Multiple sclerosis (MS) is one of the most common neurological conditions affecting working-age Australians, it most commonly affects people between the ages of 20 and 50, meaning many people diagnosed with MS are still in the workforce and hold disability insurance through their superannuation or a personal policy.
MS is a complex and highly variable condition. For some people symptoms remain manageable for many years and ongoing work is possible with no restrictions or only minimal restrictions. For others, the condition progresses in a way that makes continuing to work impossible. If MS has forced you to reduce or stop work or you are working and struggling, you may be entitled to claim total and permanent disability (TPD) or income protection (IP) benefits.
How MS affects work capacity
MS occurs when the immune system attacks the myelin sheath surrounding nerve fibres in the brain and spinal cord. Because it can affect any part of the central nervous system, symptoms vary significantly between individuals. Some common MS symptoms that have lead to successful claims include: fatigue, pain, cognitive impairment, brain fog, incontinence, heat intolerance and mobility issues (more below).
The main types of MS relevant to claims are
- Relapsing-remitting MS (RRMS).
- Secondary progressive MS (SPMS)
- Primary progressive MS (PPMS.
Each if these different types of MS can lead to valid claims and its is the symptoms aand functional impacts which are most important. Symptoms that commonly affect work capacity include fatigue (often described as overwhelming exhaustion not relieved by rest), weakness and difficulty walking, cognitive difficulties including problems with memory and concentration (sometimes called "cog fog" or “brain fog”), vision disturbances, sensory symptoms, bladder dysfunction, and depression or anxiety, which occur at high rates in people with MS and can independently affect work capacity.
TPD claims for MS
For a successful TPD claim, you must show that your MS prevents you from returning to work in your usual occupation, or in any occupation suited to your education, training and experience, depending on your policy definition. You can read more about these definitions in our earlier blog: TPD claims and the difference between 'own occupation' and 'any occupation'.
The fluctuating nature of RRMS creates a specific challenge. Insurers may argue that because a person experiences periods of remission, their incapacity is not permanent. This argument is common and frequently wrong. What matters is not whether you have occasional better days, but whether your overall condition, taking into account accumulated relapses, residual deficits, fatigue, cognitive symptoms and long-term prognosis, makes a sustained return to suitable work unlikely. Your medical evidence must address this directly.
Insurers also tend to assess MS symptoms individually rather than collectively. A person managing significant fatigue, cognitive difficulties and bladder dysfunction simultaneously faces a very different picture to someone with only one of those issues. Your treating doctors need to articulate the cumulative impact of your symptoms on your work capacity, not just describe each one in isolation.
For people with SPMS or PPMS, the permanence of functional limitations is usually easier to establish given the progressive and largely irreversible nature of these forms of MS.
These issues can usually be addressed and overcome with support from your treating doctors.
Income protection claims for MS
Income protection focuses on whether your MS prevents you from performing the duties of your occupation during a given period, rather than requiring permanent incapacity. Therefore, IP claims can be more accessible for people with relapsing remitting MS to help provide financial support during or after attacks, in the acute phase of the disease.
Also, any people with MS do not stop work entirely but move to reduced hours or modified duties as their condition progresses. Under many policies, a partial income protection benefit is payable where you are working in a reduced capacity due to illness and suffering a corresponding loss of income. For more on partial benefits, read our earlier blog: Can I claim on my income protection insurance if I am only partially incapacitated?
If you are on a disease-modifying therapy, insurers may argue that you are well-managed and capable of work. Your medical evidence needs to explain what your functional capacity actually is, not just what your treatment regimen looks like. Being on medication does not mean you can work.
What medical evidence is required?
Strong medical evidence is the foundation of any MS claim. Reports from your treating neurologist are essential. They should confirm your MS type and diagnosis, describe your relapse history and any residual deficits, comment on the trajectory of your condition, and give a clear opinion on your capacity for work now and into the future.
Where cognitive symptoms are significant, a formal neuropsychological assessment can be far more persuasive with an insurer than a general clinical observation. Occupational therapy assessments can also be valuable in translating your clinical picture into practical work-related terms. Your GP is important for demonstrating the long-term pattern of your condition and its impact on daily functioning. Where depression or anxiety is a significant feature, a psychiatrist or psychologist report should also be obtained.
Medical reports should clearly explain how your symptoms collectively affect your ability to work, not just confirm a diagnosis. Vague or diagnosis-focused reports are one of the most common reasons MS claims face delays or are disputed.
What are the main reasons MS claims are rejected?
Insufficient specialist evidence is a common problem. A claim supported only by a GP, without neurologist involvement addressing work capacity, is vulnerable to challenge.
Inconsistency between medical evidence and employment records also creates disputes. If the date your doctors say you stopped working does not align with your employment history, insurers will use this against you. This is particularly important in progressive conditions where decline is gradual. For more on this, read our earlier blog: The date you stopped work is crucial in TPD claims.
Insurers arguing that disease-modifying therapy means you are well-managed is a tactic that needs to be addressed directly in your medical evidence.
Also, in our experience, many people with MS do not keep their doctors fully updated on their illness progression and symptoms because of a feeling that not much can be done to help. This can sometimes lead to issues when, after a period of battling to continue to work, you cease work due to MS and ask your doctor to comment on your illness and work capacity. In this situation, doctors can be reluctant to sign-off that ceasing work is required due to illness and we recommend that you keep your doctors fully informed of your progression and ask that they note changes to support any possible future claim.
Get help from a disability insurance lawyer
MS claims require careful preparation. The variability of the condition, the interaction between relapses and remission, and the way insurers approach these claims mean that getting the medical evidence right from the start is critical.
If your MS has forced you to reduce or stop work and you are unsure about your entitlements, or if your claim has been delayed or rejected, we can help. We offer a free first interview and run claims on a no win, no fee basis.
Contacting Berrill & Watson TPD lawyers
📞 Melbourne: 03 9448 8048
📞 Brisbane: 07 3013 4300
📞 Anywhere else in Australia: 03 9448 8048
How we charge
We are Australia's best-value superannuation/insurance law firm. Other law firms charge nearly double (& sometimes more than double) what we charge. So, if you get a quote from them, or have a cost agreement, ask us what we will charge you.
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