TPD Claims for Mental Illness
Handling Mental Illness TPD Claims for Clients in Melbourne and All of VIC
It can be challenging to lodge a successful TPD claim for mental illness. However, if your mental health impacts your ability to work or live on your own, you owe it to yourself to explore your entitlement to Total and Permanent Disability compensation.
Mental illness is often misunderstood, and severe mental health problems may be dismissed by employers and super insurers alike. No one should be stigmatised for their mental health, and seeking qualified legal support is often key for obtaining a disability benefit.
TPD Compensation Lawyers have the skills and experience to help you make a TPD claim for mental illness. We represent clients throughout Victoria from our office in Melbourne. Call 03 9966 7188 today for a FREE consultation.
Does TPD Cover Mental Illnesses?
Yes, superannuation insurance policies generally do provide TPD cover for mental illnesses the way they would a physical injury or illness. However, some policies may exclude pre-existing conditions. If you previously received treatment for a mental illness—even if it was for a brief period many years ago—the insurer may consider that a pre-existing condition and add a blanket mental health exclusion.
A lawyer specialising in TPD claims can review the fine print on your insurance policy to determine if any mental health exclusions apply. Such policies may also be challenged in court on the grounds of unlawful discrimination.
When Is a Mental Illness Considered a Total and Permanent Disability?
The legal definition of disability is totally separate from Total and Permanent Disability, which is a term used by insurers. Each insurance company uses a specific definition of Total and Permanent Disability. Only by meeting this definition will you be able to obtain a TPD benefit.
You may have a TPD claim for mental illness if you meet one of the following criteria:
- A mental illness prevents you from doing your job (‘Own Occupation’ cover).
- You are unable to work any job for which you have the necessary education, experience, training, etc. as a result of a mental illness (‘Any Occupation’ cover).
- A mental illness prevents you from performing the ‘activities of daily living’ (‘Activities of Daily Living’ cover).
Mental illnesses account for a significant portion of the TPD claims received by super insurers in Victoria and throughout Australia. They will closely scrutinise applications centred on mental health issues, potentially making it difficult to obtain an entitlement. Consulting a knowledgeable lawyer is essential for ensuring that your application is complete and likely to meet the threshold set by the insurance company.
What Are the 10 Most Disabling Mental Illnesses?
Mental illness comes in many different forms. Some individuals are able to manage with the aid of psychotherapy and medication, while others endure significant distress and disruption of their daily lives.
TPD Compensation Lawyers can determine if you are eligible for a Total and Permanent Disability benefit and help you navigate the process of making a claim. Mental illnesses that are most likely to result in a Total and Permanent Disability include:
1. Major Depressive Disorder
According to Psychology Today, mood disorders as a whole are associated with the highest rate of functional impairment (including days missed from work, difficulty performing work-related tasks, etc.). Of these conditions, major depressive disorder is the most prominent when it comes to discussions of disability.
Major depressive disorder is characterised by the following symptoms:
- Persistent sad, anxious, or ‘empty’ mood
- Loss of interest or a lack of pleasure in favourite activities
- Feelings of hopelessness or pessimism
- Irritability
- Fatigue or loss of energy
- Difficulty concentrating
- Memory troubles
- Struggles with decision making
- Insomnia or sleeping too much
- Changes in appetite or body weight
- Thoughts of death or suicide
- Headaches
- Cramps and problems with digestion
- Aches and pains with no clear cause
If you feel overwhelming sadness every day—to the point where you are unable to focus on work or even get out of bed—you may be entitled to a TPD benefit.
Read More: Can You Get TPD for Depression?
2. Schizophrenia
Schizophrenia is a serious mental illness that affects a person’s thought processes, behaviour, and emotions. The symptoms of schizophrenia can vary in intensity and duration, and may include:
- Hallucinations: Perceptions without actual external stimuli, such as hearing voices or seeing things that are not there.
- Delusions: Strongly held false beliefs that are resistant to reasoning or contrary evidence.
- Thought Disorders: Unusual or dysfunctional thought patterns, which may manifest as disorganised thinking, difficulty organising thoughts, or trouble connecting thoughts logically.
- Affective Flattening: Reduced expression of emotions through facial expression, voice tone, or gestures.
- Anhedonia: Reduced ability to experience pleasure from activities previously found enjoyable.
- Avolition: Lack of motivation to initiate and sustain purposeful activities.
- Social Withdrawal: Decreased interest in social interactions and relationships.
- Impaired Executive Function: Difficulty focusing, organising thoughts, and making decisions.
- Memory Impairment: Challenges in remembering information and processing new information.
3. Bipolar Disorder
Bipolar disorder, also called manic depression, is a mood disorder that can lead to Total and Permanent Disability. It is characterised by extreme changes in mood that shift from manic to depressive episodes.
Symptoms may include:
- Manic Episodes:
- Elevated or irritable mood
- Increased energy and activity
- Racing thoughts and fast speech
- Decreased need for sleep
- Impulsive behaviour and poor judgement
- Grandiose beliefs about one’s abilities
- Depressive Episodes:
- Persistent sadness or low mood
- Loss of interest or pleasure in activities
- Changes in sleep patterns (insomnia or hypersomnia)
- Changes in appetite or weight
- Fatigue or loss of energy
- Feelings of worthlessness or excessive guilt
- Difficulty concentrating or making decisions
- Thoughts of death or suicide
4. Substance Use Disorder
Addiction to alcohol and drugs (known as substance use disorder) can take a toll on one’s physical and mental health. This includes the ability to work.
Individuals who suffer from alcoholism or drug addiction may be able to lodge a TPD claim for mental illness. Obtaining proper medical care is essential, as the insurer needs to be satisfied that the condition will not improve with further treatment (and therefore constitutes a Total and Permanent Disability).
5. Obsessive-Compulsive Disorder
People with obsessive-compulsive disorder (OCD) experience persistent, unwanted thoughts (obsessions) and engage in repetitive behaviours or thought processes (compulsions) to find relief. The cycle of obsessions and compulsions can interfere with multiple aspects of daily life, leading to significant distress.
Compulsive rituals are time-consuming, and obsessions can make it difficult to concentrate on work-related tasks. This can lead to issues such as reduced productivity, increased stress and anxiety, interpersonal challenges, and absenteeism. You may have a TPD entitlement if OCD symptoms are severe enough to prevent you from working.
6. Post-Traumatic Stress Disorder
Exposure to a traumatic event may result in post-traumatic stress disorder (PTSD). Symptoms of PTSD can vary, but they generally fall into four main categories:
- Re-experiencing the traumatic event by way of flashbacks, nightmares, and intrusive thoughts
- Emotional numbing and avoidance of reminders
- Negative changes in mood and cognition
- Irritability, difficulty concentrating, hypervigilance, and sleep disturbances (known collectively as hyperarousal)
7. Panic Disorder
A panic attack is a period of intense fear or discomfort. Individuals with panic disorder suffer recurrent and unexpected panic attacks. These attacks can occur suddenly, without any apparent trigger, and often lead to significant distress.
According to Beyond Blue, approximately 5% of Australians experience a panic disorder at some point in their lives. People with panic disorder may find it difficult to hold down a job.
8. Adjustment Disorder
Adjustment disorder is characterised by emotional and behavioural symptoms that occur in response to a specific stressor or life event. Symptoms may include:
- Feelings of sadness or hopelessness
- Anxiety
- Changes in social or occupational functioning
The condition generally develops within 3 months of the triggering event and typically resolves within 6 months. In rare cases, however, adjustment disorder may persist. If the condition doesn’t respond to treatment and impacts your ability to work, you may be entitled to TPD compensation.
9. Borderline Personality Disorder
Individuals with borderline personality disorder experience pervasive patterns of instability in interpersonal relationships, self-image, and emotions. Difficulty maintaining employment is common due to issues such as intense mood swings, difficulties with self-identity, and challenges in maintaining stable relationships.
10. Eating Disorders
Eating disorders are mental health conditions characterised by disturbances in eating habits, body image, and weight management. They often involve extreme and unhealthy behaviours related to food consumption.
Common eating disorders include:
- Anorexia nervosa: An eating disorder characterised by an intense fear of gaining weight and a distorted body image, leading to self-imposed starvation and excessive weight loss. Individuals with anorexia often exhibit extreme dietary restrictions, engage in obsessive weight control behaviours, and may exhibit a relentless pursuit of thinness.
- Bulimia nervosa: An eating disorder characterised by episodes of binge eating, during which individuals consume large amounts of food in a short period, followed by self-induced vomiting, excessive exercise, fasting, and other behaviours to avoid gaining weight. Bouts of bingeing and purging can lead to serious physical and mental health complications.
- Binge eating disorder: An eating disorder characterised by recurrent episodes of consuming large amounts of food in a short period, accompanied by a lack of control during the episodes. Binge eating disorder is associated with feelings of guilt, shame, and distress, and it often leads to overweight or obesity.
The physical and psychological impacts of eating disorders are serious. You may have a TPD claim for mental illness if the physical and/or psychological effects of an eating disorder prevent you from working.
If you are in crisis, call Lifeline Australia straight away at 13 11 14.
Frequently Asked Questions About TPD Claims for Mental Illness
How Do I Know If My Insurance Covers a TPD Claim for Mental Illness?
A mental illness must meet the insurer’s definition of Total and Permanent Disability to be covered by TPD insurance. Generally, this means that the condition causes psychological, emotional, social, and/or physical symptoms that stop you from working.
Knowing if you have a TPD claim for mental illness can be difficult because insurance policies are written in a very technical manner. Therefore, it is in your best interest to seek legal counsel without delay.
TPD Compensation Lawyers understand complex insurance matters. We start by reviewing your super policy to determine how Total and Permanent Disability is defined, then evaluate your medical records to assess whether the mental illness meets the eligibility criteria. Our firm handles claims on a No Win, No Fee basis, meaning you pay nothing for the initial consultation and only owe us a fee in the event of a successful outcome.
What Mental Illnesses Count as a Disability?
There are multiple mental illnesses that may be considered a disability. Common examples include:
- Depression
- Anxiety
- Bipolar disorder
- Post-traumatic stress disorder
- Schizophrenia
- Obsessive-compulsive disorder
- Panic attacks and panic disorders
- Dissociative disorders
- Eating disorders
- Substance abuse disorders (alcoholism, addiction to prescription or illegal drugs, etc.)
According to the Australian Institute of Health and Welfare, more than 40% of Aussies experience mental illness at some point in their lives. While living with mental illness is a struggle, the majority of people are able to continue or resume their work and home lives with the aid of therapy, medication, and support.
Mental illnesses that persist, prove resistant to treatment, and/or significantly interfere with day-to-day functioning may be considered a disability. If the condition is (a) severe enough to interfere with your ability to work and (b) your doctors don’t expect you to improve, you may be entitled to Total and Permanent Disability for mental illness. A knowledgeable TPD lawyer can determine if you qualify for a lump sum payment based on your symptoms and prognosis.
Is Depression a Total and Permanent Disability?
Depression is one of the most common mental illnesses, affecting one in seven Aussies. It is characterised by feelings of extreme sadness, loss of energy, and behavioural changes lasting more than two weeks.
Episodes of major depression (also known as clinical depression) typically last anywhere from six months to more than a year. These episodes can lead to a number of symptoms, including:
- Feelings of melancholy, pessimism, and hopelessness
- Loss of pleasure in hobbies or interests
- Irritability
- Anxiety
- Trouble sleeping or sleeping too much
- Persistent negative thoughts about oneself
- Headaches, neck pain, and back pain
Professional treatment (which may involve a combination of antidepressant medications, psychotherapy, and changes in lifestyle) can make these symptoms more manageable. However, if you don’t experience improvement and depression symptoms make it impossible for you to work, you may have a Total and Permanent Disability entitlement.
Read More: Can You Get TPD for Depression?
Can You Get TPD for Anxiety?
Everybody feels anxious sometimes, such as when you have to give a big presentation at work. However, if the feelings of nervousness don’t go away and you find it difficult to control your thoughts or calm down, you might have an anxiety disorder.
There are several types of anxiety disorder:
- Generalised anxiety disorder: People with generalised anxiety disorder experience feelings of excess worry, apprehension, or dread with no clear cause. Symptoms may occur most days or every day.
- Obsessive-compulsive disorder: Also known as OCD, obsessive-compulsive disorder results in repeated unwanted thoughts that lead to stress or fear. Individuals with OCD then engage in compulsive behaviours as a means of coping with the intrusive thoughts.
- Social anxiety disorder: People with social anxiety disorder or social phobia experience extreme stress and anxiety in social situations. They are typically fearful of embarrassing themselves or drawing negative attention
- Panic disorder: Approximately 40% of Australians experience one or two panic attacks in the course of a lifetime. Recurrent panic attacks resulting in severe disruption to normal life may be diagnosed as a panic disorder.
As with other mental illnesses, a person with anxiety would only qualify for Total and Permanent Disability if they are unable to meet the requirements of their current job, do any kind of work for which they are qualified, or perform daily activities. If you have been diagnosed with an anxiety disorder and the symptoms significantly interfere with your life, our lawyers can help you make a successful TPD claim for mental health.
What Does a Mental Health Exclusion Mean?
Some insurers include a TPD mental health exclusion in their policies. This exclusion applies to pre-existing mental health conditions. Effectively, it gives insurance companies the ability to avoid paying a benefit if a claimant has a history of mental health issues.
When applying for superannuation or TPD insurance, you will be asked a series of questions about your medical history. Usually, this includes one or more questions about whether you have sought treatment for anxiety, depression, or another psychological issue. If you answer ‘Yes’, the insurer may apply a mental health exclusion to your policy.
Often, people don’t realise that their TPD cover may exclude pre-existing conditions (including mental illnesses). Worse, they may fail to disclose a mental health issue that they consider minor or short-lived. This could result in the entire insurance policy being voided.
Honesty and accuracy are key when providing your medical history. If you become disabled due to mental illness, TPD Compensation Lawyers can review your policy for a TPD mental health exclusion and help you navigate the claims process.
Can You Get Your Super Out for Mental Health?
Yes, claimants with Total and Permanent Disability cover through super may be entitled to a TPD payout for severe mental health issues. Superannuation insurance generally uses the ‘Any Occupation’ definition of Total and Permanent Disability.
To make a successful TPD claim for mental health through super, you will need to show that:
- A mental illness completely prevents you from performing any job you could reasonably do based on your education and work history.
AND - Further treatment will not alleviate the condition and allow you to return to work.
Mental disorders are more subjective in nature than physical injuries and illnesses. TPD claims for mental illness are also highly prevalent, accounting for 20–25% of payouts. As such, super insurers tend to employ greater scrutiny when determining whether a mental illness qualifies for Total and Permanent Disability.
Bottom line: It is in your best interest to consult a knowledgeable TPD claims lawyer if a mental illness impacts your capacity for employment. TPD Compensation can explore your right to compensation through super, including income protection, Total and Permanent Disability, and more.
Read More: How Is TPD Insurance Different from Income Protection Insurance?
How Long Do TPD Mental Health Claims Take?
On average, TPD claims are finalised within six months of the initial application. However, multiple factors can affect the time it takes for a claim to be approved. These include:
- The complexity of the claim
- How well-documented the mental illness is
- Whether additional assessments are required
- Requests for additional information from the insurance company
- The definition of Total and Permanent Disability used by the insurer
TPD policies also have a waiting period that needs to be satisfied before you can apply. We can review your insurance cover to determine your eligibility, take the lead in preparing your application, act on your behalf in communicating with the insurance company, and fight for a favourable resolution.
Read More: How Long Does a TPD Claim Take?
Find Out More from TPD Compensation Lawyers Today
Whether you have TPD cover through super or a policy you bought yourself, knowledgeable legal counsel can make a big difference in getting your claim approved. At TPD Compensation Lawyers, we understand how insurance companies operate. Our expertise enables us to guide and support you through the application process, answering any questions you may have.
If you need assistance with a TPD claim, contact TPD Compensation Lawyers for a FREE consultation at 03 9966 7188.
How Do I Lodge a TPD Claim for Mental Illness?
Making a successful TPD claim for mental illness can be difficult. Psychiatric disorders are often considered ‘invisible illnesses’ because they typically lack discernable symptoms. This can lead to incomplete medical documentation of the mental illness, reluctance to seek treatment, and other issues that can complicate the process of claiming TPD.
Nonetheless, the effects of mental illness are very real. People with these conditions may be entitled to Total and Permanent Disability compensation if they can’t work or struggle to care for themselves. You owe it to yourself to explore your TPD insurance cover and determine your eligibility.
Contact TPD Compensation Lawyers for FREE Today
You will need complete medical records to lodge a TPD mental illness claim, including:
- Records from psychiatric assessments and evaluations that led to the diagnosis of the mental health condition
- Documentation of the treatments received, including individual or group therapy
- Records related to any hospitalisations for mental health reasons (if applicable), including inpatient or outpatient treatment
- Information on prescribed medications, dosage, and duration of use
- Progress notes and reports from mental health professionals, psychologists, and/or therapists providing counselling or psychotherapy
- Documentation that outlines the functional limitations and impairments resulting from the mental health condition, as assessed by a mental health professional
- A comprehensive medical history, including any co-occurring medical conditions that may contribute to or affect the mental illness
- Reports and assessments from a psychiatrist, neuropsychologist, and other specialists
You will also need to submit information about your work history, including records of any accommodations or modifications made in the workplace due to your mental health condition. If you are unable to work in spite of accommodations made by your employer, you may have a claim for TPD.
TPD Compensation Lawyers Can Help
Living with mental illness has a number of challenges. If your condition has prevented you from doing your job (or any kind of work) for 3–6 months, you may be entitled to a Total and Permanent Disability benefit.
TPD Compensation Lawyers handle claims involving mental illness with the utmost discretion and sensitivity. Our team works to understand your unique situation, assess the available TPD insurance cover, and maximise your entitlement. With our No Win, No Fee policy, you pay nothing for our services upfront and will only pay fees if we successfully resolve the matter.
It can be difficult to make a TPD claim for mental illness on your own. The key to a successful outcome is to consult a lawyer specialising in TPD claims as soon as possible.
For a FREE consultation, call TPD Compensation Lawyers at 03 9966 7188. Our firm serves clients in Melbourne and throughout Victoria.