Increasingly, we are getting enquiries from people about making disability insurance claims due to endometriosis and the hugely debilitating and devasting impact that this illness can have on peoples’ work capacity and lives. This blog will look at how and when people with endometriosis may be entitled to disability insurance benefits, including income protection and Total and Permanent Disability (TPD).
Before we go further, it’s important to understand that your injury or illness, including endometriosis, does not have to be related to work to be able to claim income protection or TPD benefits.
What is endometriosis
Endometriosis is a condition where tissue similar to the lining inside the uterus grows outside the uterus, causing various symptoms that can severely impact a person’s quality of life.
Can people with endometriosis claim income protection benefits?
Income protection benefits are monthly insurance payments that can be claimed if you are unable to work due to injury or illness, including endometriosis.
As mentioned in our earlier blog, “What is income protection and how do income protection claims work?” the eligibility and conditions for these claims vary from policy to policy. However, if you are unable to work your usual job due to the debilitating symptoms of endometriosis, you may be entitled to these benefits. The critical factor in the assessment is how the symptoms of endometriosis affect your ability to perform your work duties rather than which specific symptoms you experience.
Can people with endometriosis claim Total and Permanent Disability (TPD) benefits?
In addition to income protection, individuals with endometriosis may also be eligible to claim TPD benefits under certain conditions. TPD will usually provide a lump sum payment if a person is permanently unable to work due to illness or injury.
For someone with endometriosis, claiming TPD can be challenging but possible if the condition significantly impairs their ability to perform any type of work on a permanent basis. The key considerations when applying for TPD benefits due to endometriosis are:
Medical evidence
Claims for TPD will require medical evidence from your treating doctors to demonstrate that endometriosis has caused a permanent reduction in your work capacity. This may involve specialist reports, ongoing treatment records, and diagnostic evidence such as laparoscopy results or imaging that highlight the severity of the condition.
Work capacity
TPD benefits can require an inability to work in your own job, or (more commonly) they will require an inability to work again in your own job or any other job that you may be suited to by education, training or experience.
For endometriosis sufferers, this might involve proving that the condition has caused irreversible physical or mental limitations that prevent performing any meaningful work. This could be due to severe pain, fatigue, gastrointestinal issues, or other symptoms that interfere with daily activities.
You can read more about work capacity in our earlier blog, “What’s the deal with TPD claims and your capacity to work?”
Duration of the condition
Insurers typically require evidence that the illness is chronic or that it has lasted for a prolonged period, and that it is permanent. With endometriosis, the condition can vary in severity, but those who experience long-term, uncontrollable symptoms may qualify for TPD if they are no longer able to sustain employment.
The role of each of the above will depend on your specific policy terms and conditions, which vary across funds and insurers.
If you’ve lodged an income protection claim or TPD claim due to endometriosis and that claim has been denied, get in touch for some free advice.
What symptoms of endometriosis can lead to disability insurance claims?
The severity and range of symptoms related to endometriosis vary from person to person, but the following are symptoms that can impact work capacity and, therefore, may lead to a successful income protection or TPD claim:
- Chronic pelvic pain: This pain is often the most debilitating symptom, ranging from mild to severe, and can interfere with daily activities.
- Heavy or irregular menstrual bleeding: This can include heavy periods or bleeding between periods, which can lead to fatigue and anaemia.
- Gastrointestinal issues: This can include bloating, nausea, constipation, diarrhea, or painful bowel movements, which often worsen during menstruation.
- Fatigue: Many people with endometriosis report feeling constantly tired, regardless of how much rest they get.
- Infertility: Endometriosis is a leading cause of infertility, affecting the ability to conceive.
- Urinary problems: Painful urination, especially during menstruation, can occur if the endometrial tissue affects the bladder or urinary tract.
Get help from a disability insurance lawyer
Given the variety and severity of symptoms and their impact on daily life, endometriosis can profoundly affect a person’s ability to perform their job. If this is the case for you, there may be entitlements under income protection or TPD policies you hold, usually inside your superannuation.
If you’re unsure about any entitlement, get in touch with a member of our team. We provide free initial advice and run cases on a “no win, no fee” basis. So, it costs you nothing to find out where you stand.
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