Register a Total & Permanent Disability Case (TPD)
Use this form to register a TPD medical or other professional negligence case with HCCC Legal Services. We will contact you within 48 hours to discuss your matter further. Your information will be encrypted.
Name
First Name
Last Name
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Email
example@example.com
Please give a short description the injuries or illness / condition that has resulted in your disability, and how these effect your ability to perform usual work duties.
What sort of work are you qualified or have experience working in?
What is the last date you were able to work in any type of employment
-
Day
-
Month
Year
2 digit day, 2 digit month, 4 digit year
Date
What was the job title of the last work you were able to do?
Have you already made a claim upon your superannuation for a disability claim?
Yes
No
What date did you make your claim, if you have made a claim (leave blank if no claim made)
-
Day
-
Month
Year
2 digit day, 2 digit month, 4 digit year
Date
If you have made a claim what has been the response to your claim?
The claim was rejected
I have not heard back
The claim was accepted but the amount offered was too low
The insurer is conducting further investigationsi
Have you made any other claims for compensation related to your TPD claim (pick all that apply)
I have made a workers compensation claim
I have made a motor accident claim
I have made a professional negligence claim
I have made a claim on a private employment or disability insurer
Has anyone been given legal advice about this claim?
No I have not had advice from another lawyer
Yes I have a current lawyer but I am thinking of changing
Yes, I have a previous lawyer regarding this case but they are no longer representing me.
Please attach any files you would like HCCC Legal to review in relation to this case. We will securely store these files and destroy them if we are unable to assist in this case.
Browse Files
Drag and drop files here
Choose a file
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How you would you like HCCC Legal Services to contact you for further discussion about your case?
By telephone during business hours
By telephone after hours
By video conference during business hours
By video conference after hours
By email
I will log on to the HCCC Legal Services contact page and arrange an appointment that suits me.
Submit
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