What 'Activities of Daily Living' Means for Your TPD Assessment

If your super fund or insurer has mentioned "Activities of Daily Living" in connection with your Total and Permanent Disability (TPD) claim, you may be wondering what that phrase actually means, and why it matters. The terminology sounds clinical, and the process can feel opaque, especially when you're already dealing with the physical and emotional weight of a serious condition.

The truth is that Activities of Daily Living (ADLs) is a specific insurance test with a narrow definition, and one that can be applied in ways that don't reflect the reality of living with a disability. Understanding what ADLs are, how they are assessed, and where the process can go wrong is essential if you want to protect your claim.

This guide explains, in plain language, how ADL assessments work inside Australian TPD claims, why they can produce misleading results, and what you can do if your claim has been delayed or denied based on an ADL assessment.

Over $1 billion in super insurance benefits goes unclaimed in Australia every year. Many of the people who miss out do so not because they aren't eligible, but because they don't know how the assessment process works, or how to challenge it.

An ADL assessment measures very basic physical functioning. It does not measure your ability to hold down a job. Someone can fail an ADL test but still be denied a TPD claim, and someone can pass an ADL test and still be totally and permanently disabled. The ADL test is just one part of a more complex assessment.

What Are Activities of Daily Living, and Why Are They Part of a TPD Claim?

Activities of Daily Living is a medical and insurance term that refers to the basic self-care tasks a person needs to perform to function independently. In a clinical or aged care context, ADLs are used to assess whether someone needs daily assistance or residential care.

In the context of a TPD claim, ADLs are used by some super fund insurers as one measure of functional capacity — specifically, how much physical independence you retain.

The six ADLs most commonly referenced in Australian super insurance policies are:

• Bathing and showering: the ability to wash and clean yourself unaided

• Dressing: the ability to put on and remove clothing independently

• Eating and feeding: the ability to get food from a plate to your mouth

• Mobility: the ability to walk, move around, and change positions

• Toileting: the ability to manage toileting independently

• Transferring: the ability to move from one position to another, such as from a bed to a chair, or from a chair to standing

These tasks represent the most fundamental level of physical independence. They are, deliberately, a very low bar.

When Does an ADL Test Apply to a TPD Claim?

Not all TPD policies use ADL tests. Whether an ADL assessment applies to your claim depends entirely on the wording of your specific fund's insurance policy.

ADL-based definitions appear most commonly in:

• Some retail super fund policies, particularly those held through bank-affiliated or employer-sponsored retail funds

• Some older policy definitions that pre-date the shift toward "any occupation" definitions that are now more common

• Some occupation-exempt definitions, used for claimants who do not fit easily into the "any occupation" or "own occupation" framework — for instance, people who were not working at the time of their disability onset

In many policies, the ADL test operates as an alternative or additional pathway within the TPD definition. The policy might say, in effect: if you cannot perform any work in any occupation you are suited to, you qualify for TPD — OR, if you cannot perform a specified number of the listed ADLs without assistance, you qualify.

The practical effect is that in some policies, failing a sufficient number of ADLs can establish TPD eligibility independently of the occupational test. In others, the ADL test is a minimum floor, the insurer argues you must fail ADLs before they will consider you disabled at all.

This is why reading and understanding your specific policy wording matters enormously. Better Claim reviews your policy before taking any other steps, to confirm which test applies and how it operates in your case.

The Core Problem: ADLs Measure Physical Function, Not Work Capacity

This is the most important thing to understand about ADL assessments in TPD claims, and the point where most claimants are misled.

The ADL test was not designed to measure whether someone can work. It was designed to measure whether someone needs help getting dressed, showering, or getting out of bed. A person can be entirely unable to sustain any form of employment, because of chronic pain, cognitive impairment, severe mental health conditions, fluctuating neurological symptoms, or any number of other conditions, and still be able to shower and dress themselves on a good day.

Insurers sometimes use a passing ADL result as a basis for denying a TPD claim. The logic they apply, that someone who can bathe and dress themselves must be capable of work, is not always legally correct, and it has been challenged successfully through internal review and at AFCA.

Conversely, for claimants whose TPD definition includes an ADL pathway, a well-documented failure of ADLs can establish eligibility even where occupational evidence is contested.

If your insurer is using your ADL assessment result in a way that doesn't reflect your actual functional capacity, that assessment is contestable.

How ADL Assessments Are Conducted

When an insurer requires an ADL assessment as part of your TPD claim, they will typically arrange for an occupational therapist (OT) to visit you at home or assess you in a clinical setting. The OT observes or tests your ability to perform each of the listed ADLs and produces a written report for the insurer.

There are several things you should know before this assessment takes place:

The OT is engaged by the insurer

Just as with an Independent Medical Examination (IME), the occupational therapist conducting your ADL assessment is paid by the insurer. This does not mean the OT is dishonest, but it does mean you should not assume the assessment is a neutral clinical exercise. The report will be used by the insurer as part of its decision-making process.

The assessment captures a snapshot, not your reality

A one-to-two-hour home visit captures how you function on that specific day, at that specific time, under those specific conditions. If you have a fluctuating condition, one that involves better days and worse days, the assessment may occur on a relatively better day and produce a result that does not reflect your typical daily function.

You are allowed to be honest about limitations

You do not need to perform tasks to the best of your ability to demonstrate capability. If a task causes pain, takes you longer than it would in normal circumstances, requires rest afterwards, or cannot be completed safely without risk of falling or injury, say so during the assessment. The report should document your actual experience of the task, not a best-effort performance.

You can have a support person present

You are generally entitled to have a trusted person with you during an ADL assessment. A family member or carer who can observe and, if needed, later provide a statement about the accuracy of the OT's observations, can be valuable.

What Your Super Fund Won't Tell You About ADL Assessments

There are several things you will not be told proactively:

• You have the right to a copy of the OT report. Once the insurer receives the ADL report, you are entitled to obtain a copy. Request it as soon as the assessment is complete, before any decision is made. Review it carefully for inaccuracies or findings that do not reflect what occurred during the assessment.

• An inaccurate ADL report can be challenged. If the OT's report contains factual errors, mischaracterises what you were able to do, or does not account for the time, pain, or effort involved in completing each task, this can be addressed through a written response and supporting evidence from your treating specialists.

• Your treating specialist can provide their own ADL assessment. A report from your treating specialist, whether a physiotherapist, occupational therapist of your own choosing, neurologist, or other specialist — addressing your functional capacity and ADL limitations carries real weight in internal reviews and AFCA proceedings.

• ADL results are not the only evidence in your claim. Even if the insurer's OT reports that you can perform all ADLs independently, this does not automatically defeat your claim. Medical evidence, specialist reports, and evidence of your inability to sustain employment remain relevant and can outweigh an ADL assessment.

• Super funds are not required to explain which ADL-based definition applies to you or how it will be used. The policy document contains this information, but the fund will not walk you through it. Better Claim reads your policy and explains exactly what you need to demonstrate.

Do You Qualify? Understanding the ADL Test in Your Policy

Whether ADLs are relevant to your claim depends on your policy wording. You may be assessed under an ADL-based definition if:

• Your policy includes an ADL pathway in the TPD definition, typically expressed as being unable to perform a specified number (often two or more) of the listed ADLs without assistance

• Your condition affects physical function in a way that aligns with the ADL framework — conditions affecting mobility, strength, coordination, or cognition

• You were not in the workforce at the time your condition emerged, and the occupational test therefore does not apply straightforwardly to your circumstances

• The insurer has chosen to arrange an ADL assessment as part of a broader functional assessment of your claim

If you are unsure whether ADLs apply to your specific policy, contact Better Claim for a free, plain-language review of your insurance documents.

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Step-by-Step: What Happens in an ADL-Related TPD Claim

Step 1: Obtain your policy documents

Request your Product Disclosure Statement (PDS) and insurance schedule from your super fund. Better Claim can do this on your behalf. The policy documents will specify whether an ADL definition applies to your claim.

Step 2: Understand the ADL threshold in your policy

Most ADL-based definitions specify a number of ADLs, typically two or more, that you must be unable to perform without assistance. Some specify "unable to perform" and others "requires assistance to perform." This distinction matters and affects how your assessment is framed.

Step 3: Gather evidence of functional limitation

Before the insurer arranges its own assessment, obtain reports from your treating specialists that document your functional limitations — specifically, which ADLs are affected, by how much, and why. This provides an evidence baseline that the insurer's OT assessment will need to account for.

Step 4: Attend the insurer's ADL assessment honestly

If the insurer arranges an OT assessment, attend and be honest about your limitations. Do not minimise difficulties to appear capable, and do not exaggerate, simply describe your actual experience of each task on a typical day.

Step 5: Request the OT report

After the assessment, request a copy of the OT's report as soon as it is submitted to the insurer. Review it against your own recollection of the assessment and your treating specialists' records.

Step 6: Respond to inaccuracies

If the report contains inaccuracies or does not accurately reflect your functional capacity, provide a written response with supporting medical evidence. This should go to the insurer before they make a final decision.

Step 7: Lodge the claim with complete documentation

Submit your TPD claim form, together with all supporting documentation, including medical specialist reports, your claimant statement, any responses to the OT report, and a certified copy of government-issued photo ID (such as a passport or driver's licence), which is required for all Australian super insurance claims.

Step 8: Decision and, if necessary, appeal

If the claim is approved, the benefit is paid to your super account for release. If denied, Better Claim reviews the basis for denial and advises on internal review or AFCA escalation.

REALISTIC TIMEFRAMES

• Policy review and eligibility check: 1–2 weeks (Better Claim)

• Evidence gathering (medical reports and functional assessments): 6–12 weeks

• Insurer assessment, including ADL assessment: 2–4 months

• Decision: 3–6 months from lodgement

• Internal review (if denied): 2–3 additional months

• AFCA complaint (if needed): 6–12 additional months

Better Claim manages every step, so you are not left navigating the process alone.

Why ADL-Based TPD Claims Get Denied, and How to Fight Back

"You can perform all six ADLs independently"

The OT's report states that you completed all assessed tasks. The insurer denies the claim on this basis. Challenge: the OT report may not account for pain, effort, or duration; your treating specialists' assessment of functional capacity should be obtained and presented. Being physically able to complete a task in an assessment setting does not necessarily mean you can sustain employment.

"You failed fewer than the required number of ADLs"

The policy requires inability to perform two or more ADLs, and the OT records only one. Challenge: review the OT's methodology and the definition of "assistance required" in the policy; additional medical evidence may establish that the assessment did not capture the true level of limitation.

"The ADL assessment indicates functional capacity inconsistent with your claimed disability"

The insurer uses the OT report to contradict your medical evidence. Challenge: a rebuttal report from your treating specialist and a detailed claimant statement documenting your actual daily function, on typical days, not just good days, can address this directly.

"Your condition affects ADLs intermittently, not permanently"

The insurer argues that because you can sometimes perform ADLs, the limitation is not permanent. Challenge: the legal test for permanence in Australian TPD law does not require constant inability, it requires that the condition is unlikely to improve to a point where you can return to work. Fluctuating conditions that prevent sustained employment can still satisfy the permanence test.

A denied claim is not the end. Better Claim specialises in reviewing and appealing denied super insurance claims, including those denied on the basis of ADL assessments.

If Your Claim Was Denied Based on an ADL Assessment

If you have already received a denial citing an ADL assessment, the following steps apply:

1. Request the full OT report and denial letter: you are entitled to both under Australian insurance law

2. Have the OT report reviewed — Better Claim reviews these reports for methodology flaws, factual inaccuracies, and findings that do not align with your treating specialists' records

3. Obtain a functional capacity assessment from a specialist of your choice: this provides a counter-assessment to the insurer's OT report

4. Lodge an internal review: submit the new evidence and a written submission challenging the basis of denial

5. Escalate to AFCA if the internal review fails: the Australian Financial Complaints Authority (AFCA) at afca.org.au handles super insurance disputes and has the power to overturn insurer decisions; AFCA has found repeatedly in favour of claimants where ADL assessments did not accurately represent functional capacity

Better Claim reviews denied ADL-based TPD claims and advises on the most effective appeal pathway for your specific circumstances. Our TPD Claims page explains the full scope of support we provide.

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How Better Claim Can Help With Your ADL-Based TPD Claim

ADL-based TPD assessments are a specialised area. The interaction between your specific policy wording, the OT assessment, your medical evidence, and the legal definition of permanence requires someone who understands all four.

Better Claim provides:

• Policy review: plain-language explanation of which TPD definition applies to you and whether an ADL test is part of it

• Evidence preparation: coordination with your treating specialists to obtain functional capacity reports that specifically address the ADL requirements in your policy

• ADL assessment support: advice on what to expect from the assessment, how to document your limitations accurately, and how to review the OT report for errors

• Internal review submissions: written submissions challenging denied claims with targeted medical and functional evidence

• AFCA complaints: management of your complaint through the AFCA process, including preparation of evidence and submissions

• End-to-end claim management: from eligibility check through to settlement, on a no-win, no-fee basis

Better Claim works on a no-win, no-fee basis: you pay nothing unless your claim succeeds. Our fee comes from your settlement.

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Frequently Asked Questions

What does "unable to perform an activity of daily living" actually mean?

In the context of an Australian TPD claim, "unable to perform" an ADL typically means you require physical assistance from another person to complete the task. Some policy definitions extend this to include tasks that can be completed but only with significant difficulty, pain, or risk of injury. The exact definition varies between funds. Better Claim reviews your specific policy language before the assessment.

Do all TPD claims involve an ADL assessment?

No. ADL assessments are only part of a TPD claim where the specific policy definition includes an ADL test. Most modern Australian super fund policies use an "any occupation" or "own occupation" definition that focuses on work capacity rather than basic self-care. Better Claim reviews your policy first to confirm which test applies.

Can I challenge an OT report I think is wrong?

Yes. OT reports are not final and can be challenged through the internal review process and at AFCA. If the report contains factual errors, doesn't account for fluctuating conditions, or contradicts your treating specialist's assessment of your functional capacity, that is grounds for a challenge. Better Claim reviews OT reports regularly.

What if I can do some of the ADLs but not all of them?

Most ADL-based policy definitions require you to be unable to perform a specified number of ADLs — commonly two or more. Being unable to perform one ADL may not be sufficient on its own. However, this depends on your specific policy wording, and the interaction between your ADL result and your occupational evidence may still support a successful claim.

My insurer arranged an OT who said I could do everything. What are my options?

Request a copy of the OT report. Have your treating specialist review it and provide a rebuttal. Lodge an internal review with the counter-evidence. If the internal review is unsuccessful, escalate to AFCA. Better Claim manages this process from start to finish.

How much does Better Claim charge?

Better Claim works on a no-win, no-fee basis. The initial eligibility check is free, and our fee is only charged if your claim succeeds — taken from your settlement, not from your pocket.

Can I claim income protection at the same time as a TPD claim?

Yes. If your condition may be permanent, you should lodge both a TPD claim and an income protection claim simultaneously, they are not mutually exclusive. Income protection pays a monthly benefit during the TPD assessment period. Once TPD is approved, offset provisions typically apply. Better Claim advises on both claims where relevant.

Resources

• AFCA: Free, independent dispute resolution for denied super insurance claims in Australia

• ASIC MoneySmart: Plain-language guides to super insurance and TPD claims

• ATO Super Lookup: Find all your super fund accounts through MyGov

• SuperConsumers Australia: Independent research on Australian super funds and insurance

The Bottom Line

An Activities of Daily Living assessment is a specific, narrow test, and it does not determine the full picture of your TPD eligibility. Whether you are in the process of a first claim or dealing with a denial based on an ADL report, the result is not final.

ADL assessments can be challenged, rebutted, and placed alongside other evidence that better reflects your actual functional capacity. Better Claim knows how these assessments work, where they go wrong, and how to build the case that the insurer's report does not fairly represent.

You've already been through enough — let us handle the paperwork.

Contact Better Claim for a free assessment of your TPD claim, including any ADL-related issues — no commitment, no cost, no jargon.

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This article is intended as general information only and does not constitute legal, financial, or insurance advice. Super insurance entitlements vary between funds and individual circumstances. Better Claim recommends seeking professional advice specific to your situation. For complaints or disputes, contact AFCA at afca.org.au.