Back injuries are one of the most common reasons Australians stop working, yet they’re also one of the most misunderstood when it comes to eligibility for Total and Permanent Disability (TPD) and income protection (IP) claims. How a back injury affects your ability to keep working is crucial when looking to make a claim.
If you’re dealing with a serious back condition where you’re either considering stopping work or have stopped work, this guide provides you with the key things to consider when making a claim either for TPD or IP.
Important general information
- Your back injury/condition does not have to be work-related to be eligible for TPD or IP.
- To claim either TPD or IP, you must have had active disability insurance at the time you stopped work due to your injury, and not necessarily at the time you lodge a claim.
For example, you may have stopped working due to your back injury three years ago. As a result of stopping work, your TPD and/or IP insurance lapses. As long as the insurance was active at the time you stopped work, you can still lodge on a future date. For more information, read our earlier blog, “I stopped work five years ago due to illness. Can I still make a Super TPD claim?”
TPD claims for a back injury – key considerations
For a successful TPD claim, you must show that your back injury prevents you from working again in your own occupation or any occupation that you are suited to by education, training or experience, depending on your policy definition.
Insurers don’t just look at your diagnosis. They assess:
- your job duties before you stopped working;
- your education, training and experience;
- whether you are reasonably suited to any alternative work;
- the long-term prognosis of your condition.
Chronic back injuries such as disc degeneration, bulging, herniated or slipped discs, nerve damage or impingement, can meet TPD definitions if they permanently restrict your capacity to work. Much will depend on the treatment options available, your age and your work.
Whether or not you have undergone surgery, if surgery is available, and the outcome of surgery can also be key factors in determining success on a claim. In our experience, ongoing chronic pain and pain disorders are one of the leading causes of TPD claims for back injuries.
However, insurers often argue that claimants could perform lighter or sedentary roles, even when pain or functional limits make this unrealistic and attempt to push people back to work.
This is why the way your claim is prepared is critical. If you haven’t already lodged your claim or if you’re having issues with a current claim, seeking legal advice early can lead to better outcomes.
Income protection claims for a back injury – key considerations
Income protection claims focus on temporary incapacity, not permanence. To be paid benefits, you must show that your back injury stops you from performing the duties of your occupation during the insured period (not permanently). Also, it’s not always necessary to stop all work (a partial reduction and loss of salary can be enough).
For IP claims, insurers assess:
- whether you are totally or partially disabled;
- your functional capacity day-to-day;
- medical restrictions placed on you by treating doctors;
- whether suitable duties are available with your employer.
Back injuries frequently give rise to income protection claims, especially where pain, reduced mobility, or flare-ups prevent consistent work. However, disputes often arise if insurers believe you can return to modified duties or reduced hours sooner than your doctors recommend.
What medical evidence is required for a successful TPD or IP back injury claim?
Medical evidence is the backbone of both TPD and income protection claims for back injuries.
Insurers typically require:
- reports from your GP and treating specialists;
- imaging results (MRI, CT scans or X-rays);
- functional capacity or occupational assessments;
- evidence of treatment history and compliance, and opinions regarding the availability and appropriateness of invasive treatments such as surgeries (i.e. discectomy, fusions, guided cortisone injections).
Importantly, medical reports should clearly explain how your back injury limits your ability to work, not just list symptoms. Even where the injury itself is genuine, vague or inconsistent medical evidence can lead to;
- delays in progressing a claim;
- Surveillance; or
- Your claim being rejected.
Reports should also discuss the availability and risks of invasive treatments.
Returning to work or attempting to return to work – key considerations
This is one of the most common questions we hear: “Can I return to work if considering or pursuing a TPD or IP claim?”
The answer is: it depends on the type of claim.
Income protection
A return to work on a part-time or modified basis does not necessarily end your claim. Many policies provide partial IP benefits.
TPD
Attempting a return to work does not automatically prevent a successful claim, particularly if the return is unsuccessful or short-lived.
Insurers often scrutinise work attempts, so it’s important to get advice before returning to work if you’re considering or already pursuing a claim.
Get help from a disability insurance lawyer
Back injury claims can be complex, especially when insurers challenge whether your condition is serious enough or long-term enough to qualify for TPD or IP benefits. Getting the right advice early can make a significant difference to the outcome of your claim.
If you’re unsure whether your back injury qualifies for a TPD or income protection claim, or you’re experiencing delays or resistance from an insurer, we can help you understand your position and your options. We offer a free first interview and run claims on a “no win, no fee” basis, so there’s nothing to lose in finding out where you stand.
Contacting Berrill & Watson
📞 Melbourne: 03 9448 8048
📞 Brisbane: 07 3013 4300
📞 Anywhere else in Australia: 03 9448 8048
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