Insurance companies' treatment of mental health concerns raises concern, as demonstrated by a recent reversal in coverage decision.
In the complex world of superannuation insurance, mental health claimants often face significant barriers and burdens of proof. These hurdles, as consumer advocacy groups like Super Consumers Australia and CHOICE highlight, can delay or deny access to financial support when it is most needed, exacerbating mental health outcomes and adding undue stress during challenging periods.
One such individual is Dirk Purcell, a forty-two-year-old Queensland man who worked as an Aboriginal liaison officer at a hospital in north Queensland for 12 years. Dirk developed severe post-traumatic stress disorder, anxiety, and depression due to his work. When he was unable to continue working, he lodged a claim for total and permanent disability (TPD) with his super fund, ART Life. However, his claim was initially denied.
The processes involved in these claims are often described as inefficient, opaque, and lacking compassion. For instance, some super funds require claimants to score a certain rating on the Psychiatric Impairment Rating Scale before any payout, and others mandate that medical assessments be performed only by insurer-appointed psychiatrists. This inconsistency and uncertainty about what constitutes sufficient proof across different funds create a lottery effect, adding stress and disillusionment for claimants.
Moreover, finding qualified counselors or psychiatrists and obtaining the necessary ongoing treatment or assessments can be difficult and expensive. Since clinical support often underpins claim approval, this financial and logistical barrier disproportionately affects claimants.
Hayriye Uluca, a principal lawyer at Maurice Blackburn, expresses concern about insurers potentially not believing claimants and using this as a means to deny claims. This lack of empathy and fairness undermines trust in the superannuation insurance system.
Susan Quinn from Super Consumers Australia urges the federal government to task the Productivity Commission with conducting a '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.
Fortunately, Dirk's TPD claim was later approved by QSuper, making a significant difference to his life. However, Paula, a recent Maurice Blackburn client, had her TPD claim rejected despite providing all requested information, worsening her anxiety and depression. Her claim was eventually approved after Maurice Blackburn submitted a complaint to the super fund and their insurer.
In the last financial year, 92% of claims for TPD were approved, according to the Australian Prudential Regulation Authority. Despite this, mental health in super insurance remains a complex area, with some funds placing unnecessary barriers and burdens of proof. It is crucial that reforms are implemented to ensure claimants receive a fair deal on the premiums paid and that the quality of cover is not eroded by increasing claim hurdles.
- mental health claimants, like Dirk Purcell, may find the processes associated with superannuation insurance claims overwhelming and debilitating, as they frequently face complex and stringent barriers to accessing financial support, such as the need for a certain rating on the Psychiatric Impairment Rating Scale or assessments by insurer-appointed psychiatrists.
- In the realm of health-and-wellness, financial providers should prioritize supporting mental health, as the lack of empathy and fairness toward claimants can exacerbate existing mental health issues, such as worsening anxiety and depression, and negatively impact their overall health and wellbeing.
