TPD claims for mental illness

Making a TPD claim for a mental illness

Mental health conditions are assessed in the same way as physical illnesses and injuries, although some TPD policy terms may differ.

If you have been diagnosed with a mental illness and your condition has permanently affected your ability to work, you may be able to make a TPD claim through your superannuation. Every policy is different, but factors that are commonly considered include:

• whether you had TPD insurance cover when you stopped working
• your diagnosis and medical history
• evidence from your treating doctors or specialists
• the impact your condition has had on your ability to work

What matters most is not how your condition developed, but how it affects your ability to work now and into the future.

Which mental health conditions may qualify for TPD?

The Australian Bureau of Statistics' National Study of Mental Health and Wellbeing (2020-22) found that 21.5% of Australians aged 16 to 85 had experienced a mental disorder in the previous 12 months. Given how common mental health conditions are, it’s not uncommon for people to make a TPD claim based on the impact of a psychological illness.

There’s no fixed list of conditions that qualify for a TPD claim. A range of mental health conditions may support a claim, including:

• depression
• anxiety disorders
• PTSD
• bipolar disorder
• schizophrenia and other psychotic disorders

The diagnosis itself is only one part of the assessment. The key question is whether your condition has had a lasting impact on your capacity to work.

Understanding your TPD policy

TPD policies also differ in how they assess whether an incapacity is considered permanent, and these assessments can vary depending on whether the condition is physical or psychological.

Most default superannuation TPD cover applies what is commonly known as an "any occupation" test, although the label can be misleading. It doesn’t mean you must be incapable of performing all work. Rather, the assessment focuses on whether you can work in an occupation that is reasonably suited to your education, training, or experience.

Whether a claim is accepted or disputed often turns on what education, training, or experience the policy considers relevant. Some policies assess this at a fixed point in time, commonly when you stopped working or at the end of the waiting period and consider only the skills and experience you had acquired by then. Others go further, directing the insurer to also consider any retraining or rehabilitation you could reasonably be expected to undertake in the future.

This distinction can be particularly important in psychological injury claims. Mental health conditions are more likely to fluctuate over time and may respond differently to treatment. As a result, it is not uncommon for treating doctors and insurer-appointed specialists to disagree about whether a person may have the capacity to return to some form of work in the future.

In these cases, the key issue is often not the diagnosis itself, but whether future work capacity exists. That question can be decisive in the outcome of a TPD claim.

Does the mental illness need to be work-related?

No. Unlike workers' compensation claims, a TPD claim through your superannuation does not usually depend on where or how your condition arose.

Whether your mental illness was related to work, a personal event, a traumatic experience, or developed over time, you may still be entitled to claim if it has permanently affected your ability to work.

What if your claim has been rejected?

A rejected claim does not necessarily mean the matter is over. In some cases, decisions can be reviewed or challenged, particularly where additional medical evidence is available, or important information has not been properly considered.

If your claim has been declined, our team can explain the reasons for the decision and help you understand what options may be available.

You're not alone

Living with a mental health condition can be difficult, and seeking help isn't always easy. If reading this has raised concerns for you, support is available. You can contact:

• Beyond Blue on 1300 22 4636
• Lifeline on 13 11 14

If you're ready to explore your TPD entitlements, our superannuation and insurance team can review your cover and explain what options may be available, at no cost.

Use our free online claim check tool and find out in minutes if you have a TPD claim through your super.

Casey's story

We've helped many people who believed they had run out of options after another claim was rejected.

Casey, a disability support worker, developed stress, anxiety and depression following workplace bullying and was unable to continue working. After her WorkCover claim was rejected, she assumed there was no further support available.

When we reviewed her circumstances, we identified TPD insurance across two superannuation accounts. We helped her pursue both claims and secured approximately $300,000 in insurance benefits.

Every claim is different. Outcomes depend on individual circumstances and the terms of the relevant policy.

"People often assume an 'any occupation' TPD policy means being unfit for every job that exists. It doesn't; it means the work you were actually shaped and fitted for by your own education, training and experience, and whether the insurer can also point to retraining you might reasonably undertake in future. That question is usually harder, and more contested, for a psychological condition than a stable physical injury, and it is often where these claims are won or lost." ‑ Josh Mennen, Principal Lawyer.

We're here to help

If you're not sure whether you have a TPD claim, we're here to help.

Our superannuation and insurance lawyers can review your cover, explain your options and help you understand what support may be available. For many matters, we act on a No Win, No Fee basis.

Prefer to speak with someone? Call 1800 196 050 or get in touch online.