Diabetes is one of the most common chronic conditions in Australia, affecting over 1.5 million Australians people. While many people with diabetes manage their condition and remain in the workforce, for others the complications of diabetes, or the severity of the condition itself, can make it impossible to continue working.
If diabetes, or its complications, has forced you out of the workforce, you may be entitled to claim total and permanent disability (TPD) or income protection (IP) benefits through your superannuation or a personal insurance policy. This blog covers what you need to know about making a claim, including what medical evidence is required, which doctors can best support your claim, and the common reasons diabetes-related claims are rejected.
Insurance claims and Diabetes - what you need to know
- Your diabetes 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 condition, not necessarily at the time you lodge your claim or the time your illness was diagnosed.
- Both type 1 and type 2 diabetes can give rise to valid claims, the type of diabetes is less important than the severity of your condition and its impact on your ability to work.
For example, if you stopped working due to diabetic complications two years ago and your insurance has since lapsed, you may still be able to lodge a claim. As long as the insurance was active when you stopped work, eligibility is not affected by a later lapse. For more information, read our earlier blog, "I stopped work five years ago due to illness. Can I still make a Super TPD claim?".
Can I claim TPD or income protection if I have diabetes?
Many people assume that because diabetes can be managed with medication, they would not qualify for a disability insurance claim. This is a misconception. What matters is not the diagnosis alone, but the effect your condition has on your capacity to work.
Diabetes and its complications can become severely disabling, even with all available treatment options being used. Conditions that can arise from poorly controlled or advanced diabetes include:
- Peripheral neuropathy: nerve damage causing pain, numbness, weakness or loss of function in the hands, feet or legs.
- Diabetic retinopathy: damage to the blood vessels of the retina, which can cause significant vision loss or blindness.
- Diabetic nephropathy: kidney disease that may progress to kidney failure, requiring dialysis or transplant.
- Cardiovascular disease: heart disease and stroke occur at significantly higher rates in people with diabetes.
- Diabetic foot complications: including ulcers, infections, and in severe cases, amputation;
- Hypoglycaemia unawareness: where a person loses the ability to detect low blood sugar episodes, making it dangerous to perform certain tasks or operate machinery or drive cars or trucks.
- Depression and anxiety: which frequently occur alongside diabetes and can independently affect work capacity.
Any one of these complications, or a combination of them, may be sufficient to support a TPD or income protection claim.
TPD claims for diabetes - key considerations
For a successful TPD claim, you must show that your diabetes or its complications prevent 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. This requires consideration of the functional limitations of your illness and also your work duties and employment history.
A person whose diabetes has caused severe peripheral neuropathy, significant vision loss, or limb amputation may clearly meet a TPD definition. But claims can also succeed where the cumulative effect of multiple, less serious complications makes returning to any suitable work impossible (taking in account the nature of your work).
Income protection claims for diabetes - key considerations
For IP claims, insurers usually assess:
- The impact of your illness on your ability to work; and
- If you are seeing a doctor.
Importantly, your work incapacity does not need to be permanent. This usually makes IP claims easier than TPD claims.
What medical evidence is required for a diabetes TPD or IP claim?
Medical evidence is central to any TPD or income protection claim, and diabetes claims are no exception. Insurers will typically require:
- Reports from your GP and treating specialists confirming your diagnosis and detailing the nature and severity of your complications;
- A clear explanation from your doctors of how your condition and complications limit your ability to work, not just a list of diagnoses;
- Your treatment history, including whether you have complied with recommended treatment and why your condition has not improved sufficiently to allow you to return to work; and
Crucially, medical reports should clearly link your specific complications to your specific job duties. A report that says only "patient has type 2 diabetes and is unfit for work" will not be sufficient.
Does a pre-existing condition exclusion affect your diabetes insurance claim?
If your diabetes was diagnosed before you joined a superannuation fund, or before you took out a personal insurance policy, there may be a pre-existing condition exclusion clause in your policy that affects your claim.
However, it is important not to assume that a pre-existing condition exclusion automatically prevents a claim. Whether the exclusion applies depends on the exact wording of the clause, the nature of your disability, and when and how you got insurance cover. In many cases, it is possible to claim on the basis of a complication or associated condition that is not itself excluded.
If you are unsure whether a pre-existing condition exclusion affects your entitlement, contact us for free advice before abandoning your claim. Further reading: "Pre-existing condition exclusion clauses in disability insurance claims".
Get help from a disability insurance lawyer
If you are unsure whether your diabetes or its complications qualify for a TPD or income protection claim, or if you are experiencing delays or resistance from an insurer, we can help you understand your options. We offer a free first interview and run claims on a "no win, no fee" basis, so there is nothing to lose by finding out where you stand.
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