In this big win, we explain how our client was initially discouraged (by another law firm) from pursuing disability insurance benefits, including TPD and income protection through his super, only for our team to later secure multiple approved claims after a careful reassessment. It highlights why second opinions, proper evidence, and specialist knowledge can make a critical difference.
Background
David (a pseudonym) stopped work in 2011 due to his schizophrenia. At the time, his condition made it impossible for him to continue working. David tried to return to work a couple of times in 2012 but was unsuccessful.
Like many people in David’s position, he was unsure of his entitlements and relied on professional advice to understand whether he could access disability benefits, like TPD and income protection through his superannuation.
David is told his disability claim is unlikely to succeed
In 2013, David approached another law firm to explore whether he could make a Total and Permanent Disability (TPD) claim through his superannuation fund.
Unfortunately, he was told that he was unlikely to be successful. He was also advised that the only way he might have a chance was if he paid approximately $5,000 upfront for an independent medical examination to support his claim.
For someone who had not been working due to mental illness, this cost was simply not realistic.
Without the financial means to proceed, David gave up on pursuing any disability insurance claims and continued on without the financial support he may have been entitled to.
Barriers faced by people with mental illness and limited finances
David’s experience is, sadly, not uncommon.
People living with serious mental illness often face significant barriers when trying to access disability insurance benefits. These barriers can include fluctuating symptoms, difficulty navigating complex claims processes, and the misconception that mental illness is somehow less disabling than physical injury.
Financial barriers can make matters worse. Many people who are unable to work due to mental illness simply do not have the funds to pay for independent medical examinations or extensive reports, and are discouraged from pursuing claims as a result. Others are (often wrongly) told their claim will be too difficult or unlikely to succeed, leading them to abandon their entitlements altogether.
This is why careful investigation, strategic evidence gathering, and an understanding of how insurers assess mental health claims are critical.
You can read more about claims due to psychological injury/illness in our earlier blog, “Super TPD claims and Mental Health”
A second chance, more than a decade later
In 2024 (13 years after stopping work), David came across an advertisement for Berrill and Watson. Still uncertain but hopeful, he reached out to see whether we could take another look at his situation.
After carefully reviewing David’s history, we identified that not only did he have strong prospects for a TPD claim with the superannuation fund he was aware of, but that he had also been insured through another superannuation fund at the same time, unbeknownst to David.
This meant David potentially had multiple disability claims, not just one.
Further reading
- Can I make a claim for a TPD benefit on more than one policy or superannuation account?
- I stopped work five years ago due to illness. Can I still make a Super TPD claim?
Keeping costs down while building a strong case
We understood from the outset that keeping medical and out-of-pocket costs to a minimum was critical for David, given his circumstances.
Rather than requiring expensive new medical assessments, we:
- obtained contemporaneous medical records from around the time David ceased work in 2011; and
- briefed David’s current treating doctors to provide further supportive medical evidence, based on both his long-term condition and its impact over time.
This approach allowed us to build a compelling case without placing unnecessary financial pressure on David.
The importance of treating doctor support in TPD claims
In many TPD claims, particularly those involving mental illness, the opinions of a person’s treating doctors are extremely important.
Treating practitioners often have a long-standing and detailed understanding of how a condition impacts a person’s capacity to function over time. Their evidence can be far more persuasive than a one-off assessment, especially where the insurer is required to assess incapacity as at a historical point in time.
By working closely with David’s doctors, we were able to present clear and consistent medical evidence addressing his diagnosis, prognosis, and ongoing inability to return to suitable employment. This evidence played a critical role in demonstrating that David had been totally and permanently disabled since he stopped work back in 2011.
It’s important to note that your TPD eligibility is related to the insurance cover you had in place at the time you stopped work, not at the time you made a claim.
Our submissions to the insurers
We relied on the combination of:
- the medical evidence from the time David stopped work; and
- updated medical opinions from his treating practitioners.
We made detailed submissions to the insurers explaining why David had clearly met the definition of Total and Permanent Disability since 2011.
We addressed the insurers’ requirements directly and demonstrated that David’s schizophrenia had continuously prevented him from returning to suitable employment.
The insurers accept David’s claims
Following our submissions, the insurers accepted all of David’s claims.
The final outcome was life-changing.
David went from believing he had no prospects at all to having three separate disability claims approved, including:
- TPD benefit of $125,000;
- TPD benefit of $58,000;
- Income Protection benefit of $1,300 per month, payable until age 60.
The importance of a second opinion
David’s case is a powerful reminder that being told “no”, even by another professional, does not always mean you are not entitled to benefits.
At Berrill and Watson, we are specialists in superannuation and insurance law. We know where to look, what evidence matters, and how to pursue claims efficiently and compassionately.
If you have been told you have no prospects, or you are unsure whether you have received everything you are entitled to, it may be worth getting a second opinion.
Sometimes, that second look makes all the difference. We provide free initial advice and run cases on a “no win, no fee” basis. So, there’s nothing to lose to find out where you stand.
Contacting Berrill & Watson
📞 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.