We often receive calls from people after a diagnosis of autism spectrum disorder (ASD) and associated mental health conditions like anxiety, depression or autistic burnout, asking if they can take time off work post-diagnosis and claim on their income protection or TPD insurance benefits. This blog will cover all that you need to know about claims for TPD and income protection for ASD.
The increase in the diagnosis and understanding of ASD and associated illnesses has been well publicised recently. Along with this publicity has come increased awareness and (in our observation) a spike in later life diagnosis of ASD and associated illnesses.
Can I claim income protection benefits for ASD and associated conditions?
We have helped people to claim income protection entitlements after they have been diagnosed with ASD. When you are diagnosed with ASD, or in many cases before this diagnosis is reached, you may also be dealing with, or diagnosed with other mental health issues.
If you are diagnosed as being neurodivergent and due to this neurodivergence or associated conditions like autistic burnout, anxiety or depression, you are certified by your doctors as being unable to work, you may be entitled to income protection benefits under your income protection insurance policy. For background information, you may find one of our earlier blogs, “What is income protection and how do income protection claims work?” helpful.
Importantly, being diagnosed with ASD or as neurodivergent is not what entitles you to income protection benefits. The entitlement will require that this diagnosis of ASD or associated illnesses impacts on your work capacity and that your doctors provide this certification. That is, your doctors say that your ASD or related condition is preventing you from returning to work.
Under most income protection insurance policies, you will be entitled to income protection benefits if:
- you are unable to do one or more of the important income-producing duties (or some aspect of your work) due to illness or injury; and
- this work incapacity causes you to be totally or partially unable to do your job for a period of time.
Therefore, if your doctors say that your ASD or associated illnesses impact your work capacity (either totally or partially), you should consider an income protection claim. A certification by a specialist is not always required, but it always helps.
The requirements to claim income protection benefits are complex, particularly if you are still working in a reduced capacity and are claiming a partial benefit. For example, you will usually have to have a period of no work at all before you can claim a partial benefit. Also, the ways of working out how your ongoing income impacts your work capacity can be hard to understand, so we recommend that you get advice before lodging an income protection claim.
If you’re unsure about whether or not your ASD diagnosis entitles you to income protection, give us a call and we can provide you with some free advice about your entitlements.
Can I claim TPD due to an ASD diagnosis?
Success on a TPD or total and permanent disability claim requires that your doctor certifies that you are permanently unlikely to work again within your education, training or experience (or similar). Therefore, if your doctors say that ASD permanently impacts your work capacity, it’s worth considering a TPD claim. As with income protection claims, a specialist certification is not required, but it is a big help.
You can read more about work capacity in our earlier blog, “What’s the deal with TPD claims and your capacity to work?”
In our experience, it’s less common that a person who is diagnosed with ASD as an adult is certified as unlikely to work again due to that diagnosis alone. However, a later diagnosis of ASD with an associated diagnosis of autistic burnout or anxiety or depression can lead to a successful TPD claim with doctor support.
Will a late ASD diagnosis count as a pre-existing condition under my insurance policy?
In most cases where ASD has been diagnosed, it is not a new condition. That is, it has always been present, but some new event (often the diagnosis of one of your children) has led you to being examined and subsequently diagnosed.
In this sense, the ASD is a pre-existing condition. However, this is not usually an issue for income protection and TPD claims. This is because pre-existing condition exclusions are rare in these policies, or at least they don’t usually work in the way you think they will.
Many disability insurance policies will only exclude claims for pre-existing conditions if you were not working in your full capacity when you got your cover. Also, under some other insurance policies, there may be exclusions for claims due to pre-existing conditions,, however, under the relevant insurance laws, the insurance company can only exclude pre-existing conditions that you were reasonably aware of when you got your cover.
This is good news for a TPD or income protection claim because it means that a later diagnosis of ASD may not be covered by these pre-existing condition exclusion clauses if you could not reasonably have been aware that you had ASD when your cover started (which is often the case pre-diagnosis).
For more information about exclusion clauses like this, you can read our earlier blog, “Pre-existing condition exclusion clauses in disability insurance claims”.
Also, even if your ASD is covered by a pre-existing condition exclusion, associated conditions like autistic burnout, anxiety, or depression are likely to be new and, whilst associated with your ASD, are likely to have their own more recent onset (often tied to an incident). These conditions can be the basis of a claim themselves, which can help you navigate around pre-existing condition exclusion issues.
Get help from a disability insurance lawyer
If you have been diagnosed with ASD and this diagnosis or associated illnesses have caused you to require time off work (either temporarily or permanently), we recommend that you consider making a disability insurance claim. Get in touch for some free advice.
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