Navigating nuance at TPD claim time

Col Fullagar

21 May 2026

Whilst usually not crucial to a Term or Trauma insurance claim, when it comes to Total and Permanent Disability and Income Protection claims, a clear and concise description of the claimant’s occupation is up there with Cazaly.

Tempting as it may be to simply fill in the relevant blanks on the insurer’s initial claim form, this is not recommended as a way forward unless the occupation is entirely lacking in nuance, for example ……… come to think of it, the writer could not think of an example.

That first description of the claimant’s occupation will become the centrepiece of the insurer’s understanding and will either assist to steer the claim to a reasonable outcome or send it over the cliff.

With this in mind, what follows is one of no doubt many templates that might be used and adapted to achieve the necessary clarity and precision but first, some Rules of Engagement:

• The final document should be no more than 1.5 pages in length.
• It should not contain any fancy-nancy words that are more designed to impress than inform. The plainer the language, the better.
• If there are any jargon or mothering terms in the document, take them out and go to your room.
• It Is suggested that the document should be broken into sections with numbered headings such as set out in the template below. By doing so, referencing and/or finding detail later is made easier.
• The document should have plenty of air and variation in paragraph length with the aim being that it “looks like it will be easy to read”. Keep in mind, it does not matter how good the information is within a document, if no one reads it, the information is wasted.
• If the document looks anything like a corporate Position Description, delete it, start again and go back to your room.

The litmus test of whether the occupation analysis will do the job is that, when completed, it can be given to someone who does not know the claimant; they can read the document once and immediately have a good understanding of what the claimant’s occupation looks like.

Only when the above is achieved, is the document ready to submit to the relevant insurer as part of the claim lodgement.

As for the Occupation section of the initial claim form, simply mark it as See Attached.

Turning now to the content of the occupation analysis, as above the suggested template is broken into numbered and headed Sections ……….

Section 1 – Business Details

Irrespective of whether the claimant is employed or self-employed, a great place to start is to describe the business in which they work. Whilst, for convenience, this is again broken into sections below, in the actual occupation analysis it might be a continual narrative of one or two paragraphs.

• Business Name

The business name may immediately set the scene with a great example being the single word Deloitte’s or a similarly great example in the opposite being Mighty Mouse Accounting (“MMA”).

• Business Purpose

Nail it in one or two high-level objective sentences such as “The company provides audit, consulting, financial advice, tax, and legal services to public and private clients across various industries”. As per the Rules of Engagement, avoid platitudes and/or jargon phrases such as “provides cutting edge services for discerning clients”

• Business Size

How many business outlets are there? Number of employees? Annual turnover?

• Client Base

Does the business source clients locally, regionally or more widely at a state, national or even international level?

The aim of this section is to build a word picture that enables the claims assessor to all but visualise the business.

Section 2 – Claimant Details

After the business has been described, attention turns to the position of the claimant within the business:

• Position title
• To whom do they report
• If others report to them, how many
• Days and hours of work
• Annual earnings and/or salary package inclusive of benefits such as superannuation and/or regular bonuses albeit benefits could be noted separately as such.

In length, this Section might only be a single paragraph with several additional bullet points.

The logic behind the Claimant Details Section is that, notwithstanding their Position Title might be the same, someone working in an executive role with a large, multi-national firm, earning several hundred thousand dollars a year will have entirely different responsibilities and pressures than someone in the equivalent occupation working on a self-employed basis from a home office.

Section 3 – Primary Responsibilities and Work Functions

Next set out the four or maximum five, primary responsibilities of the claimant’s occupation with each being detailed in a few words at the end of which is a numeric percentage representing the approximate proportion of time spent on it.

Then set out the work functions related to each of the primary responsibilities.

The below is provided by way of example albeit it is somewhat indicative because details of the business have not been previously provided:

• Manage and Grow Client Base 50%

• Regular attendance at trade shows and business functions
• Oversee development of advertising online and in trade media
• Regular calls to existing clients, including sourcing referrals from same
• Meet with prospective clients

• Staff Management (35%)

• Hold daily staff meetings
• Assign and monitor workflow
• Undertake bi-annual staff appraisals
• Discipline and/or reward as required and as appropriate

• Statutory and Director Responsibilities (10%)

• Attend monthly Board meetings
• Prepare, present and speak to board papers
• Check and sign statutory documents such as tax returns, ASIC lodgements, etc

• Budget Control (5%)
• Prepare annual budget
• Weekly review of accounts to check revenue and expenditure, actual v budget
• Suggest and implement adjustments to budget as and when necessary

As would be evident from the above, this Section might take up half to three-quarters of a page.

Section 4 – Skills

This last section sets out the skills the claimant needs to possess and utilise consistently and at a high level over time to successfully undertake the work functions necessary to deliver the primary responsibilities of the claimant’s occupation at the required level. An introduction to this effect would be included under the Section heading.

The detailing of skills should be kept short, and they should be limited to the main ten or a dozen, for example:

• Clear thinking
• Communication and presentation skills
• People skills including patience, empathy, listening and mentoring skills
• Quick thinking and problem solving
• Multi-tasking
• Management skills
• Forward thinking
• Ability to manage pressure

This section is arguably the most crucial because it is key to the assessment of the claim.

It is contended that a sickness or injury does not of itself prevent someone from working in their occupation. Rather, a sickness or injury will prevent someone from being able to use the skills necessary to successfully work in their occupation. By way of example, if the skills of Clear Thinking and Ability to manage pressure are key to the undertaking of an important aspect of an occupation, and the claimant is suffering from a cognitive impairment and depression, then those aspects of the occupation cannot be performed.

By reviewing the requisite skills, the assessor is able to consider them against the claimant’s reported “symptoms” in order to undertake the necessary assessment.

This Section would consist of the introductory sentence and the bullet point listing of the various skills.

Section 5 – Miscellaneous

A final check might be undertaken of the initial claim form and if anything is questioned in it that is deemed relevant to gaining an understanding of the claimant’s occupation, it might be included here.

Whilst the writer has used the above or similar templates on many occasions with apparent success, flexibility is recommended ie amend as necessary. Remember, it is more important to give a claims assessor the information they need rather than simply answer the questions they ask.

As Marco from Tropoje famously said to Liam Neeson in Taken …… “Good Luck” !!