TPD claims for loss of sight and vision impairment

You may be able to claim total and permanent disability (TPD) cover through your super fund if loss of sight or failing vision has stopped you working, but it depends on the exact wording of your policy. Some policies list loss of sight as a specific event that pays on its own terms. Most others ask whether you are unlikely ever to work again in a particular way.

This article is general information, not advice on your own situation. It does not predict whether any claim will succeed or what it might be worth.

Why vision loss raises particular questions

Vision loss covers a wide range. It might follow an injury, or a condition such as glaucoma, macular degeneration or diabetic eye disease. It might affect one eye or both, central vision or side vision, and it might be stable or progressive.

A TPD claim does not turn on the diagnosis alone. It turns on what the loss of vision means for your ability to work, measured against the definition in your policy. Two people with the same eye condition can reach different outcomes because their jobs, their training and their policies differ.

Three ways a policy may treat loss of sight

Policies do not all work the same way. These are the common approaches.

Approach	What it generally asks
Specific loss or sight definition	Whether the loss of sight meets a defined medical standard, such as loss of sight in both eyes. If it does, the claim may not need a separate work capacity assessment
Own occupation	Whether you are unlikely ever to return to the occupation you held before you stopped work
Any occupation	Whether you are unlikely ever to work in any role reasonably suited to your education, training or experience

Some policies combine these, or apply different tests depending on your age, your hours of work or your employment status when you stopped. Our glossary explains own occupation and any occupation in more detail.

Some policies also include an activities of daily living test, which looks at whether you need help with basic tasks of everyday life. See the glossary entry on activities of daily living. Vision loss can bear on that test, but whether it applies at all depends on your policy.

Own occupation and any occupation in practice

For some jobs, vision is central. A driver, a pilot, a tradesperson using machinery or a surgeon may be unable to continue even with partial vision loss. An own occupation test may be easier to meet for those roles.

An any occupation test asks a wider question. The fund or insurer will consider whether your education, training and experience suit other work, and whether your vision allows it. Adaptive technology, screen readers and workplace adjustments may be raised in that discussion. Evidence about what you can realistically do, day to day, matters more than general assumptions.

The waiting period

Most policies require you to be unable to work for a set period before a claim can succeed. This is often called the waiting period. The length and the way it is counted differ between policies, so check your own policy document. Your fund can tell you what applies to your cover.

Progressive eye conditions raise a particular point. You may have reduced hours or modified duties for some time before stopping work altogether. How the policy treats that period can affect the dates that matter.

The evidence that tends to matter

Fund and insurer decision makers rely on documents. For a vision claim, the file usually draws on the following.

• Reports from your treating ophthalmologist or optometrist, including clear findings about visual acuity and visual fields
• Evidence about whether the condition is permanent, and what treatment options remain
• Your work history, position descriptions and the physical and visual demands of your roles
• Statements from employers about adjustments tried and whether they worked
• Evidence of how vision loss affects daily activities, if your policy has that test

A report that says only that your vision is poor does little. A report that explains what you cannot see, what that means for specific work tasks and why the loss is unlikely to improve is far more useful.

Where the money questions fit

A TPD claim can raise questions about tax, Centrelink and your super. Those questions arise because a payment may follow a successful claim, and they depend on your own circumstances. They belong with your accountant or financial adviser. We give legal advice, not tax or financial advice. Our article on whether a TPD payout is taxable explains how the question arises.

If a claim is declined

A declined claim is not always the end. Funds and insurers must follow processes, and complaint pathways exist, including through the Australian Financial Complaints Authority (AFCA). Strict timeframes set by the regulator apply, so seek advice promptly. Our article on what to do when a TPD claim is rejected covers this.

What to do next

Start by reading your policy definition and identifying which test applies. If you hold cover in more than one fund, see our note on multiple super funds and TPD. Gather your treating specialist reports and your work history, and keep copies of everything you send.

Time limits can apply to claims, and they differ between policies and funds. Our note on time limits for personal injury claims gives the general picture, and prompt advice is wise. For an overview, read what a TPD claim is. You can also try our claim check or contact us to talk through your situation.