When a shoulder, knee or hip injury stops you working

If a shoulder, knee, hip or other joint injury has stopped you working, there is often more than one system that can respond. Workers compensation is the one most people are shown. The insurance attached to your super is the one most people are never told about.

This page explains how that cover generally works for musculoskeletal injuries: injuries to the joints, muscles, tendons and connective tissue. That includes serious sprains and tears, joint replacements, crush injuries, and conditions that never fully recover. Nothing here is an assessment of your situation, and you don't need any documents in front of you to read it.

The cover many people hold without knowing

Most working Australians have insurance attached to their super, and many were never told. It can include total and permanent disability cover, called TPD: a lump sum benefit that can respond when an injury or illness means a return to your usual work is unlikely. Some funds also include income protection, which pays a monthly amount for a period while you cannot work.

Whether a particular policy responds depends on its wording, and only the insurer decides a claim. What we can say plainly is that the cover exists more often than people expect, and it costs nothing to find out what is attached to your account.

How these injuries can affect work

When a musculoskeletal injury takes work away, the pattern often looks like this:

• chronic pain and reduced range of movement
• difficulty lifting, standing, walking or doing repetitive tasks
• injuries that limit physical or manual work
• conditions that worsen over time, or after surgery
• pain that arrives alongside low mood or depression, which policies can also recognise

None of this is your fault, and none of it needs to be dramatic to matter. What policies look at is the lasting effect on your ability to work.

What a policy generally looks at

Every policy is different. In general, TPD policies ask questions like these:

• Has work stopped, and is a return to the usual work unlikely?
• Is the condition ongoing, or expected to be permanent?
• Was cover in place when work stopped, or when the injury happened? This varies by policy.
• How does the policy define permanent disability? This varies by fund.
• What does the medical evidence show? Imaging and specialist reports usually carry the most weight.

This is not a checklist you need to pass before asking questions. It is simply the shape of what insurers look at.

"Own occupation" and "any occupation": why the wording matters

Two policies can treat the same injury differently. Moneysmart, the Australian Government's money guidance website, describes an "own occupation" definition as meaning you are unable to work again in the job you were doing before, and an "any occupation" definition as meaning you are unable to ever work again in any job suited to your education, training or experience.

If you cannot do your old physical job but could retrain for something else, this wording can shape the outcome. The definition sits in your fund's insurance booklet. A firm on our panel can read your policy with you and explain which test applies.

If your injury happened at work

A workers compensation claim and a claim on the insurance in your super are separate things. They run through different systems, side by side, and being in one does not close the other. Many people with a work injury also hold TPD cover and were never told.

If your workers comp payments are stepping down or stopping, that letter is often the right moment to look at what else you hold. We explain that situation in its own guide: when your workers comp payments are changing or stopping.

Common questions

I can do desk work, but not my old job. Where does that leave me? This is exactly what the "own occupation" and "any occupation" wording decides. Some policies ask about any suitable work. Others focus on the job you held. The answer sits in the policy wording, and a specialist can read it with you.

My injury was at work. Does that rule out the cover in my super? Being in one system does not close the other. Workers compensation and the insurance in your super are separate, and people can claim through both, depending on the policy.

Do I need to have had surgery? Policies generally focus on the lasting impact on your ability to work, not on whether you have had an operation.

What we do, and what we never do

ClaimsGuide explains these systems in plain English and helps you work out which doors exist for your situation. We do not run claims, give legal or financial advice, or tell you whether you have a claim. That decision belongs to insurers and licensed professionals.

If you would rather not use a service like ours, that is a completely reasonable choice. If you call and ask, your super fund has to tell you what insurance is attached to your account: the law requires a fund to give a member the information they reasonably need to understand their benefits (Corporations Act 2001, section 1017C).

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 that handles this type of claim. Panel firms work no win, no fee, and each explains its own costs before you agree to anything. It costs you nothing. You never pay us. Panel firms do.

Sources

• Moneysmart, Total and permanent disability (TPD) insurance (ASIC).
• Corporations Act 2001 (Cth), section 1017C.