We have helped a number of people claim income protection and TPD benefits after they have suffered traumatic or acquired brain injury (“ABI”). While doing this work, we have learned that no two ABI/TBIs present in the same way. Such is the complex nature of the brain.
ABI symptoms that could lead to a TPD or income protection claim
Common symptoms that can be caused by brain injuries include:
- mood swings;
- physical limitations (ie limited range of movement);
- impaired attention;
- impaired ability to think (cognitive impairment);
- impairments of vision;
- touch;
- smell; and
- personality changes (to name just a few).
Often people suffer from more than one of the above symptoms, and each of the above symptoms on their own has the ability to impact on a person’s work capacity. Therefore, depending on what you did for work before you suffered your brain injury, it’s possible that the brain injury could impact on your work capacity and could even cause you to stop working altogether.
Importantly, your ABI does not have to be related to your work. There are many different ways that brain injuries can happen.
Acquired Brain Injury and TPD claims
If you have returned to work with an ABI, doing your normal duties (or the doctors think that you will be able to return to work), you may have trouble claiming TPD benefits. But you should continue speaking to your doctors if you have trouble working and seek legal advice if you’re unsure about your eligibility for a TPD claim.
If your brain injury has made you permanently unable to work again, you have a good chance of successfully claiming a TPD benefit, no matter what kind of definition applies.
If you have returned to work doing reduced or alternative duties, a TPD claim can usually be made, and the relevant definition of TPD is very important. If you have a TPD benefit with an “own occupation” definition, you can usually successfully claim a TPD benefit if your acquired brain injury means you cannot ever again do your usual job.
Where your TPD definition is in “any occupation” definition, sometimes a return to work in a restricted or alternative capacity means you are not entitled to a TPD benefit (but you should still claim).We recommend that if you are thinking of returning to work after a brain injury, please get in touch to discuss what impact the return to work will have on your TPD claim.
Also, even if you have returned to work in an alternative or restricted capacity after suffering an acquired brain injury, you should get in touch for advice about lodging a claim. This is because working in a reduced capacity or doing a different job because of your injury does not always mean that you are not entitled to be paid a TPD benefit, and some TPD definitions allow claims even for people who are able to continue working with limitations.
Acquired Brain Injury and income protection claims
In most acquired brain injury claims, we see that there is a physical event (e.g. a knock to the head) caused by an accident (e.g. a motor vehicle accident), and after this, our client takes a sustained period of time off work.
Where there is an obvious trauma, it’s usually not difficult to show that the person’s work capacity is at least temporarily impacted by the brain injury, which is usually enough to claim an income protection benefit.
However, with an increasing understanding of brain injuries and better treatment options becoming available, many people are able to get back to work after a brain injury. Importantly, for the period that the person is temporarily unable to work, they can usually claim an income protection benefit once they have met any waiting periods on their policy.
Acquired brain injury vs mental health condition
We recently assisted a person that had suffered an acquired brain injury which presented like it was a mental health condition, namely depression and chronic fatigue. In this person’s case, this presented issues when the TPD claim was assessed because the relevant policy included a mental health exclusion, which meant that the insurer didn’t have to pay any insurance benefit if they ceased work due to a mental health condition.
We had a lot of trouble showing that the symptoms that our client was suffering were caused by an acquired brain injury rather than a mental health condition. We needed to get complex testing done, and medical evidence was provided by specialists, including a neurosurgeon and neurologist.
Aside from the unusual brain injury symptoms, this case was complicated because the acquired brain injury was caused by exposure to mould rather than the more common reason being a physical head trauma. However, even in this case, we were able to get a successful TPD benefit payment for our client.
In other cases, insurance claims for acquired brain injury are more straightforward. This is because it usually does not matter what the injury is (provided there is a diagnosis) or how the brain injury was suffered. What is important is the way in which an ABI impacts a person’s work capacity.
Get help from a TPD and income protection lawyer
An acquired brain injury can be suffered in many different ways and also can present in many different ways. No matter how the injury was suffered or how it affects you, you should seek advice about a possible insurance claim, TPD and/or income protection.
We have helped a lot of people claim insurance benefits after suffering from traumatic acquired brain injury, and if you are in this situation, we can help you too.
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