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Total and Permanent Disability definitions

Definition of Total and Permanent Disablement (TPD) for all Cbus members where the date of disablement is on or after 1 December 2011

Total and Permanent Disablement in respect of a Member who at the Date of Disablement is:

  • aged less than 65 and engaged in Regular Remuneration Work within the twelve months prior to the Date of Disablement, is determined under either Part 1, Part 2, Part 3, Part 4 or Part 5.
  • aged less than 65 and not engaged in Regular Remuneration Work within the twelve months prior to the Date of Disablement and performing Home Duties, is determined under either Part 4, Part 5, Part 6 or Part 7.
  • aged less than 65 and not engaged in Regular Remuneration Work within the twelve months prior to the Date of Disablement and not performing Home Duties, is determined under either Part 4, Part 5 or Part 6.
  • over the age of 65 and an Connect (Electech) member, is determined under either Part 4, Part 5 or Part 6.

Part 1A – Fast-Track TPD Acceptance (immediate acceptance on the day that all requirements are received by HLRA)

The Member is suffering from one of the following medical conditions: Paraplegia, Quadriplegia, Hemiplegia, Diplegia, Tetraplegia.

Part 1B – Immediate Assessment Conditions

  • Where the Member is unable to follow their usual occupation as a result of suffering one or more of the following medical conditions we will waive any waiting period and assess their claim immediately: Cardiomyopathy, Primary Pulmonary Hypertension, Major Head Trauma, Motor Neurone disease, Multiple Sclerosis, Muscular Dystrophy, Dementia and Alzheimer’s disease, Parkinson’s disease, Blindness, Loss of Speech, Loss of Hearing, Chronic Lung Disease, Severe Rheumatoid Arthritis or Severe burns; and
  • In our opinion, after consideration of medical or other evidence satisfactory to us, is unlikely ever to be able to engage in any Regular Remuneration Work for which the Member is reasonably fitted by education, training or experience.

Part 2 - Unlikely to Return to Work:

The Member is unable to follow their usual occupation by reason of illness or injury for three consecutive months and in our opinion, after consideration of medical or other evidence satisfactory to us, is unlikely ever to be able to engage in any Regular Remuneration Work for which the Member is reasonably fitted by education, training or experience.

Part 3 - Permanent Impairment:

The Member is engaged in Regular Remuneration Work when suffering an injury or illness and, as a result of that injury or illness, he or she:

  • suffers a permanent impairment of at least 25% of whole person function as defined in the American Medical Association publication ‘Guides to the Evaluation of Permanent Impairment’, 4th edition, or any other recognised standard agreed to by the Fund and the Insurer; and
  • is disabled to such an extent, as a result of this impairment, that the Member is unlikely ever again to be able to engage in any occupation, business, profession, or employment for which the Member is reasonably fitted by education, training or experience.

Part 4 - Loss of Use Of:

The Member suffers the total and irrecoverable loss of:

  • the use of 2 limbs; or
  • the sight of both eyes; or
  • the use of 1 limb and the total and irrecoverable loss of the sight of 1 eye;

where ‘limb’ means an entire hand or entire foot.

Part 5 - Cognitive Loss:

The Member, as a result of illness or injury, suffers Cognitive Loss.

Part 6 – Everyday Work Activities (EWA):

The Ben suffers an illness or injury, that:

  • has prevented the Member from being able to perform at least 2 of the Everyday Work Activities without assistance from another adult person, despite the use of appropriate aids, for at least twelve consecutive months; and
  • since they became ill or injured, they have been under the regular care and attention of a Doctor for that illness or injury; and
  • in our opinion, the illness or injury means that they are unlikely to ever again be able to perform at least 2 of the Everyday Work Activities without assistance from another adult person, despite the use of appropriate aids; and
  • in our opinion, the illness or injury means that they are unlikely to ever again return to work for which they are reasonably suited by education, training or experience.

Where Everyday Work Activities means:

1) Mobility – you cannot do one of the following:

  • walk more than 200m on a level surface without stopping due to breathlessness.
  • bend, kneel or squat to pick something up from the floor and straighten up again, nor can you get in and out of a standard sedan car.

2) Communicating – you cannot do one of the following:

  • speak in your first language so that you are understood in a quiet room, nor can you hear (with or without a hearing aid or other aid) an instruction given in a normal voice in your first language in a quiet room.
  • understand a simple message in your first language, and relay that message to another person.

3) Vision – you cannot, with or without glasses or contact lenses, read ordinary newsprint and pass the standard eyesight test for a car license.

4) Lifting – you cannot lift, carry or move objects weighing up to 5kg using your hands.

5) Manual dexterity – you cannot use your hands or fingers to manipulate small objects with precision (such as picking up a coin or fastening shoelaces or buttons, using cutlery, or using a pen or keyboard to write a short note).

Part 7 - Home Duties:

The Member suffers an illness or injury, and the illness or injury wholly prevents them from:

  • engaging in Home Duties for at least 6 consecutive months; and
  • since they became ill or injured, they have been under the regular care and attention of a Doctor for that illness or injury; and
  • in our opinion, the illness or injury means that they are unlikely to ever again be able to engage in Home Duties without assistance from another adult person, despite the use of appropriate aids; and
  • in our opinion, the illness or injury means that they are unlikely to ever again return to work for which they are reasonably suited by education, training or experience;

Where Home Duties means a Member is performing home duties if they are on a full time basis doing all duties related to running the family home. This includes Cleaning, Cooking, Washing, Shopping and where applicable Looking after dependent children or providing full time care for invalid member(s) of the Member’s immediate family

Cleaning – means cleaning the family home (such as using a vacuum cleaner, sweeping with a broom, using a mop, cleaning dishes (automatic or manually)).

Cooking – means cooking the family meals (such as preparing fresh or frozen food, using an oven, stove or microwave oven).

Washing – means doing the family laundry (such as loading and unloading a washing machine and hanging out clothes or using a dryer, folding clothes and ironing).

Shopping – means shopping for food and household items (such as attending shops or using the phone or internet to purchase food or household items for the family).

Looking after dependent children – means taking care of dependent children less than 16 years of age or in full time secondary education (such as supervising, lifting, transporting, feeding and bathing).

Further definitions:

Blindness – means the permanent loss of sight in both eyes, whether aided or unaided, due to illness or injury to the extent that visual acuity is 6/60 or less in both eyes or to the extent that the visual field is reduced to 20 degrees or less of arc, as certified by an ophthalmologist.

Cardiomyopathy – means condition of impaired ventricular function of variable aetiology (often not determined) resulting in significant physical impairment, i.e. Class 3 on the New York Heart Association classification of cardiac impairment.

Chronic Lung disease – means the permanent and stage respiratory failure with FEV1 test results of consistently less than one litre, requiring continuous permanent oxygen therapy.

Dementia and Alzheimer’s disease – means the clinical diagnosis of dementia (including Alzheimer’s disease) as confirmed by a consultant neurologist, psycho-geriatrician, psychiatrist or geriatrician. The diagnosis must confirm permanent irreversible failure of brain function resulting in significant cognitive impairment for which no other recognisable cause has been identified.

Significant cognitive impairment means a deterioration in the person’s Mini-Mental State Examination scores to 24 or less and deterioration would continue but for any effective treatment. Dementia related to alcohol, drug abuse or Acquired immune Deficiency Syndrome is excluded.

Diplegia – means the total loss of function of both sides of the body due to illness or injury, where such loss of function is permanent.

Hemiplegia – means the total loss of function of one side of the body due to illness or injury, where such loss of function is permanent.

Loss of Speech – means the total and irrecoverable loss of the ability to produce intelligible speech as a result of permanent damage to the larynx or its nerve supply or the speech centres of the brain. The loss must be certified by an appropriate medical specialist.

Loss of Hearing – means the complete and irrecoverable loss of hearing, both natural and assisted from both ears as a result of illness or injury, as certified by a specialist the Insurer considers appropriate.

Major Head Trauma – means injury to the head resulting in neurological deficit causing either:

A permanent loss of at least 25% whole person function (as defined by the American Medical Association publication Guide to the Evaluation of Permanent Impairment 4th Edition of the equivalent guide to the evaluation of impairment approved by the insurer,

or

The permanent and irreversible inability to perform without the assistance of another person any 2 of the following activities of daily living:

Dressing: the ability to put on and take off clothing.

Toileting: the ability to use the toilet, including getting on and off.

Mobility: the ability to get in and out of bed and a chair.

Continence: the ability to control bowel and bladder function.

Feeding: the ability to get food from a plate into the mouth,

As certified by a consultant neurologist.

Motor Neurone Disease – means unequivocal diagnosis of motor neurone disease by a consult neurologist and confirmed by neurological investigations.

Multiple Sclerosis – means the unequivocal diagnosis of multiple sclerosis as confirmed by a consultant neurologist and characterised by demyelination in the brain and spinal cord evidenced by Magnetic Resonance Imaging or other investigations acceptable to the Insurer. There must have been more than one episode of well-defined neurological deficit with persisting neurological abnormalities.

Muscular Dystrophy – means the unequivocal diagnosis of muscular dystrophy by a consultant neurologist.

Paraplegia – means the permanent loss of use of both legs or both arms, resulting from spinal cord illness or injury.

Parkinson’s disease – means the unequivocal diagnosis of Parkinson’s disease by a consultant neurologist where the consultant neurologist confirms that the condition:

Is the established cause of two or more of the following:

Muscular rigidity

Resting tremor

Bradykinesia, and

Has caused significant progressive physical impairment, likely to continue progressing but for any treatment benefit.

The person must be following advice and treatment of a specialist neurologist.

Primary Pulmonary Hypertension – means primary pulmonary hypertension associated with right ventricular enlargement established by cardiac catheterisation resulting in significant permanent physical impairment to the degree of at least Class 3 on the New York Heart Association classification of cardiac impairment.

Quadriplegia – means the permanent loss of use of both arms and both legs, resulting from spinal cord illness or injury.

Severe Rheumatoid Arthritis – means the unequivocal diagnosis of severe rheumatoid arthritis by a rheumatologist. The diagnosis must be supported by and evidence all of the following criteria:

  • At least a six-week history of severe rheumatoid arthritis which involves three or more of the following criteria:
    • Proximal interphalangeal joints in the hands
    • Metacarpophalangeal joints in the hands
    • Metatarsophalangeal joints in the foot, wrist, elbow, knee or ankle
  • Simultaneous bilateral and symmetrical joint soft tissue swelling or fluid (not bony over growth alone), and
  • Typical rheumatoid joint deformity and at least two of the following criteria:
    • Morning stiffness
    • Rheumatoid nodule
    • Erosions seen on x-ray imaging
    • The presence of either a positive rheumatoid factor or the serological markers consistent with the diagnosis of severe rheumatoid arthritis.

Degenerative osteoarthritis and all other arthritis are excluded.

Severe Burns – means third degree burns to 20 per cent or more of the body surface, or to the whole of the face or the whole of both hands requiring surgical debridement and/or grafting.

Tetraplegia – means the total and permanent loss of use of both arms and both legs, together with loss of head movement, due to brain illness or injury or spinal cord illness or injury.