choose TPD Claims Lawyers?

  • Attention to detail: We prepare each claim to anticipate insurer requirements and objections.
  • Efficient process: Our team manages deadlines to keep your claim moving forward.
  • Peace of mind: We handle the paperwork so you can focus on your health and recovery.

Our Services Include:

  • Compiling all required medical and financial documents for your claim.
  • Drafting and completing insurer claim forms to ensure accuracy.
  • Lodging the claim with your insurer or fund and confirming receipt.
  • Managing requests for further information or clarification.
  • Providing regular updates on claim progress and expected timeframes.

With TPD Claims Lawyers, your trauma claim is prepared and lodged with precision, giving you confidence that every requirement has been met from the very beginning.

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Managing Insurer Delays & Disputes

Even when you provide complete evidence, insurers may delay decisions or dispute aspects of your trauma or critical illness claim. Our team actively manages these situations to keep your claim moving and ensure your rights are protected.

Why Do Delays & Disputes Happen?

Insurers may take excessive time to review claims, request repeated medical evidence, or challenge whether a diagnosis meets the policy’s definitions. These tactics often frustrate claimants and create unnecessary stress during recovery.

Why Is Dispute Management Important?

Without strong legal support, delays can drag on for months, and disputed claims may be unfairly rejected. Having experienced lawyers ensures that insurers remain accountable and your claim receives fair consideration.

Common Challenges with Insurers

  • Unreasonable delays: Claims sitting idle without proper updates or progress.
  • Disputed conditions: Insurers arguing that the medical diagnosis does not meet policy wording.
  • Repeated requests: Ongoing demands for extra documents after evidence has already been provided.
  • Low offers: Attempts to reduce payouts through partial or redefined benefits.

Why Choose TPD Claims Lawyers?

  • Proactive follow-up: We apply pressure on insurers to provide timely responses.
  • Expert advocacy: Our team challenges disputes directly and presents strong legal arguments.
  • Client protection: We ensure you are not taken advantage of by complex policies or insurer tactics.

Our Services Include:

  • Monitoring claim progress and holding insurers accountable for delays.
  • Responding to dispute letters or requests for further medical evidence.
  • Negotiating with insurers to resolve disagreements quickly and fairly.
  • Escalating claims to AFCA or court if disputes cannot be resolved directly.
  • Providing regular updates so you are never left in the dark about your case.

With TPD Claims Lawyers, you have an experienced advocate on your side, ensuring insurers cannot delay or dispute your trauma claim unfairly.

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Rejected or Disputed Trauma Claims

Even with valid medical diagnoses, trauma and critical illness claims are sometimes unfairly rejected or reduced by insurers. Our role is to challenge these outcomes and pursue the benefits you are rightfully entitled to under your policy.

Why Are Trauma Claims Rejected?

Insurers may dispute whether your illness or injury falls within the policy definitions, argue exclusions apply, or claim the evidence provided is insufficient. These disputes often create stress and financial pressure at the worst possible time.

Why Is Legal Support Important?

Without legal representation, it can be overwhelming to challenge an insurer’s decision. Skilled lawyers understand policy wording, medical evidence requirements, and dispute processes — ensuring your appeal is handled effectively and within strict time limits.

Common Reasons for Disputes

  • Policy wording: Insurers claim the condition doesn’t meet their definition of a “critical illness.”
  • Exclusions: Denial based on pre-existing conditions or technical policy clauses.
  • Medical evidence: Conflicting or insufficient reports from doctors.
  • Administrative issues: Errors or delays in how the claim was prepared or assessed.

Why Choose TPD Claims Lawyers?

  • Appeals expertise: We prepare strong appeals backed by detailed medical and legal arguments.
  • AFCA complaints: We escalate unfair decisions to the Australian Financial Complaints Authority when necessary.
  • Focused advocacy: Our sole focus on insurance claims means we understand how to overcome insurer tactics.

Our Services Include:

  • Reviewing rejection letters and identifying weaknesses in the insurer’s reasoning.
  • Gathering additional medical or financial evidence to strengthen your appeal.
  • Preparing formal appeals directly to the insurer or trustee.
  • Escalating disputes to AFCA or court where required.
  • Providing clear advice on your prospects of success and best next steps.

With TPD Claims Lawyers, you don’t have to accept a rejected trauma claim. We fight for your entitlement and ensure your claim is given fair and proper consideration.

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Taxation of Trauma / Critical Illness Benefits

Unlike some other types of insurance payouts, trauma and critical illness benefits are generally treated differently under Australian tax law. Understanding how your payout will be taxed is essential for planning your financial future after a diagnosis.

How Are Trauma Benefits Taxed?

Standalone trauma or critical illness benefits are usually paid as a lump sum and are not taxable in Australia if the policy was taken out personally and premiums were paid with after-tax income. However, if the cover is held inside superannuation, the benefit may be taxed upon withdrawal depending on your age and circumstances.

Why Is Tax Advice Important?

Incorrect assumptions about tax treatment can leave you with less money than expected. Getting proper advice ensures you maximise the benefit and avoid unintended liabilities.

Common Tax Considerations

  • Standalone policies: Lump sum trauma payouts are typically tax-free when held outside super.
  • Superannuation-linked trauma cover: Withdrawals may attract tax if you’re under preservation age.
  • Multiple policies: Receiving trauma alongside TPD or income protection benefits can affect how benefits interact and are taxed.
  • Estate planning: Tax implications differ if trauma benefits are paid to your estate or beneficiaries.

Why Choose TPD Claims Lawyers?

  • Policy analysis: We review how your trauma cover is structured — inside or outside super.
  • Financial awareness: We explain how your age, preservation rules, and payout structure may impact tax.
  • Collaborative support: We work with financial advisers and accountants to help you plan effectively.

Our Services Include:

  • Clarifying the tax treatment of your trauma or critical illness payout.
  • Advising on the interaction between trauma, TPD, and income protection benefits.
  • Highlighting preservation age and superannuation withdrawal issues.
  • Supporting estate planning considerations where benefits flow to dependents.

With TPD Claims Lawyers, you’ll understand the tax implications of your trauma payout so you can focus on recovery, confident your financial position is secure.

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Eligibility & Factors

Key criteria for Trauma / Critical Illness claims

  • Covered Condition: The illness or injury must match the policy’s definitions (e.g., cancer, heart attack, stroke, or other specified critical conditions).
  • Severity Requirements: Many policies require that the condition meets a set severity threshold before benefits are payable.
  • Exclusions: Pre-existing conditions, self-inflicted injuries, or conditions not listed in the policy may be excluded.
  • Medical Certification: Diagnosis must be confirmed by a specialist or medical practitioner recognised under the policy.
  • Policy Structure: Whether the trauma cover is held inside or outside superannuation can affect eligibility and tax treatment.
  • Time Limits: Strict deadlines apply for lodging trauma or critical illness claims, depending on the policy terms.
  • Benefit Level: The payout is usually a lump sum defined in the policy, not linked to income or impairment ratings.
  • Multiple Policies: If you hold more than one trauma policy, you may be able to claim under each (subject to conditions).
Why Choose TPD Claims Lawyers

Supportive. Focused. Proven.

We help you access TPD, income protection, and death benefit payouts — with expert guidance and real results.

  • Fast Response Times
  • Specialist Legal Team
  • No Win, No Fee
  • Clear Legal Guidance
  • Trusted Claim Process
  • Client-Focused
2
days
Average time to complete an initial claim review.
10
hrs
Average response time to new client enquiries.
80
%
TPD Claims Approved
Core Values

Guided by experience, driven by results

We are dedicated to helping Australians access their full insurance entitlements with clarity, compassion, and persistence. Our values shape how we approach every claim and how we support every client.
Our Mission

TPD Claims Lawyers is a specialist legal team dedicated to helping Australians access their full insurance entitlements when injury or illness prevents them from working. As part of the Carter Capner Law group, we proudly carry on a tradition of legal excellence that spans over 75 years.

Our mission is to apply our deep knowledge of TPD, income protection, and death benefit claims to deliver legal outcomes that truly support our clients’ financial recovery and peace of mind. We aim to simplify complex processes and provide guidance every step of the way.

We are committed to acting with compassion, integrity, and precision — anticipating obstacles and addressing them with strategy and care to achieve the best result possible for every client.

Our Approach

Exceptional legal service is about more than just lodging forms — it’s about supporting you through one of life’s most difficult moments with clarity, compassion, and experience.

We understand that every person’s situation is unique. Whether you’re navigating a Total and Permanent Disability (TPD) claim, pursuing income protection benefits, or seeking a death benefit after losing a loved one, we take the time to learn about your circumstances in full. We don’t just process claims — we listen, investigate, advise, and act in your best interests at every stage.

Our firm is built around a simple but powerful idea: people first. We take a compassionate, client-focused approach that makes legal processes less overwhelming. We cut through complexity and communicate in plain language — not legal jargon — so you feel informed and empowered from start to finish.

To ensure your matter progresses efficiently, we use up-to-date case management systems that allow our team to provide real-time updates. You’ll never be left wondering where your claim stands — and we’re always available to answer questions when you need us.

frequently asked questions
A trauma claim provides a lump sum payout if you are diagnosed with a serious medical condition (such as cancer, heart attack, or stroke) listed in your policy.
No. Trauma claims are based on your diagnosis and policy terms — not on proving someone else caused your condition.
Most claims take several months to assess, depending on medical evidence, policy complexity, and insurer response times.
The insured person can make the claim directly. If the policy is held within superannuation, your super fund may lodge the claim on your behalf.
Common requirements include medical reports, diagnostic test results, specialist certificates, and a copy of your policy.
You can challenge insurer decisions by providing further medical evidence, lodging a dispute internally, or escalating to AFCA (Australian Financial Complaints Authority).
Yes. Policies often impose strict deadlines for notifying or lodging a claim after diagnosis. Acting quickly helps protect your rights.
While not mandatory, a lawyer ensures your claim is fully supported, manages insurer delays, and helps if the claim is denied or disputed.
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