If you’ve made a Total and Permanent Disability (TPD) claim through your superannuation, you may have discovered that not all TPD policies are the same. Many claimants first encounter the distinction between “own occupation” and “any occupation” when their insurer requests extensive medical records, employment history, or vocational assessments or worse, when a claim is declined on the basis that they could still perform “some type” of work.
Understanding the difference between these two definitions is critical. The type of policy you hold directly affects the evidence required, how your capacity is assessed, and the likelihood of a successful claim.
What Is “Own Occupation” TPD?
Under an “own occupation” definition, you are considered totally and permanently disabled if you are unlikely ever to return to your specific occupation at the time of injury or illness.
The focus is narrow. The insurer assesses whether you can return to the role you were trained for and performing before you became unwell or injured.
For example, if a surgeon develops a hand tremor that prevents surgical practice, they may satisfy an “own occupation” definition even if they could theoretically perform administrative or teaching work.
Evidence in these claims typically centres on:
- Detailed medical reports addressing functional capacity
- A precise description of your pre-disability duties
- Specialist opinion about whether those duties can be resumed
The key issue is your ability to perform your occupation, not alternative work.
What Is “Any Occupation” TPD?
An “any occupation” definition is broader and more restrictive.
Under this definition, you must show that you are unlikely ever to engage in any occupation for which you are reasonably suited by education, training, or experience.This means the insurer does not only assess whether you can return to your previous role. They examine whether you could perform another job consistent with your background.
For example, a tradesperson who cannot return to physical work may face arguments that they could perform supervisory, estimator, or administrative roles.
Evidence in “any occupation” claims is therefore more extensive and may include:
- Functional capacity evaluations
- Vocational assessments
- Transferable skills analysis
- Labour market analysis
- Independent medical examinations
The evidentiary threshold is higher because the scope of assessment is wider.
How Does the Evidence Requirement Differ?
The distinction between these definitions fundamentally changes how evidence is gathered and presented.
In “own occupation” claims, the analysis is occupation-specific. The focus is on the inherent demands of your actual role and whether your medical condition permanently prevents you from performing those duties.
In “any occupation” claims, the insurer may explore alternative employment pathways. Even sedentary or modified roles may be considered if they align with your qualifications and experience.
This often leads to disputes over:
- The extent of physical or psychological impairment
- Whether retraining is realistic
- Whether suggested alternative roles genuinely exist
- Whether the proposed work is reasonably suited
Because insurers rely heavily on vocational and medical opinions, careful preparation of supporting evidence is essential.
Why Do Claims Get Rejected?
TPD claims are frequently declined where:
- Medical evidence is considered inconsistent
- Treating doctors do not address the policy definition directly
- Vocational reports suggest residual work capacity
- Surveillance or employment records raise doubts
The wording of the policy, often contained within a superannuation trust deed or insurance policy governed by the Insurance Contracts Act 1984, plays a critical role.
Even subtle differences in policy wording can materially affect entitlement.
How Are TPD Disputes Resolved?
If a claim is declined, options may include:
- Internal dispute resolution with the insurer
- Complaint to the Australian Financial Complaints Authority (AFCA)
- Court proceedings in appropriate cases
Strict time limits apply, and procedural steps must be followed carefully. The success of any review or complaint often depends on strengthening the medical and vocational evidence to directly address the applicable definition.
How Can TPC Compensation Lawyers Assist?
TPD claims are evidence-driven. The difference between “own occupation” and “any occupation” definitions means that a generic medical report is rarely sufficient.
Our team of expert TPD compensation lawyers assist clients by:
- Carefully reviewing the policy wording and superannuation documents
- Identifying the applicable TPD definition
- Working with treating doctors to ensure reports address the correct legal test
- Obtaining targeted vocational evidence where required
- Preparing detailed submissions for insurers or AFCA
- Advising on litigation options if necessary
They understand how insurers interpret residual work capacity and how to challenge unrealistic vocational assumptions. Early legal advice is particularly important in “any occupation” claims, where insurers may rely on broad labour market arguments to decline benefits.