When it comes to Total and Permanent Disability (TPD) claims, Australians living with rare or invisible illnesses often face significant hurdles. Unlike visible injuries or commonly understood conditions, rare diseases and chronic, non-apparent illnesses (such as fibromyalgia, ME/CFS, lupus, or complex PTSD) often lack universally accepted diagnostic criteria. This creates a gap in evidence that can be incredibly challenging to bridge.
This blog aims to guide you through these complexities and offers strategies to strengthen your TPD claim when dealing with an invisible illness.
Understanding the Nature of Invisible and Rare Illnesses
Invisible illnesses are those that are not easily observed or understood by others, including medical practitioners, insurers, or claims assessors. These may include:
- Autoimmune disorders like lupus, multiple sclerosis, and rheumatoid arthritis
- Neurological conditions such as epilepsy or chronic migraine
- Mental health conditions, including severe depression, anxiety, or PTSD
- Rare genetic disorders, often with limited research or treatment consensus
- Chronic fatigue syndrome (ME/CFS) and fibromyalgia, which may vary in severity
These conditions often present with subjective symptoms, inconsistent flare-ups, and unclear diagnostic pathways. This lack of uniform clinical evidence makes it difficult for insurers to validate the “total and permanent” aspect required in a TPD claim.
Why the Evidence Gap Poses a Serious Challenge
For standard TPD claims, a claimant must demonstrate that they can no longer return to work in their own occupation or any occupation suited to them, given their education, training, or experience.
A rare or invisible illness can be tricky because:
- Objective medical tests may fail to provide conclusive evidence
- Specialist assessments may be required, often over extended periods
- Insurers may question the credibility or minimise the illness’s impact
- Claimants are often expected to “prove the unprovable”, adding further stress to an already debilitating situation
The default approach of insurance assessors relies heavily on test results, structured medical reports, and functional capacity evaluations, all of which can fall short when it comes to rare or poorly understood illnesses.
Steps to Build a Robust TPD Claim with a Rare or Invisible Illness
1. Gather Specialist Medical Support
Specialist support is crucial. Work with medical professionals who are experienced with your condition, including:
- Rheumatologists, neurologists, psychiatrists, or immunologists familiar with rare or invisible illnesses
- Occupational therapists for Functional Capacity Evaluations (FCEs)
- Psychologists or psychiatrists where psychological assessments may be needed
Their documentation should extend beyond diagnosis and clearly outline why you can no longer perform work duties and how your illness limits your day-to-day functioning.
2. Maintain Comprehensive Medical Records
Insurance providers scrutinise timelines and consistency. Ensure your medical records include:
- A complete treatment history, including trialled medications and therapies
- Notes on any side effects or non-responsiveness to treatments
- Specialist referrals, ongoing care, and updates from various health professionals
- Consistent notes highlighting your condition’s impact on work capacity
Keeping a symptom journal and a record of appointments can also help demonstrate the chronic nature of your condition.
3. Strengthen Your Claim With Non-Medical Evidence
To overcome the evidence gap, support your TPD claim with:
- Employer statements detailing reduced hours, sick leave patterns, or performance issues
- Workplace assessments showing attempts at adjusted duties or failed return-to-work plans
- Personal statements or statutory declarations from friends, family, or caregivers that show your reduced capacity
- Daily living impact reports showing reliance on others for basic activities
This multi-faceted evidence reinforces the severity of your illness in real-world terms. It can be a powerful strategy when formal medical records are insufficient.
Navigating the Legal Maze: Why Professional Legal Help Is Essential
Many individuals living with rare or invisible conditions give up on their TPD claims out of frustration or exhaustion. Having a TPD specialist lawyer who understands both the insurance process and the nuances of these conditions can make all the difference.
At JI Solicitors & Associates, we:
- Work with leading medical experts and specialists
- Understand the specific obstacles associated with mental health and rare disease claims
- Know how to structure your claim to address anticipated insurer pushback
- Can challenge rejected or delayed claims through the superannuation complaints tribunal or court processes
Our legal expertise also ensures you meet all policy definitions, respond properly to requests for further information, and follow procedural timeframes to avoid automatic claim closure.
Dealing With Rejected Claims: Your Options
If your TPD claim is rejected due to “insufficient evidence”, you still have recourse. This may include:
- Requesting an internal review through your insurer
- Lodging a complaint with the Australian Financial Complaints Authority (AFCA)
- Initiating a legal claim if your insurer has failed in their duty to act reasonably
These steps require technical understanding and legal strategy. A qualified solicitor can guide you through the process and reduce the stress involved.
Common Mistakes to Avoid When Claiming TPD for Invisible Illnesses
- Underestimating the importance of specialist reports
- Failing to document the condition’s long-term impact
- Accepting the insurer’s first denial without challenge
- Not seeking early legal guidance
- Continuing to work despite being eligible to claim
It’s vital to understand that you don’t need to be hospitalised or visibly incapacitated to qualify for TPD. If your condition prevents you from working permanently, you have the right to fair compensation.
Why Early Legal Advice Matters
The sooner you seek legal guidance, the stronger your TPD claim is likely to be. Every insurer interprets “total and permanent” disability differently, and each policy has its own definitions and conditions. Our lawyers can:
- Interpret your specific policy wording
- Recommend the best approach between “Own Occupation” vs. “Any Occupation”
- Identify strong supporting evidence
- Prevent avoidable delays, underpayments, or claim rejections
At JI Solicitors & Associates, we have successfully assisted numerous clients with invisible or rare illnesses in navigating the complex TPD process.
Conclusion
Navigating the TPD claims process can be a challenge, especially for those living with rare or invisible conditions. By compiling detailed medical and non-medical evidence and working with experienced professionals, you can significantly improve your chances of success.
For tailored legal advice with your TPD claim, call 02 8896 6046 to book a consultation with us.
