Can You Claim TPD for Arthritis?

16 October 2023 | Total and Permanent Disability

You may have a viable TPD claim for arthritis if chronic joint pain, swelling, and stiffness prevent you from working. The best way to find out if you are entitled to TPD is to speak with an experienced lawyer.

TPD Compensation Lawyers represent clients in a wide range of Total and Permanent Disability matters, including individuals with severe arthritis. We will fully assess your eligibility for a TPD benefit.

Get help making a TPD claim for arthritis. Call TPD Compensation Lawyers today at 03 9966 7188 for a FREE consultation.

What Is Arthritis?

Arthritis is not a medical condition in itself. Rather, it refers to a host of disorders characterised principally by pain in the joints, stiffness, and other symptoms that can limit function and mobility.

There are three main types of arthritis:

  • Osteoarthritis: This is the most common form of arthritis and is often associated with ageing. With osteoarthritis, the cartilage that protects the ends of the bones wears away. This leads to pain, swelling, and decreased joint mobility. It commonly affects weight-bearing joints such as the knees, hips, and spine.
  • Rheumatoid arthritis: Affecting people of any age, rheumatoid arthritis is an autoimmune disease where the body’s immune system mistakenly attacks the lining of membranes that surround the joints (known as the synovium). This results in inflammation in multiple joints, causing pain, swelling, and joint deformities.
  • Gout: Gout is characterised by the accumulation of uric acid crystals in joints, most commonly in the big toe. This results in sudden and severe pain, redness, and swelling in the affected joint.

Other types of arthritis include:

  • Juvenile arthritis, which can start in childhood or adolescence and may persist into adulthood
  • Psoriatic arthritis—common in patients with psoriasis
  • Ankylosing spondylitis—a type of arthritis that affects the joints of the spine

Joint pain, inflammation, and other symptoms of arthritis are also associated with health conditions such as lupus, coeliac disease, hepatitis, scleroderma, and more. If you start to experience pain in your joints, have difficulty walking, or lose range of motion in your extremities, you should visit your GP as soon as possible. You should also look into making a TPD claim for arthritis if your ability to earn a living is affected.

How Common Is Arthritis?

The Australian Institute of Health and Welfare reports that 1 in 7 Australians suffers from some form of arthritis. Osteoarthritis is the most common type, affecting more than 2 million Australians, while approximately 456,000 people in Australia have rheumatoid arthritis.

Can Arthritis Lead to Total and Permanent Disability?

Arthritis is one of the leading causes of disability in Australia. Musculoskeletal disorders (i.e., conditions that affect the muscles, bones, tendons, and ligaments—of which arthritis is a notable example) account for nearly 30% of physical disabilities.

While arthritis may meet the legal definition of ‘disability’ put forth by the Australian Government, whether the condition is considered a Total and Permanent Disability is another matter. ‘Total and Permanent Disability’ is an insurance term, not a legal designation. You will need to show that your arthritis meets the insurance company’s definition to obtain a TPD benefit.

You may be entitled to a TPD lump sum payment if you meet one of the following criteria:

  • ‘Any Occupation’ cover
    Your arthritis prevents you from any employment you are qualified for.
  • ‘Own Occupation’ cover
    The symptoms of arthritis prevent you from performing your regular job. 
  • ‘Activities of Daily Living’ cover
    You are unable to perform the ‘activities of daily living’ as a result of arthritis.

Can You Get TPD with Arthritis?

Before lodging a TPD claim for arthritis, you will need to satisfy the waiting period. Insurers generally require that an applicant be unable to work for 3–6 months before applying.

To make a successful claim, you will need to provide medical documentation and evidence of your arthritis diagnosis, treatment history, and how the condition affects your daily life and ability to work. Super insurers will only pay TPD if your condition meets the threshold for ‘Any Occupation’, ‘Own Occupation’, or ‘Activities of Daily Living’ cover (see above).

Insurance companies will assess a variety of factors in determining your eligibility for TPD compensation. Typically, these will include:

  • The nature and severity of arthritis symptoms
  • Your occupation and the work functions involved
  • The effects of arthritis on day-to-day activities, such as walking without assistance or caring for yourself
  • Your education, training, and work history
  • Whether you can be retrained for another occupation
  • Medical records and expert statements on your condition and prognosis

Most types of arthritis are progressive, meaning the symptoms tend to get worse over time. Worsening joint pain, stiffness, and swelling may prevent you from performing your regular duties at work.

If your arthritis is so severe that you can no longer work, it is important to explore your TPD entitlement. A specialist lawyer can review your super insurance policy and help with all aspects of lodging a claim.

Get Started on Your TPD Claim for Arthritis

With arthritis a major cause of disability among Australians, super insurers see a significant volume of TPD claims involving the condition. The majority of these claims are initially rejected, but having qualified legal counsel can improve the likelihood of obtaining a TPD payout for arthritis.

Contact TPD Compensation Lawyers for FREE today.