Need to know
- Wayne claimed for total and permanent disability (TPD) insurance after suffering a stroke
- His insurance company rejected the claim because he didn’t pass the 'activities of daily living' (ADL) test
- Restrictive ADL definitions are making TPD policies worthless and creating ‘junk’ insurance products
"I'd been paying out for five years for the total and permanent disability insurance, and now that I needed it, I got nothing" says Wayne McDougall.
For much of his life, Wayne had worked as a long haul truck driver, travelling between Sydney, Brisbane, Melbourne, Adelaide among other places.
On one cross-country job in May 2016, he was heading to WA when he suffered what was initially thought to be a severe sinus headache.
After another driver took over the trip, Wayne returned home to Sydney. His partner took him to Campbelltown Hospital, where he was diagnosed with having suffered a stroke.
He spent the following week in hospital, but says he's still recovering from the devastating impact of the stroke.
Not worth the paper it's written on? Despite paying into total and permanent disability insurance for five years, Wayne got nothing. "It's a scam," he says. "They shouldn't be allowed to do it."
'ADL' test to blame for Wayne's claim being rejected
Some TPD insurance includes an 'activities of daily living' (ADL) test. To be paid out on a claim, a claimant needs to show they can't do two activities from a list. These activities are basic physical tests such as being able to eat, bathe or dress yourself without assistance.
A recent report from the Australian Securities and Investment Commission (ASIC) found there was a "very high" rate of denied claims when this test is applied. ASIC says it's "suited only to disability caused by the most catastrophic type of injury or illness".
Wayne is one of the three Australians each day who'll face the onerous ADL test when they make a TPD insurance claim.
Many Australians have insurance that is essentially useless, otherwise known as junk insurance
Wayne's employer at the time had a super plan with BT, the superannuation business of Westpac. The TPD insurance in his super was provided by AIA.
At one point, the insurer changed the list of "hazardous" occupations to include long-haul truck drivers. This meant he would now have to satisfy the ADL test to claim on his insurance.
The fact that a truck driver was signed up by his employer to a plan that forced truck drivers into the ADL test highlights a common problem with insurance in super. Many Australians have insurance that is essentially useless, otherwise known as junk insurance, because of such restrictions.
BT rejected Wayne's claim as he didn't satisfy the ADL assessment.
If Wayne had been assessed under the standard definitions in the TPD policy, he would have qualified for the insurance benefit
If Wayne had been assessed for the standard definitions in the TPD policy, he would have qualified for the insurance benefit.
In Wayne's case, he was unable to dress himself but could still do the other basic tasks, such as walking and speaking.
His doctor and neurologist stated he was unlikely ever to work again because of the stroke, but even this wasn't enough to qualify him for the insurance benefit.
Wayne approached Firths The Superannuation Lawyers to take up his case, which they're now working on.
'It's a scam'
Wayne had assumed he had adequate insurance cover.
"I wasn't real happy," he says of finding out about the ADL."That's the cover that they agreed to and that's what I'd been paying for. You naturally assume that's what you're insured for.
"They knew I was a truck driver when they opened the policy. It's a scam. They shouldn't be allowed to do it."
Stroke's massive impact on Wayne's life
The stroke also left Wayne with reduced peripheral vision in both eyes, which continues to hamper his everyday life.
"Anything on my left hand side, I really can't see it," he says. "I keep running into (things). If people come up the left hand side of me, I don't see them."
The physical and mental toll of the whole episode has been enormousWayne McDougall, whose claim for total and permanent disability (TPD) insurance was denied
Wayne now has no prospects of making a living driving Australia's highways. His condition has affected his other interests too – he also used to enjoy restoring cars, but can't do that anymore because of his reduced vision.
The physical and mental toll of the whole episode has been enormous.
"I won't say it's been frustrating," says Wayne.
"I'd say it's been suicidal. Every day, it's just a battle to keep going, one step at a time. It's all I can do."
National 24/7 crisis services:
Lifeline 13 11 44 lifeline.org.au
MensLine Australia: 1300 789 978 mensline.org.au
Have you had difficulty claiming on the TPD insurance through your super? Does an ADL test apply to your claim?
Super Consumers Australia at CHOICE is interested in hearing your story about junk TPD insurance. Get in touch with us email@example.com
This content was produced by Super Consumers Australia which is an independent, nonprofit consumer organisation partnering with CHOICE to advance and protect the interests of people in the Australian superannuation system.