Total and permanent disability
22 Jul 2024
Jim makes an appointment to see you. You inherited him from a colleague who recently retired, and you’ve only seen him once or twice.
Jim is 45 years old, with a history of chronic back pain. He hasn’t returned to his construction job since he accepted a workers’ compensation settlement two months prior.
He comes in today asking you to complete a TPD form.
You eventually sign the form, after pressure from the patient’s lawyers. Jim hasn’t been in since, so you’re surprised when he presents a year later, with a stack of paperwork in hand.
“I blew my TPD payout on jet-skis and holidays, and now I need to return to work. Can you give me a certificate to say I’m completely fit to work in the construction industry? My back feels much better now.”
You offer to examine him, while noting it will be difficult to provide a clearance so soon after signing a TPD form.
Jim snatches up the paperwork and leaves the consultation, yelling expletives.
What is TPD?
Definitions can vary according to the terms of the policy. A patient may be eligible for a TPD payment when they lose the ability to work in their own profession. More commonly, eligibility is triggered if a patient can never return to any occupation reasonably suited to their education, training or experience.
This is a fairly high threshold, and you must read the wording carefully before you sign a TPD form, in accordance with 10.9.1 of the Medical Board’s Good Medical Practice: A Code of Conduct for Doctors in Australia.
Things to think about
- How old is the patient, and when did they become disabled?
- Is there objective evidence of a permanent disability?
- Is the patient compliant with treatment recommendations?
- Has the patient reached maximum medical improvement?
- Factor in any comorbidities, psycho-social influences, education and work history.
Should I sign the form?
Medico-legally, you should exercise your best clinical judgement based on information available to you at the time, and document this clearly in the notes.
Consider a referral to an occupational physician if necessary, and don’t allow anyone to pressure you into completing the form if you don’t feel it is appropriate to do so.
If you support the patient’s TPD claim, you can complete the form as requested. Consider advising the patient that if they opt to rejoin the workforce without any identifiable improvement to their disability (i.e. new treatment or surgical intervention), it may be difficult for you to provide a certificate of fitness.
If in doubt, contact our Medico-legal Advisory Services team for prompt and personalised advice.
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