Determining whether you are suffering Total and Permanent Disability

If you are suffering from a serious and disabling injury, illness or disease, that has permanently impaired your ability to work, you may be eligible to claim on your private total and permanent disability insurance policy or on a total and permanent disability insurance policy linked to your superannuation.

People who are suffering from an injury, illness or disease, often utilise short and long term benefits payable pursuant to disability insurance. Short term benefits are designed to see you through short term total disability resulting in loss of income. Long term benefits are designed to compensate you if you are permanently unable to work at all, or in your chosen occupation (if you have own occupation disability insurance).

Determining whether you are suffering “total and permanent disability” is a factual issue that depends on your occupation, education, training and experience, AND the insurance policy’s definition of total disability or totally disabled or total and permanent disability. That is, the medical evidence you need to submit with, and in support of, your claim, needs to address all elements of the definition. See my article on total and permanent disability insurance policy. For this reason, it generally is a good idea to engage a lawyer experienced in total and permanent disability insurance claims to advise you on the evidence you need, to put you in the best position to have your claim accepted by the insurance company or trustee of your superannuation fund (as the case may be).

Some of the more common injuries and medical conditions that may lead to total and permanent disability insurance claims are:

• Depression 
• PTSD
• Anxiety disorder
• Neck strain
• Back strain
• L3/4 and L4/5 disc bulge
• C3/4 disc bulge
• Rotator cuff tear
• Supraspinatus tear 
• Repetitive strain injuries
• Carpel tunnel syndrome
• Fibromyalgia 

If your insurance company denies your total and permanent disability insurance claim, we can help you put together an appeal to the insurance company, utilising its internal review process. 

We understand that you may be without benefits during the time it takes to resolve your total and permanent disability insurance claim with the insurance company, so our goal is to attempt to resolve your claim as quickly as possible and without litigation. However, if your insurance company’s internal review does not result in it accepting your claim, we will lodge a complaint with the Australian Financial Complaints Authority (AFCA*) and litigate for you, as applicable.

Note

*AFCA – the Australian Financial Complaints Authority operates an external complaint resolution scheme to resolve complaints by complainants about financial firms including insurance companies. If your insurance company is an AFCA member, then you may be able to avail yourself of this scheme.  We can manage the complaint process for you including drafting and lodging the complaint and undertaking all communication with AFCA and your insurance company. Alternatively, you can engage us to only attend to certain steps in the process, for example, drafting your complaint.