Diseases related to dementia are often associated with older people and, for this reason, are not commonly thought of as conditions that lead to TPD, income protection or trauma insurance claims. However, the reality is that many people suffer from dementia symptoms, most commonly due to Alzheimer’s disease, whilst they are still working. These people are almost always entitled to claim insurance entitlements such as TPD benefits, income protection, and even trauma insurance benefits due to dementia (no matter what the actual cause) if they are forced to cease work.
TPD and income protection claims for Alzheimer’s and other dementia diseases
Most of the insurance claims that we have done for people with dementia symptoms were done for people who have Alzheimer’s disease. However, the cause of the dementia is not as important as:
- the symptoms which are suffered;
- the severity of those symptoms; and
- how they impact on your work capacity.
Usually, it is people in the early stages of the onset of a dementia-related disease who are still working and entitled to claim TPD and/or income protection benefits. Often the early signs and symptoms are:
- memory loss;
- poor judgement;
- confusion or other cognitive issues;
- mood swings;
- frustration;
- and/or difficulty communicating.
All of the above symptoms can impact on your work capacity, and if they are present and lead to a diagnosis of Alzheimer’s disease or dementia, you should seek advice about a possible insurance claim.
Challenges with dementia and Alzheimer’s insurance claims
Most insurance cover for TPD and income protection stops somewhere between your 60th and your 70th birthday. However, if you still have insurance coverage and remain in employment when symptoms of your dementia first start, you have a good chance of being able to claim insurance benefits.
However, the claims are not always straightforward, and we have seen difficulties in claims due to early misdiagnosis of Alzheimer’s disease as depression or other mental health conditions. Sometimes these conditions are considered more likely to resolve, which can lead to rejection of claims.
Other times, delays in diagnosis of dementia diseases can mean that the true extent of the condition and associated work incapacity is not understood until well after you have stopped work. This can lead to issues proving that you stopped working due to dementia/Alzheimer’s disease (as is usually required to claim TPD or other insurance benefits). Delays in diagnosis can also lead to a diagnosis after the insurance cover lapses, which can also present issues on claims.
These are challenges, not necessarily complete barriers. It is highly recommended that you seek advice from a lawyer experienced in insurance claims to ensure any entitlements are protected.
Trauma insurance claims for Alzheimer’s and other dementia diseases
Many trauma insurance policies provide coverage for early-onset dementia and Alzheimer’s disease. The requirements to claim vary between policies. One leading insurer requires that the following definition be satisfied whilst the policy is on foot before it will pay a benefit:
The unequivocal diagnosis of Dementia or Alzheimer’s disease, by a Doctor, causing permanent failure of brain function
OR
A deterioration in the life insured’s Mini Mental State Examination score to 24 or less is required.
OR
Alternatively, we will consider other neuropsychometric tests acceptable to us that conclusively diagnose the condition to at least the same level of stated severity.
If you’re unsure about the requirements of your trauma insurance policy, you should seek advice from a lawyer experienced in trauma insurance claims.
Challenges with dementia and Alzheimer’s disease trauma claims
Trauma insurance claims for Alzheimer’s or other dementia diseases can also be hampered by delays in diagnosis, which can lead to delays in making claims. Claims made after the policy has expired will need to include a doctor’s diagnosis and certification of the above, which can often be hard to get years after symptoms first present.
Because dementia and Alzheimer’s disease are diseases that usually impact older people, people that are diagnosed do not always consider their entitlement to claim insurance benefits and instead accept the diagnosis and quietly retire.
However, if you are working when you are diagnosed and have current insurance (TPD, income protection and/or trauma insurance), you can make valid disability insurance claims. Also, if your symptoms onset when you were working and had insurance cover but were not properly diagnosed immediately, it still may be possible to make an insurance claim at a later date, and we strongly recommend that you get advice.
Dementia and Alzheimer’s claims and your decision-making capacity
The sad reality of a dementia or Alzheimer’s disease diagnosis is that you may lose the capacity to make legal decisions and give instructions on your claim before the claim is finalised. This is something that we are always aware of, and we can help you put in place a number of different strategies to manage decision-making on a disability insurance claim.
This is because we think it’s really important that you remain involved and are kept up to date with the work that we are doing on your claim. We also know that it’s important that you have the right supports in place to help you through the process, if needed.
Get help from a disability insurance lawyer
Whilst claims involving dementia-related illnesses can be a little more complicated, it shouldn’t deter you from making a claim or at the very least, investigating your options and entitlements. We provide free advice for all our clients, so whether you’re at the early stages of considering a TPD, income protection or trauma claim, or you’re having issues with a current claim, we’re here to help.
Contacting Berrill & Watson
📞 Melbourne: 03 9448 8048
📞 Brisbane: 07 3013 4300
📞 Anywhere else in Australia: 03 9448 8048
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