What Are the Most Common TPD Claims?
Based on the latest industry data from Council of Australian Life Insurers (CALI) and insurer disclosures, the most common TPD claims in Australia break down as follows:
This page goes deeper into each category - what qualifies, what the approval data shows, and what the rise of mental health claims means for how you think about your cover.
The Biggest Shift in TPD Claims History
Ten years ago, musculoskeletal conditions - bad backs, joint disorders, spinal injuries - were comfortably the leading cause of TPD claims. That's no longer the case.
Mental health is now the leading cause of TPD claims in Australia, making up almost one in three claims paid across the market, according to the Council of Australian Life Insurers (CALI).
That 732% figure for people in their 30s is not a typo. It reflects a genuine structural change in who is claiming TPD and why - and it has significant implications for how TPD insurance is priced and whether it is the right tool for every situation.
Conditions That Commonly Result in TPD Claims
TPD insurance is definition-based, not diagnosis-based. What matters is whether your condition meets the policy's disability definition - not the name of the illness itself. With that said, some conditions are consistently more likely to result in a successful claim than others.
So, what does that mean? When you buy TPD you select an “occupation definition” that any future claim is assessed against. Usually this is “any” or “own” occupation, but there are even more restrictive definition such as “homemaker” and “activities of daily living” having more limited cover. See our TPD Occupation definitions guide.
When you claim, your claim is assessed not just on your health situation but against this selected definition.
Mental Health Conditions
Depression, anxiety disorders, PTSD, and schizophrenia are the most common mental health conditions behind TPD claims. According to AIA's 2024 group TPD data, mental health accounts for 31% of TPD claim payments - ahead of every other category. In AIA's financially advised book, the figure is even higher: 37% of male TPD claims and 27% of female TPD claims.
The complexity with mental health is permanence. TPD requires that your disability is unlikely to improve - and for many mental health conditions, that is genuinely difficult to establish. This is reflected in the decline data: mental health claims have a higher decline rate (16.9%) than disease-based claims (9.7%), according to APRA and ASIC data.
Musculoskeletal Disorders
Back injuries, spinal conditions, severe arthritis, and joint disorders have historically been the most common TPD claim type. They remain the second-largest category at 23–30% of claims, depending on the policy type. AIA's 2024 group TPD data shows musculoskeletal at 23%, consistent with broader industry estimates.
These claims tend to have a lower decline rate at assessment because functional limitations - reduced mobility, chronic pain, inability to sit or stand for sustained periods - are measurable and documentable. They are also common in manual and trade occupations where the physical demands of the specific job are central to the claim assessment.
Cancer and Disease
Cancer is a significant driver of TPD claims, particularly advanced or terminal diagnoses where ongoing employment is clearly not feasible. Cardiovascular conditions - including heart attacks and stroke - also feature prominently, as do neurological conditions such as multiple sclerosis, Parkinson's disease, and motor neurone disease.
Disease-based claims have the lowest decline rate of any major category at 9.7% - partly because the permanence of the condition is often easier to establish medically than it is for musculoskeletal or mental health claims.
Accidents and Physical Injury
Traumatic brain injuries, severe fractures, spinal cord injuries, and limb loss account for roughly 10–15% of TPD claims. AIA's 2024 group data shows accidents and injury at 12% of TPD claim payments. These claims tend to be assessed more straightforwardly where the injury is clearly documented and the functional impact on work capacity is permanent.
TPD Claim Acceptance Rates - What the Data Shows
The headline acceptance rate for TPD claims is high - but the numbers look different depending on how you hold your cover.
| Cover type | Admission rate | What this means |
|---|---|---|
| Individual advised (retail) | ~83% | Policies arranged through an adviser or comparison platform - underwritten upfront |
| Individual non-advised (direct) | ~70% | Direct-purchase policies - underwriting often deferred to claim time, creating more uncertainty |
| Group super | ~92% | Default cover through your super fund - higher admission rate but more restrictive definitions |
Source: APRA Life Insurance Claims and Disputes Statistics.
The withdrawal picture
The most important number in the declined claims data is one that rarely gets explained clearly: 81% of what gets counted as a TPD "refusal" is actually a withdrawal - not a hard decline by the insurer.
Withdrawals happen when the claimant stops the process. Common reasons include returning to work, not responding to information requests, or deciding not to proceed. A withdrawal is not the same as the insurer assessing your claim and saying no - but it gets counted the same way in aggregate statistics.
Why claims are declined or delayed
❌The policy definition is not met - most commonly because the disability is not assessed as permanent
❌Capacity to work in another role - relevant under any occupation definitions where retraining potential is a factor
❌Insufficient or inconsistent medical evidence - the most common fixable reason for delay
❌Superannuation release conditions not met - the insurer may approve but the trustee cannot yet release funds
❌Policy lapse - cover was not active at the time of disablement
What the Mental Health Shift Means for Your Cover
The rise of mental health as the leading TPD claim cause has had a direct impact on TPD premiums - and it raises a legitimate question about whether TPD alone is the right tool for this type of risk.
Why mental health claims are pushing TPD costs up
Insurers price TPD based on claim frequency and severity. As mental health claims have increased - particularly among white collar workers in their 30s and 40s - the cost of TPD insurance for that demographic has risen accordingly. If you are a professional in this age group, you are paying for a risk pool that now looks quite different to what it looked like a decade ago.
The structural mismatch
TPD is a binary product. It pays a lump sum if you meet the definition of total and permanent disability - and pays nothing if you do not. CALI themselves have described TPD as a "square peg in a round hole" for mental health conditions, because many mental health conditions are not permanent in the clinical sense, even when they are seriously debilitating.
This creates a gap: someone experiencing severe depression or anxiety may be genuinely unable to work for months or years, but not meet the permanence threshold required by their TPD policy. In that scenario, a TPD claim may be declined - not because the person is not struggling, but because the product is not designed for recoverable conditions.
Where income protection fills that gap
Income protection (IP) insurance is triggered by loss of ability to earn, not permanent incapacity. It pays a monthly benefit - typically 70–75% of your income - if illness or injury prevents you from working, including partial incapacity and gradual recovery scenarios. It does not require permanence.
For the conditions most likely to disrupt your working life - mental health, musculoskeletal conditions, cancer during treatment - income protection is often the cover that actually responds, because it covers the period before anyone knows whether the disability will be permanent.
TPD works best when:
- âś…The disability is clearly permanent and unlikely to improve
- âś…You need a capital amount to clear debt, fund care, or replace future earnings
- âś…The event is catastrophic - spinal injury, severe neurological condition, limb loss
- âś…You have long-term financial obligations that need a lump sum to resolve
Income protection works better when:
- âś…The condition may be recoverable - mental health, soft tissue, many cancers
- âś…You need income replacement rather than a lump sum
- âś…Partial incapacity is a realistic scenario - reduced hours, reduced capacity
- âś…You want cover that responds before anyone knows if the disability is permanent
TPD Claim Causes by Insurer (2024)
Industry-wide averages mask real variation at the insurer level. Where insurers publish cause-of-claim data, the picture is broadly consistent with the market trend - but with differences worth noting.
| Insurer | Mental health | Musculoskeletal | Accident/injury | Other |
|---|---|---|---|---|
| AIA Group TPD (2024) | 31% | 23% | 12% | 34% |
| AIA Advised TPD - Male (2023) | 37% | 17% | - | 46% |
| AIA Advised TPD - Female (2023) | 27% | 23% | - | 50% |
| Industry (CALI/KPMG 2024–25) | ~30–36% | ~25–30% | ~10–15% | remainder |
Sources: AIA group insurance claims brochure (2024); AIA financially advised claims brochure (2023); CALI/KPMG Cause of Claims Results Report (2024–2025). Note: AIA "other" includes nervous system, cancer, cardiovascular and other categories. Industry figures are estimates based on published CALI/KPMG data.
Frequently Asked Questions
What are the most common TPD claims in Australia? +
Mental health conditions are now the most common cause of TPD claims in Australia, making up almost one in three claims paid. Musculoskeletal disorders such as back and spinal conditions are the second most common, followed by disease and cancer, then accidents and injury.
What medical conditions qualify for a TPD claim? +
TPD insurance is definition-based, not diagnosis-based. Any condition can qualify if it permanently prevents you from working under your policy's definition. In practice, the most commonly approved conditions include severe mental health disorders, musculoskeletal conditions, cancer, neurological diseases, and traumatic physical injuries.
What percentage of TPD claims are approved in Australia? +
Approval rates vary by how cover is held. For individually advised retail policies, APRA data shows an admission rate of around 83%. For direct non-advised policies, the figure is closer to 70%. Group super policies have a higher admission rate of around 92%, but with more restrictive definitions. Importantly, around 81% of what is reported as TPD refusals are actually withdrawals by the claimant - not hard declines by the insurer.
Why are mental health TPD claims sometimes declined? +
Mental health claims have a higher decline rate than disease-based claims because permanence is harder to establish. TPD requires that your disability is unlikely to improve - for many mental health conditions, that threshold is difficult to meet medically, even when the person is genuinely unable to work.
Has the rise in mental health claims affected TPD premiums? +
Yes. The significant increase in mental health TPD claims over the past decade has contributed to higher TPD premiums, particularly for white collar workers in their 30s and 40s - the demographic most affected by the trend.
Is income protection better than TPD for mental health conditions? +
They serve different purposes but income protection is often better suited to mental health conditions because it does not require permanence. It pays a monthly benefit if you are unable to work, including for recoverable or partial conditions. TPD pays a lump sum only if the disability is total and permanent - a threshold many mental health conditions do not meet even when seriously debilitating. Most people benefit from holding both.
What is the most common reason TPD claims are declined? +
The most common reasons for a hard decline are that the policy definition is not met - usually because the disability is not assessed as permanent - or because the claimant has capacity to work in another suitable role under an any occupation definition. Insufficient medical evidence is the most common fixable reason for delay or initial refusal.
Can I claim TPD for depression or anxiety? +
Yes, depression and anxiety can result in a successful TPD claim if the condition is assessed as total and permanent under your policy's definition. Claims for mental health conditions are assessed carefully because permanence must be established - this is why specialist psychiatric evidence and a clear treatment history are important for these claims.