A PTSD TPD claim may be possible where your condition and its effects meet the requirements of your insurance policy. Mental health TPD claims can also involve depression, anxiety or other psychological conditions, subject to the applicable cover and exclusions.
A diagnosis alone does not establish eligibility. The evidence must address the disability definition and other requirements applying to your claim.
Explain how symptoms affect work
When preparing your claim, ask whether the medical evidence explains the limitations relevant to your policy. Depending on your circumstances, these might include difficulties with concentration, memory, reliability, particular environments or interaction with others.
Give accurate examples of what happens in practice. Describe better and worse periods, workplace adjustments, reduced hours and attempts to return to work. The aim is to explain your circumstances clearly, not to make every day sound the same.
Treatment and prognosis
Ask your treating practitioners to explain your treatment history, response to treatment and expected outlook. If there have been gaps in treatment or difficulties accessing care, provide that context when preparing the claim.
Continue making treatment decisions with your healthcare team. Do not stop treatment, avoid rehabilitation or change work arrangements simply to support an insurance claim.
Check the policy rather than assuming cover
TPD insurance can cover psychological conditions, but the applicable definition, exclusions, cover dates and eligibility requirements still need to be checked. Some policies apply different definitions depending on your employment circumstances.
When gathering records, include any relevant medical retirement, workers compensation, DVA or CSC decisions. Do not rely on those decisions alone: the TPD claim still needs evidence addressing the insurance policy’s requirements.
What if the claim is declined?
Obtain the written reasons and identify the issue being disputed. It may concern whether cover existed, which definition applies, an exclusion or whether the medical evidence meets the policy’s requirements. Time limits may apply to challenging a declined claim, so seek advice early.
KSC Law can help review your TPD insurance, prepare supporting evidence or consider the reasons for a declined claim. Book a free consultation to discuss your options and the next steps.