A person living with multiple sclerosis can make a total and permanent disability claim, and the outcome turns on the policy definition, the medical evidence and the work history.
You can claim total and permanent disability cover through your super fund if multiple sclerosis (MS) stops you from working, but the claim must meet the definition in your policy. The difficulty with MS is that symptoms often come and go, so the real question is usually whether your incapacity is permanent, not whether you are unwell.
This article explains how those claims are generally approached. It is general information, not advice on your own situation, and it does not predict whether any claim will succeed or what it might be worth.
Why MS raises particular questions
MS is a condition of the central nervous system. For many people it follows a relapsing and remitting pattern, with periods of fatigue, vision problems, weakness, balance difficulty or cognitive symptoms, followed by periods of recovery. For others it progresses steadily.
A TPD definition does not ask whether you have a diagnosis. It asks whether you are unlikely ever to return to work of a kind the policy describes. A fund or insurer reading a file full of good days may conclude that you could work again. A file that explains how unpredictable the condition is, and what it does to reliability and stamina, tells a more complete story.
The definition in your policy comes first
Every policy sets out its own test, and the wording matters. Two common approaches are set out below.
| Type of test | What it generally asks |
|---|---|
| Own occupation | Whether you are unlikely ever to return to the occupation you were working in before you stopped |
| Any occupation | Whether you are unlikely ever to work in any role reasonably suited to your education, training or experience |
Some policies use one test, some use another, and some apply different tests depending on your age, your hours of work or your employment status when you stopped. Your cover may also have been reduced or changed over time. Our overview of what a TPD claim is sets out the general framework, and if you have cover in more than one fund, read our note on multiple super funds and TPD before you lodge anything.
How permanence is approached
Insurers usually require that you have been unable to work for a qualifying period, and then that the medical evidence shows you are unlikely to work again, having regard to reasonable treatment. With a relapsing condition, the questions tend to be these:
- How often do relapses occur, and how long do they last?
- Between relapses, what symptoms remain, such as fatigue or cognitive slowing?
- Has the condition progressed over time, and what do disease modifying treatments realistically offer?
- Could you sustain regular work, as opposed to managing a good week?
Fatigue and cognitive symptoms are often the heart of an MS claim, yet they can be hard to see on a scan. They need to be described clearly and consistently by the people treating you.
The evidence that tends to matter
Reports from your treating neurologist usually carry the most weight. A helpful report goes beyond diagnosis and addresses your functional capacity: how long you can concentrate, how reliably you can attend work, how heat or exertion affects you, and what the outlook is. Reports from a general practitioner, an occupational therapist or a neuropsychologist can add detail, particularly about cognitive effects.
Your work history is just as important. Records of reduced hours, adjusted duties, sick leave, and any attempt to return to work help show how the condition has affected you in practice. If an employer tried adjustments that did not hold, a written record of what was tried and what happened is useful.
Be consistent. What you say in the claim form should match what your doctors have recorded and what your employer knows. Insurers read all of it together.
Common sticking points
A claim can stall where the medical evidence describes the diagnosis but not the effect on work, where there are long gaps in specialist review, or where the file suggests a stable period that does not reflect the wider pattern. An insurer may also ask for its own medical examination. Our guide on the TPD claim process walks through the stages, and if a claim is declined, our article on what to do when a TPD claim is rejected explains the options.
If you stopped working some time ago, you may still be able to make a claim. Keep in mind that when a significant amount of time has passed, it can be harder to obtain the medical or financial evidence needed to support your claim. Time limits can also apply if you need to take your matter to court, and strict timeframes set by the Australian Financial Complaints Authority (AFCA) apply to complaints. Read our guide to time limits and seek advice promptly.
Money questions that follow a claim
If a claim is paid, questions often arise about tax, Centrelink and what to do with the funds. Those questions arise out of the claim, but the answers depend on your own circumstances and belong with your accountant or financial adviser. We give legal advice, not tax or financial advice.
What to do next
Make sure you are clearly communicating your symptoms and how MS is affecting your daily life and ability to work to all of your treating doctors, including your GP, neurologist and any other specialists. Then get in touch with us. We can investigate your super, track down your insurance policies and review the terms on your behalf, so you do not have to work through the fine print yourself.