When an eating disorder becomes so severe that you can no longer work, your superannuation TPD cover may provide a financial lifeline. But claiming a TPD benefit in those circumstances is rarely straightforward. You will need strong medical and occupational evidence, clear policy definitions and an understanding of common pitfalls. Below, we address some of the key questions and challenges.
Can I claim a TPD benefit if I have stopped working due to an eating disorder?
Yes, you may be eligible to claim a TPD benefit if your eating disorder (or the associated illnesses) has rendered you unable to perform your own occupation (or any occupation suited to your education/training, depending on your policy).
The critical factors are:
- Your policy must be valid at the time you stop working, and you must be covered for TPD under your super fund or personal policy. Your eligibility is related to the TPD insurance cover you had in place at the time you stopped working, not the time you lodge your claim.
- The eating disorder must result in a permanent incapacity, meaning that you’re unlikely ever to return to suitable work that is within your education, training or experience (or similar, depending on your policy definition) because of the condition.
- You must provide medical evidence from doctors that your illness has caused the cessation of your employment and that there is no “real-world” possibility that you will return to your role or another role (taking into account your illness, but also other barriers to work like work-availability, accommodations required in the workplace, etc).
- Insurers will look at the nature and severity of the eating disorder, any complications (such as cardiovascular, gastrointestinal, endocrine and other psychiatric issues), treatment history and prognosis.
- Since many eating disorders involve fluctuations in health and capacity, the evidence must show not just that you have the illness, but that its impact on your ability to work is sustained and permanent.
If you have stopped working because of an eating disorder and this illness has made you unable to perform your job safely or reliably, make sure your medical evidence and employment history clearly align. A long break from work, consistent treatment history, and professional evaluations will strengthen your TPD claim.
What types of eating disorders may lead to a TPD claim?
There is a range of eating disorders, which may be eligible for a TPD payout if the disorder, or associated illness, causes you to stop working.
Some of the most common ones include:
- anorexia nervosa;
- bulimia nervosa;
- binge eating disorder;
- ARFID (Avoidant/restrictive food intake disorder); and
- OSFED (Other specified feeding or eating disorder).
There is also a range of lesser-known or emerging eating disorders that can significantly impact a person’s ability to continue working. If you’re unsure if your condition would be eligible for a TPD claim, call us for some free advice.
Importance of your doctor’s support for your TPD claim
Doctors play a vital role in a TPD claim where an eating disorder is involved.
The best medical evidence will come from clinicians who understand the nature, treatment and functional and occupational impact of eating disorders. In some cases, the support of your treating doctors will be the most important requirement of your claim.
You can read more in our earlier blog, “The importance of your doctors for a successful TPD claim”.
Which doctors are important for eating disorder TPD claims?
- A psychiatrist who is treating you for your eating disorder or any other associated mental health conditions (such as obsessive compulsive disorder).
- An endocrinologist, gastroenterologist and/or cardiologist if there are serious physical complications.
- Your treating general practitioner (GP) who coordinates care, keeps records and monitors functional impact over time.
- Occupational physicians or functional capacity assessors can also help establish the extent of your capacity for work if your treating team is not sure.
How to approach your doctors to support your TPD claim
In our experience, the best way to approach doctors for support for a TPD claim is to:
- regularly consult with your doctor and engage with your treatment plan to show them that you are making clear efforts to try to improve your health and get back to work;
- let your treating doctors know that you’re considering a TPD claim and that an insurer will expect a report that addresses your capacity to work, the permanence of your condition, treatment history and functional limitations;
- provide them with context: your job duties, what you were doing before the eating disorder impacted your work, how you’ve tried to work or attempted to work and why you are now unable;
- gauge their support for a claim verbally in consults;
- be available to consult with your doctors when you ask them to complete medical forms or when the insurer asks them to complete reports relating to your condition;
- ensure that your medical records are consistent: dates of diagnosis, times of worsening, treatment history, and reflections of impact on work performance.
In short, your doctors should not just diagnose an eating disorder; they must articulate in practical terms how your illness has affected your capacity to work now and into the future.
What are the main reasons TPD claims due to eating disorders are rejected?
TPD claims based on eating disorders can face higher scrutiny because of the complex nature of the condition and the variation in how it presents. Some of the most common reasons for rejection include:
Lack of sufficient doctor support
- Your treating clinicians may not explicitly link your eating disorder to work incapacity or may express uncertainty about your long-term prognosis.
- Reports that focus on diagnosis alone (e.g., “patient has anorexia nervosa”) but do not address functional limitations, working capacity or prognosis often fall short.
- If your treatment history is sparse, inconsistent or poorly documented, insurers may doubt whether your condition is sufficiently disabling.
- The doctors certify you unable to work from the wrong date (see below).
Incorrect date of disablement
- If you stopped working due to your eating disorder, but the date of cessation isn’t clearly aligned with when your medical evidence began, the insurer may dispute whether you were covered or disabled at the relevant time.
- If you returned to work for a period or your duties were modified without clearly documented incapacity, insurers may argue that you were not totally disabled when you made a claim.
- With an eating disorder that progresses over time, the insurer might argue you didn’t become disabled until a later date (after you ceased work), which can affect your eligibility or entitlements.
- If you are self-employed and don’t have good employment records, it can be hard to work out when you stopped work without timesheets, payslips, etc to rely on.
Further reading:
Lack of certainty about work capacity in the future
- Insurers will often challenge whether you could return to work with treatment or whether retraining might mitigate your incapacity. With eating disorders, because improvements can occur, insurers may argue your condition is not “permanent”.
- If you have attempted work (even part-time or for a short period as part of a failed attempt to return to work) since the onset of the illness, insurers may argue you retain capacity.
- If your doctors do not provide a clear prognosis stating that return to work is unlikely, or if treatment options remain, the insurer has room to deny or delay the claim.Top of Form
Further reading:
Get help from a TPD lawyer
TPD claims for eating disorders require careful preparation, clear evidence and expert medical support. The complexity of eating disorders means that insurers will check the diagnosis, functional impact, prognosis, and the capacity for work very closely.
If you’re facing a TPD claim due to an eating disorder, Berrill & Watson’s superannuation and insurance team can help you prepare the evidence, engage the right clinicians, and manage your claim, all on a no win, no fee basis.
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