Too unwell to work: how insurers look at your condition

There is no official list of conditions. Insurers do not decide these claims by diagnosis. They decide them by what your condition stops you doing at work, and whether that is likely to be permanent.

If an illness or injury has kept you off work, and it is not getting better, that is an exhausting place to be. It is usually where the questions start. This page explains how insurers look at a health condition: the type of insurance most working Australians hold inside their super, the guides we have written on particular conditions, and what happens when more than one thing is going on at once.

The insurance many people don't know they have

Moneysmart, the Australian Government's money guidance website, says most super funds automatically give members life cover and total and permanent disability cover, usually shortened to TPD, once they are aged 25 or over. TPD is designed for one situation: you can no longer work in a job suited to your training, education and experience, and that is unlikely to change.

There is no diagnosis in that sentence. TPD cover is written around capacity to work, not around named conditions.

What insurers actually assess

When an insurer receives a TPD claim, they generally look at three things.

• The medical evidence. What your treating doctors say about your condition, your treatment, and your capacity for work, now and in the future.
• The policy wording. Every fund's definition of total and permanent disability is slightly different. The same person can meet one fund's definition and not another's.
• Your work history. "A job suited to your training, education and experience" means your realistic options, not any job in theory.

Because of this, two people with the same diagnosis can have very different claims. What matters is how the condition, the evidence and the policy wording line up. That depends on the policy, which is why no website can tell you the answer in advance. Including this one.

Guides on particular conditions

There is no ranked list of the conditions behind these claims, and we will not invent one. One thing is measured: the Council of Australian Life Insurers (CALI) reports that mental ill health is now the leading cause of TPD claims, at almost one in three claims paid. (Source: CALI, "Mental ill health is straining Australia's safety net", 30 May 2025.)

We have written a fuller guide on each of these, explaining how insurers tend to assess it.

Conditions we have not written up yet

The list above is not a boundary. Claims are also made for conditions like these.

Autoimmune and chronic illness. Arthritis, lupus, multiple sclerosis (MS), fibromyalgia, chronic fatigue syndrome, Crohn's disease and other inflammatory bowel disease (IBD), and complications of diabetes.

Neurological and brain. Acquired brain injury, epilepsy, Parkinson's disease, chronic migraine, and nerve damage (neuropathy).

Injuries and chronic pain. Amputation, complex regional pain syndrome (CRPS), crush injuries, carpal tunnel syndrome, and hand, leg and foot injuries.

Respiratory and other. Chronic obstructive pulmonary disease (COPD) and other lung disease, kidney disease, vision or hearing loss, and long term chronic pain.

If your condition is not named anywhere on this page, that tells you nothing about your situation. The assessment is about capacity to work, so the absence of a name from a list is not a signal either way.

When more than one condition is involved

Many people are dealing with several things at once: a physical injury alongside depression, for example, or a chronic illness with a pain condition on top. Insurers assess the combined effect on your capacity to work, not each condition in isolation. If you ever talk to a firm about your situation, it helps to mention everything, even the things that feel minor next to the main one.

If an insurer has already said no

A decision under one policy is a decision under that policy's wording. TPD definitions vary between funds, and many people hold cover in more than one fund without knowing it. A no from one insurer does not automatically mean the same answer everywhere. A firm that handles these claims can look at what cover actually exists across your accounts and what each policy says.

Where ClaimsGuide fits

ClaimsGuide is not an insurer and not a law firm, and we don't assess claims. We explain how these systems work, in plain English, and we know which firms handle which types of claim.

If you want to talk any of this through, we'll explain which doors exist for your situation and, if you want, introduce you to a firm on our panel. It costs you nothing. You never pay us. Panel firms do.

Sources

• Moneysmart, Insurance through super (ASIC), last updated 18 June 2026.
• CALI, Mental ill health is straining Australia's safety net, 30 May 2025.