Total and permanent disablement

a TPD payment
Applying for

26 August 2023
This information is about Cbus Super. It
doesn’t account for your specific needs.
Please consider your financial position,
objectives and requirements before making Not being able to work is a
financial decisions. Read the relevant Product scary prospect. We know
Disclosure Statement (PDS) and Target
Market Determination to decide if Cbus Super you’ll want financial security,
is right for you. Call 1300 361 784 or visit so we’ll make sure your claim
cbussuper.com.au.
is assessed as quickly as
United Super Pty Ltd ABN 46 006 261 623
AFSL 233792 as Trustee for the Construction possible.
and Building Unions Superannuation Fund
ABN 75 493 363 262 (Cbus and/or This brochure will help you
Cbus Super). understand:
Use of ‘us’, ‘we’, ‘our’ or ‘the Trustee’ is a ■ if you might qualify for a
reference to United Super Pty Ltd. Use of
‘Fund’ refers to Cbus Super. TPD payment
Insurance is issued under a group policy ■ how to apply, and
with our insurer, TAL Life Limited
ABN 70 050 109 450, AFSL 237848. ■ what happens after you
1214.1 08-23 ISS9 submit your claim.
 Over the past 3 years, we’ve approved

96.6% of all TPD

claims*

Total and permanent disablement (TPD) cover provides a safety net in the
form of a lump sum payment for eligible members whose working life is
cut short by injury or illness.
What’s a TPD payment? Is there a waiting period?
If you have TPD cover with Cbus Super and are totally and Usually, you’ll need to be off work because of your disability
permanently disabled, you may be able to get a TPD payment. for at least three months in a row before your claim can be
A TPD payment can be made up of: assessed. This is to ensure that claims are only made for serious
injuries or illnesses that cause significant long-term disability,
■ your super (less any fees and taxes that apply), and
which is what TPD cover is for.
■ an insurance payment (based on how much TPD cover you
have, your occupation category and your age). But if you have a specified medical condition the insurer will
assess your claim straight away, without a waiting period.
Are you covered? These conditions are listed on page 6.

Most Cbus Super members have some TPD cover. To see if you do: Do you need a lawyer?
■ log into your account at cbussuper.com.au/login
It’s entirely your decision, but you should consider that:
■ check your latest statement – note that your cover may
have changed since the statement was issued, or ■ we’ll assist you through each step of the process
■ call us on 1300 722 152. ■ all claims are assessed fairly and reasonably on their merits,
and most are paid
Your insurance cover needs to have been in place when you
■ timeframes and payment amounts are not influenced by
became disabled – see the next section on when you can claim.
legal representation
If you’re over 65, you won’t be insured for this type of benefit ■ we have a legal obligation to act in the best interests of our
unless you’re in our electech or electech utilities occupation
members, and
category or you’ve chosen to extend your TPD cover to age 70.
Unfortunately, you won’t have any cover through Cbus Super if ■ lawyers’ fees and disbursements may be considerable, so
you’re over 70. you should fully understand any costs involved when you
engage a lawyer.
To find out more about eligibility and when cover may stop,
see the insurance guide for your membership, available at
cbussuper.com.au/insurance or call us for a copy.
What if you don’t have insurance?
If you don’t have TPD cover but can’t work anymore due to
When can you make a TPD claim? illness or injury, you may be able to get access to your super
because of permanent incapacity.
To receive a payment, you must have had TPD cover when you
became disabled and our insurer must be satisfied that you We will let you know if this applies to you and explain what you
meet the definition of total and permanent disablement in the need to do.
insurance policy. Generally speaking, this means:
■ you’re unlikely to ever be able to work again in any job you’re
reasonably suited for (based on your education, training or We’re here for you
experience when your claim is assessed), or
We understand that if you need to make a claim you’re
■ you can’t do certain activities anymore or you have a mental
already going through a lot. The good news is that you
disorder that meets the TPD definition in the policy. don’t have to do it alone – we’re here to help.
Check the definition on page 5 to see if it covers your situation. Our Claims team will get to know your situation, talk you
through the process and support you with what you need
If you’re terminally ill to do. If you have any concerns along the way, we’ll help
If you have a terminal illness with a life expectancy of 24 months or resolve them.
less from when it was diagnosed, you may be able to get a terminal If you need some help, call us on 1300 722 152
illness payment (including an insured amount if you have cover). to speak to our Claims team, or you can email
Please call us for information on how to apply, as this is a [email protected].
different application to a TPD claim.

*Average TPD claim acceptance rate in the three years to 30 June 2023.

2 | Applying for a TPD payment

How to apply
There are a few steps involved in making a claim, but we’ll let you know what you need to do and will
keep you updated on your claim’s progress. If you have any questions along the way, our Claims team
will be happy to help.

1: Call our Claims team on 1300 722 152

During this call, we’ll talk to you about your situation and check if you might qualify for a payment. We’ll ask you about:
■ your illness or injury
■ the name and contact details of the employer where you last worked
■ when you stopped working.

After we have gathered your relevant information, we will send you a claim pack.

What does the Claims team do?

Our Claims team will help you understand the process and lodge your claim with the insurer. They’ll work with you to ensure
we have all the required information so your claim can be assessed as soon as possible. Once the claim is lodged they’ll also
make sure you’re kept updated.
If you have any questions you can always call our Claims team on 1300 722 152.

2: Prepare your application

The next step is to supply some information so your claim can be assessed. Details will be in the letter we post or email to you.
You’ll need to:
■ complete a claim form
■ ask your doctor to complete a form about your condition and provide any medical reports, test results or other evidence to
support your claim
■ get a certified copy of your driver’s licence (both sides) or your passport
■ sign a form so the insurer can access information needed to assess your claim (such as medical records).

The insurer may contact your last employer to confirm how long you worked for them, the sort of work you were doing and
why you stopped working.

What’s a certified copy?

To certify your documents:
1. Make copies. Remember to copy both sides if your ID is double-sided (for example, your driver’s licence).
2. Take the original documents and your copies to a post office or police station. If you can’t get to a post office or police
station, see our Identification requirements brochure at cbussuper.com.au/cs/id or call us to find out who else can certify
your documents.
3. Ask them to certify your copies. They’ll compare your original identification with the copies and certify them.
4. Send us your certified copies. Send your certified copies (not the originals) to us along with any other forms and
documents we asked for. You can send certified documents to us in the post, or provide them to us in person by visiting a
front counter or contacting your local Coordinator.

3: Check your application and send it to us

Before sending us your application, make sure:
■ your doctor’s form is fully completed and signed
■ you’ve got everything we asked for in our letter (including certified copies of your ID), and
■ you’ve signed any forms you needed to complete.

It could take time for your doctor to complete the form, so you might need to schedule an appointment to see them. We
recommend contacting your doctor to understand their requirements. Please note there may be an additional fee for
completing this form, which will be your responsibility to cover.
When you have everything ready, please scan and email or post your completed forms to our Claims team. (Any certified copies
must be posted or provided to us in person.)

Applying for a TPD payment | 3

 4: The insurer assesses your claim
The insurer will review the information they’ve received as quickly as possible, update you on progress and let you know if they
need anything else to assess your claim. They may:
■ ask for more information from you, your doctors or your former employer, or
■ make an appointment for you to see another doctor – the insurer will pay for this, but if you miss your appointment you may
have to pay a non-attendance fee.
In some situations, you’ll be asked to review the information that’s being used to assess your claim. You’ll also be given the
chance to provide any further medical or other evidence that could help support your claim for the insurer to consider.

5: The insurer decides and we review

Based on the information provided, the insurer will decide your eligibility for cover and if they’re satisfied that you meet the TPD
definition in the insurance policy. They’ll advise us of their decision to accept, defer or decline your claim.
■ Accept: If your claim is accepted, any insurance payment will go into your super account and we’ll write to you to confirm
the details and ask how you’d like to be paid. You can choose to:
– have the whole amount paid into your bank account
– keep some or all of the payment in your Cbus Super account, or
– transfer some or all of the payment to a Cbus Super Income Stream account or another approved super fund.
In some cases, you may need to provide another medical certificate at this stage before we can release your payment.
We’ll let you know if this applies to you.
■ Defer: The insurer may decide to defer your claim for a period if they believe more time is needed to determine the full extent
of your disability and whether it’s permanent. For example, they may do this if you need to have surgery, or your doctor feels
your condition is likely to improve over time with treatment. They’ll review your claim again at the end of this period.
■ Decline: If we agree with the insurer’s decision to decline your claim, we’ll write to you to explain why.

What if we disagree with the insurer’s decision?

If the insurer believes your claim should be deferred or declined, we’ll independently review your claim and form our own
opinion. The role of this review is to ensure the insurer’s decision is fair and reasonable and complies with our insurance
policy, trust deed and super laws.
If we disagree with the insurer’s decision, we may ask them to reconsider the claim or ask for further medical evidence.

6: We’ll tell you the final decision

At the end of the review, we’ll write to you to tell you if your claim has been accepted, deferred or declined. If you disagree
with the decision or you’re not happy with how your claim has been managed, you can ask for a review or lodge a complaint –
see page 8 for details.

About your payment

If your TPD claim is successful, the money will go into your super account and be invested in the same investment options
as the rest of your super. We’ll then get in touch to let you know:
■ how you can withdraw some or all of your insurance payment and super
■ how withdrawals will be taxed, and
■ any ongoing conditions you’ll need to meet for withdrawals after 12 months from payment of the insured benefit.

Once your payment is approved, you won’t have any more cover through Cbus Super. This means you or your family won’t
be eligible for any other insurance payments (including for death, terminal illness or TPD). But if you die or are diagnosed
with a terminal illness within 14 days of the insurer making a TPD payment and you have more death cover than TPD, we’ll
pay the death cover amount less the TPD amount already paid.
Insurance premiums will stop being deducted from your account the day we receive your TPD payment from the insurer.

You should get financial advice

We recommend you seek financial advice to understand the implications for you, including how you'll be taxed. It's important to
understand your options and how a TPD payment may affect other potential benefits such as Centrelink payments.
Call us on 1300 361 784 or go to cbussuper.com.au/advice for more information.

4 | Applying for a TPD payment

What does TPD mean?
The TPD definition is in two parts. The part that applies to you depends on whether you were working before you became disabled:

Part 1 – This applies if immediately before your date of disablement you were:
Unlikely • in full-time, part-time or casual work (or on employer-approved leave)
to return • self-employed and had done some paid work in the past 24 months, or
to work • unemployed for less than 24 months.
You’ll be considered totally and permanently disabled if:
• you can’t do your usual occupation because of injury or illness for three months in a row, and
• in the insurer’s opinion (based on medical and other evidence) you’re unlikely ever to be able to do any regular
remuneration work for which you’re reasonably suited, taking into account your education, training or experience when
your claim is assessed.
The three-month waiting period doesn’t apply if you have a specified medical condition.

Part 2 – This applies if part 1 doesn’t apply. You’ll be considered totally and permanently disabled if:
Everyday work • you have a mental disorder (as defined below), or
activities or • an injury or illness stops you from being able to do at least two of the five everyday work activities listed below without
psychiatric help from another adult (even if using appropriate aids) for at least 12 months in a row and the insurer believes you’re likely
impairment to need another adult’s help for the rest of your life to do at least two of these activities.
The 12-month waiting period doesn’t apply if you have a specified medical condition.
In either case you must also be:
• getting regular care from a doctor (or for a mental disorder, from a psychiatrist) for your injury or illness, and
• in the insurer’s opinion (based on medical and other evidence), unlikely ever to be able to do any regular remuneration work
for which you’re reasonably suited taking into account your education, training or experience when your claim is assessed.
Everyday work activities are:
1. Mobility – you can’t:
– walk more than 200m on a level surface without stopping due to breathlessness, or
– bend, kneel or squat to pick something up from the floor and straighten up again and get in and out of a standard
sedan car.
2. Communicating – you can’t:
– speak in your first language so that you’re understood in a quiet room and hear an instruction in your first language
said in a normal voice in a quiet room (even with a hearing aid), or
– understand a simple message in your first language, and relay that message to another person.
3. Vision – you can’t read ordinary newsprint and pass the standard eye test for a car licence (even with glasses or contact lenses).
4. Lifting – you can’t lift, carry or move a 5kg object with your hands.
5. Manual dexterity – you can’t manipulate small objects precisely with your hands or fingers (such as pick up a coin, tie
shoelaces, button a shirt, use cutlery or write a short note with a pen or keyboard).
A mental disorder is one that:
• has been diagnosed by a psychiatrist under the latest edition of the Diagnostic and Statistical Manual of Mental
Disorders (DSM) issued by the American Psychiatric Association (or a similar diagnostic tool determined by the Royal
Australian and New Zealand College of Psychiatrists Board)
• your psychiatrist believes won’t improve, and
• has been assessed by a psychiatrist appointed by our insurer as having an impairment of 19% or more on the Psychiatric
Impairment Rating Scale.

When is With reference to the relevant part of the TPD definition, date of disablement means:
your date of • for part 1: the date you were diagnosed with a specified medical condition or the date you first couldn’t do your usual
disablement? occupation for three months in a row, or
• for part 2: the date you were diagnosed with a mental disorder (as defined above) or the date you first couldn’t do at least
two of the five everyday work activities listed above for 12 months in a row or because of a specified medical condition.
To be eligible for a TPD payment, you must be insured under the policy on your date of disablement and meet part 1 or part 2
of the TPD definition.

What sort of work are you reasonably suited for? In other words, the insurer must believe there’s no real chance
What counts as suitable work will be: that you’ll return to work that suits your education, training or
experience.
■ based on any education, training or experience you’ve had
up to when your claim is assessed, and How often do you need to see your doctor?
■ determined when the insurer has enough evidence to make You need to be under the regular care and attention of a doctor
a decision. for your injury or illness. In most cases, this means you’d need
If you only need minimal retraining for work to be suitable, that to be seeing your doctor at least once a month, but the insurer
work will be considered to be within your education, training may make an exception if it’s clear that your condition doesn’t
or experience. require active medical management.
If relevant, your treating doctor will also provide medical
What does ‘unlikely ever’ mean? evidence to help determine if your condition stops you from
You’ll be considered unlikely ever to engage in regular suitable doing at least two of the five everyday work activities listed
work if, after reviewing all available relevant information, we and above and if this is likely to continue. The insurer may also
the insurer are satisfied that your prospects of being able to do arrange a test to measure your ability to do these tasks (known
this sort of work again are no better than remote or speculative. as a functional capacity evaluation) if they feel it’s needed.

Applying for a TPD payment | 5

Specified medical conditions*
If you’ve been diagnosed with one of these conditions your claim can be assessed straight away, without the need for a waiting period:
Advanced heart The persistent and irrecoverable failure of cardiac function resulting in severe symptoms to the degree of at least New York
failure (including Heart Association functional class III and interfering with daily life despite maximum evidence-based medical therapy.
cardiomyopathy)
Advanced Definitively diagnosed severe rheumatoid arthritis confirmed by a consultant rheumatologist, causing at least one of:
rheumatoid • permanent rheumatoid joint deformity supported by radiographic evidence of bone destruction and erosion, typical of severe
arthritis with rheumatoid arthritis
significant • permanent and irreversible inability to do at least two activities of daily living listed on page 7, or
permanent • permanent whole person impairment of at least 25% attributable to the condition.
impairment The diagnosis must be consistent with the latest American College of Rheumatology (ACR) / European Alliance of
Associations for Rheumatology (EULAR) classification criteria for rheumatoid arthritis. Degenerative osteoarthritis and all
other forms of arthritis are excluded.
Blindness The permanent and irrecoverable loss of sight (whether aided or unaided) in both eyes as a result of illness or injury to the
(permanent) extent that visual acuity on a Snellen scale after correction by suitable lenses is less than 6/60 or the visual field is reduced to
20 degrees or less of arc.
Chronic lung End-stage chronic lung disease with a consistent pulmonary function test result of:
failure (on • FEV1 less than 60% predicted, or
permanent • a DLCO less than 60% predicted, and
oxygen therapy) requiring permanent oxygen therapy.
Deafness The irrecoverable profound loss of all hearing in both ears, resulting in an auditory threshold of 91 decibels or more, averaged
(permanent) at frequencies of 500, 1000 and 3000 hertz, both natural and assisted, as a result of illness or injury. The condition must be
diagnosed by an appropriate specialist doctor.
Dementia The unequivocal diagnosis of dementia by an appropriate specialist doctor. The diagnosis must confirm dementia or
including Alzheimer’s disease due to permanent failure of brain function with associated cognitive impairment. A Mini-Mental State
Alzheimer’s Examination score of 24 or less out of 30 is required.
disease
(permanent)
Idiopathic Idiopathic pulmonary arterial hypertension with substantial right ventricular enlargement established by investigations
pulmonary arterial including cardiac catheterisation, resulting in permanent impairment to the degree of New York Heart Association functional
hypertension (of class III or above.
specified severity)
Loss of use of The total and permanent loss of function of two or more limbs through illness or injury causing permanent damage to the
limbs (permanent) nervous system. This includes quadriplegia, paraplegia, diplegia and hemiplegia.
Major head Accidental head injury resulting in neurological deficit causing:
trauma (with • permanent whole person impairment of at least 25%; or
permanent • the total and permanent inability to do any activities of daily living listed on page 7.
neurological
deficit)
Motor neurone Progressive neurological disorders that destroy motor neurons, unequivocally diagnosed by an appropriate specialist doctor
disease (with based on motor neuron signs and progression of symptoms over time. The diagnosis must be supported by neurophysiological
worsening tests and the exclusion of other causes by imaging and appropriate investigations.
neurological
deficit)
Multiple sclerosis A disease characterised by demyelination in the brain and/or spinal cord, unequivocally diagnosed by an appropriate
(with persisting specialist doctor. There must be more than one episode of well-defined neurological deficit resulting in persisting
neurological neurological abnormalities, or progressive worsening of neurologic function. Neurological investigations, such as a lumbar
abnormalities) puncture, MRI (magnetic resonance imaging) evidence of lesions in the central nervous system, evoked visual responses,
and evoked auditory responses, are required to confirm diagnosis.
Muscular The unequivocal diagnosis of muscular dystrophy by an appropriate specialist doctor. The diagnosis must be supported by
dystrophy appropriate clinical investigations, including a genetic test, muscle biopsy or electromyography.
Parkinson’s The unequivocal diagnosis of degenerative idiopathic Parkinson’s disease by an appropriate specialist doctor, caused by
disease degeneration of the nigrostriatal system and characterised by the clinical manifestation of bradykinesia in combination with
rigidity or rest tremor (or both). The condition must also have interfered with movement despite maximum evidence-based
medical therapy.
Severe burns Tissue injury caused by thermal, electrical or chemical agents causing full thickness burns to at least:
• 20% of the body surface area as measured by the Lund and Browder body surface chart
• 50% of both hands, requiring surgical debridement and/or grafting, or
• 50% of the face, requiring surgical debridement and/or grafting.
Speech loss The total and irrecoverable loss of the ability to produce intelligible speech as a result of permanent damage to the larynx or
its nerve supply or the speech centres of the brain. The loss must be certified by an appropriate specialist doctor.
*
The insurer may review and change these conditions from time to time, but you won’t be disadvantaged by this.

Different definitions may apply depending on your date of disablement. Call us if you’d like more information.

6 | Applying for a TPD payment

What are ‘activities of daily living’? ■ Toileting – The ability to get on and off the toilet and clean
Activities of daily living are: yourself without the physical assistance of another person.
You’ll be considered able to toilet yourself if you can care
■ Bathing – The ability to wash yourself in the bath or shower for your stoma or catheter or use adaptive devices to do
without the physical assistance of another person. You’ll be this task.
considered able to bathe yourself if you can do these tasks ■ Mobility – The ability to move in and out of a bed and chair
using equipment or adaptive devices.
without the physical assistance of another person. You’ll be
■ Dressing – The ability to put on and take off all garments considered mobile if you can do these tasks using motorised
without the physical assistance of another person. You’ll be equipment and supportive devices such as bed rails, grab
considered able to dress yourself if you can do these tasks bars, walkers, transfer platforms and canes.
using modified clothing or adaptive devices such as tape
fasteners or zips. How is whole person impairment assessed?
■ Feeding – The ability to get food from a plate into your Whole person impairment is a way of measuring a person’s
mouth without the physical assistance of another person, degree of impairment as a result of injury. The extent of
once the food has been prepared. You’ll be considered able impairment is expressed as a percentage of the functional
to feed yourself if you can do these tasks using assistive capacity of an uninjured healthy person, based on the
devices such as modified utensils and adaptive dinnerware. American Medical Association’s Guides to the Evaluation
of Permanent Impairment.

Applying for a TPD payment | 7

If you’d like a review
We strive to provide great service to our members and resolve
any issues as quickly as possible. So if you’re not happy with how
your claim was managed or the final decision, it’s important we
hear from you.

1. Tell us your complaint

■ Online: cbussuper.com.au/complaint
■ Call: 1300 722 152
■ Write to:
Complaints Officer
Cbus Super
PO Box 24231
Melbourne 3001

2. We’ll investigate
■ We’ll investigate your complaint, making sure it’s dealt
with fairly and promptly.
■ We may also ask you to provide more information so we
can fully understand the issues you’re not happy about. Need some help? Contact us
3. We’ll let you know the outcome [email protected]
cbussuper.com.au
■ In most cases, we’ll write to you to let you know the
Log in to chat to us online
outcome of our review, the reasons for our decision
and what else you can do if you’re still not satisfied.
■ If your concerns are resolved by phone within five days 1300 722 152 8am to 5.30pm (AEST/AEDT)
of receiving your complaint, we won’t follow up with a Monday to Friday
written response unless you ask for one.
You can also lodge your complaint with the Australian Financial Visit us in person in Adelaide, Brisbane, Melbourne,
Complaints Authority (AFCA). Perth and Sydney.
Details: cbussuper.com.au/contact
Write to: AFCA, GPO Box 3, Melbourne VIC 3001
Call: 1800 931 678
Email: [email protected] Contact your local Cbus Super coordinator if you
need additional support in your area.
Visit: afca.org.au
Details: cbussuper.com.au/coordinators
For more about the complaint process and the timeframes
that apply, go to cbussuper.com.au/complaint or call us.
Cbus Super, Locked Bag 5056
PARRAMATTA NSW 2124

This fact sheet is a summary, and benefits will only be paid in accordance with the Trust Deed and the full eligibility terms and conditions in the relevant insurance
policy. For more information on insurance cover visit cbussuper.com.au/insurance.

8 | Applying for a TPD payment