For Dirk Purcell, the last few years have been hell.
The forty-two year old Queensland man worked as an Aboriginal liaison officer at a hospital in north Queensland for 12 years, but in the last few years of his work, his job started to take its toll.
"At the start it was just liaising with the Aboriginal and Torres Strait Islander people who would come in and the doctors, making sure they understood everything and what the journey in hospital would look like," he says.
"A lot of them don't speak good English, so I would often translate for them."
"Then, in the last few years management started asking us to go into areas we weren't trained for, like extreme mental health situations or emergency ICU areas. You need people specifically trained for those situations, but they just put us on the frontline."
Dirk developed severe post-traumatic stress disorder, anxiety and depression. He would wake after nightmares about work, and says he became so physically ill he would vomit in the work carpark before a shift.
Dirk developed severe post-traumatic stress disorder, anxiety and depression
In December 2021, he stopped working on the advice of a doctor and was initially granted income protection insurance through his super fund, QSuper, now part ofAustralian Retirement Trust (ART).
When a doctor later told him he could never return to work, he lodged a claim for total and permanent disability (TPD), but the super fund and their insurer, ART Life, refused to approve the claim.
When Dirk's income protection insurance ran out, he had to move towns and is now living off very limited income.
QSuper said that because Dirk wasn't receiving ongoing treatment from a psychotherapist, they would not approve his claim. This was despite the fact that there is only one psychologist practicing in the region Dirk lives in and they don't provide any subsidised sessions, meaning he can't afford to go.
Mental health in super insurance
Paul Watson from Berrill and Watson Lawyers has been assisting Dirk with his case since 2022. He says that, whilst overall claims timeframes have shortened in recent years, they still see some delays in TPD insurance claims-handling by super funds.
"From a claims perspective, we see cases that just go on for far too long," he says.
"If you make the claims process difficult, there is a certain percentage of people who will say 'this is too hard' – particularly people with a mental illness. They might just disengage with the process, which is awful, because they're no less entitled than anyone else to be paid the benefit."
If you make the claims process difficult, there is a certain percentage of people who will say 'this is too hard'
Paul Watson, Berrill and Watson lawyers
Most super funds provide TPD and death cover to eligible workers between the ages of 25–65. Some provide this automatically as part of their default cover, while income protection is opt-in in some funds. The amount paid out by a company in the event of a TPD benefit claim can vary greatly, but the average is $144,000.
In the last financial year, 92% of claims for TPD were approved, according to the Australian Prudential Regulation Authority. It's not known how many of the rejected claims relate to mental health, but Super Consumers Australia's director of advocacy (communications) Susan Quinn says it's a more complex area than physical disability, with many funds placing unnecessary barriers and burdens of proof.
"It really is a bit of a lottery depending on your super fund," she says. "Some of them have got quite specific sorts of tests and requirements in the insurance policies; others have got really general broad tests that are pretty ambiguous if there's someone walking in trying to make a claim."
"People are experiencing something really difficult and it's likely the worst time in their life when it comes to this point of making a claim," says Quinn.
People are experiencing something really difficult and it's likely the worst time in their life when it comes to this point of making a claim
Susan Quinn, director of advocacy (communications), Super Consumers Australia
"Super funds need to be asking: 'Is the process fast, efficient and transparent for the person going through it?' and 'Is there a bit of compassion and empathy in these claims?' Often we are not seeing that."
Some super funds require claimants to score a certain rating on the Psychiatric Impairment Rating Scale before any payout, and others need medical assessments to be done by insurer-appointed psychiatrists only.
Quinn is urging the federal government to task the Productivity Commission with conducting a long overdue 'root and branch' review of insurance in superannuation to determine whether Australians are getting a good deal for the billions of dollars that is paid in insurance premiums through super every year.
Finding a counsellor or psychiatric support can be difficult and expensive, but is often a prerequisite for a mental health claim.
Counting on claimants to give up
Hayriye Uluca, a principal lawyer at Maurice Blackburn, says getting ongoing psychologist and psychiatrist care is increasingly expensive and difficult, yet super funds are often making it a prerequisite of any insurance payout.
"I do feel concerned at times that there might be a lack of belief in the person and their actual subjective experience and what they are reporting to their treating doctors," she says.
"Insurers might latch onto that to try and deny claims, delay them, and hope that people might give up and return to work, even against the advice of doctors."
Paula*, a recent Maurice Blackburn client in Melbourne, says her TPD claim was knocked back after she provided all the information requested by AustralianSuper, worsening her anxiety and depression even further.
I felt like I wanted to give up, that I had no hope of success due to the process being unfair
TPD claimant Paula*
"I felt that it was very unfair that my claim was rejected for not providing a specialist report – that they had not even requested," she explains. "I felt like I wanted to give up, that I had no hope of success due to the process being unfair, but I felt a responsibility to my family to continue with the TPD claim."
"Trying to get a psychiatrist appointment was a nightmare, and I had many rejections, which was also very distressing."
After Maurice Blackburn submitted a complaint to the super fund and their insurer, TAL, the decline was reversed and Paula has now been told her claim will be paid in full.
Positive outcome for Dirk
Super Consumers Australia sent questions to ART earlier this year about Dirk's case and asked why they were continuing to deny his claim. Roughly a week later, his lawyer received a positive update.
QSuper had decided to approve his full TPD claim, a six-figure sum, which will make an immeasurable difference to his life. ART say they are unable to comment about the specifics of the case.
Dirk says he just wants to be able to provide for his family, something he has been unable to do during the legal battle over the last two years.
"I want my kids to grow up with a fresh start and opportunities I never had," he says.
*Some names have been changed.
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