How do you prove your injury or illness prevents you from working when your illness is invisible? For those suffering from mental illnesses and seeking TPD cover, this can be a huge obstacle. 

But this doesn’t (and shouldn’t!) stop sufferers from seeking financial relief through making a TPD claim. In fact, data shows that mental illness was the leading basis for TPD claims in Australia in 2019. Yet insurers remain hesitant to approve TPD claims for mental illness, largely because it is difficult to ‘prove’ mental illness. 

Back in 2016, ASIC identified that there were ‘significant shortcomings with managing life insurance’, especially in regards to mental illnesses. Decline rates were high, and disputes regarding mental illness required more evidence than those based on physical injury or illness. In short: claimants were held to a higher, and more burdensome, standard of proof. 

So four years on, what does the landscape for making mental illness based TPD claims look like? 

Since 2016, talking about mental illness has become much more common; stress, anxiety and mental illnesses generally are no longer considered taboo topics. There’s also been increasing recognition of mental illnesses as the basis of TPD claims. Having said that, some mental and psychological conditions that are more likely to be approved by an insurer (such as PTSD, bipolar disorder and schizophrenia), whereas anxiety, stress and depression fall into a somewhat grey area. It is possible to claim TPD cover successfully off the back of these conditions, but only where you can show these conditions impact you to the extent that returning to work is out of the question—and that can be particularly burdensome for claimants because of how insurers view TPD claims for mental illness. 

How do insurers view TPD claims for mental illness?

The first element insurers will consider is whether your illness meets the thresholds of ‘total and permanent disability’ as defined by their policies. Unfortunately, there’s no one set definition, and some are more easily met than others. So the first step in claiming TPD for mental illness is ensuring you understand which definition applies to you, and what it means.

Some definitions require that you cannot return to work in ‘any occupation’, while others have the narrower definition of ‘own occupation’ (own occupation refers to the work you were performing immediately prior to your injury or illness). Other discrepancies in definitions can include the threshold of ‘disablement’, the period away from work, and the claimant’s ability to perform daily living tasks. Unfortunately, the devil is in the detail, and the best way to combat these inconsistencies is to have a meticulous lawyer work through your policy’s definition. 

The second, and more concerning element, is that insurers will dig well into your past to question whether your condition prevents you from working. Insurers may look for evidence of a pre-existing medical condition to suggest your injury is not new, and instead has been manageable over a period of years. At the same time, if you disclose a pre-existing medical condition to your insurer before making a TPD claim, they may insert a mental health exclusion clause to your policy. The best thing to do if you are concerned about the impact of a pre-existing medical condition (disclosed or not) is to speak to us about how this is likely to impact your claim.

So when should you claim TPD cover for mental illness?

This is a judgement call: no-one knows your situation better than you. Having said that, there are a few things to factor into your consideration of whether or not you should make a claim for mental illness.

  • Has your condition been diagnosed by a GP or health professional?
  • Are you able to work in other fields that are loosely or closely related to the work you previously did? 
  • Are you able to make adjustments to your workplace or routine which would enable you to keep working?
  • Do you have the necessary support around you to assist in making this claim?

If your condition has been diagnosed by a health professional, and adjustments to your area of work or workplace are not possible, you may want to consider making a TPD claim for mental illness. 

While it can be difficult and somewhat cumbersome to claim TPD on the basis of mental illness, we would strongly encourage sufferers to seek relief where they can. Be aware of insurers’ reluctance to approve claims based on mental illnesses, but don’t be deterred by it.  A professional lawyer can help fight the fight for you. If you can no longer work due to your mental illness, please contact WKB TPD Lawyers for a free review of your case. We offer a no win, no fee guarantee if we take your claim on.