Case study: $1.5M TPD claim approved under Own Occupation definition
Background
This is a real-life scenario, with the medical condition changed to protect the individual’s privacy.
The client was a high-earning professional, earning well into the six figures annually, working in a demanding, high-pressure role that required sustained cognitive performance, strategic decision-making, and frequent public engagement.
They were diagnosed with chronic vestibular migraine, a neurological condition that causes unpredictable episodes of vertigo, dizziness, and cognitive fog. While not physically disabling in a general sense, the condition made it impossible for the client to continue in their specific occupation, where precision, clarity, and consistency were essential.
The claim
The client held a Total and Permanent Disability (TPD) policy with the Own Occupation definition. This meant the Insurer assessed their ability to perform the duties of their specific occupation at the time of disability, not just any occupation they could theoretically do.
Because the client could no longer meet the demands of their high-pressure role, the claim was approved, and they received a $1.5 million payout.
What if they had Any Occupation TPD?
Had the client held an Any Occupation TPD policy, the outcome would likely have been very different. Under that definition, the Insurer would assess whether the client could work in any occupation suited to their education, training, or experience.
Given the client’s qualifications and ability to perform in lower-pressure roles, the claim may have been declined, resulting in a payout of $0, despite being permanently unable to return to the career they had built over decades.
Why this matters
This case highlights how Own Occupation TPD can be the difference between financial security and financial strain for professionals whose careers depend on peak cognitive and emotional performance.
Conditions like chronic vestibular migraine, functional neurological disorders, or early-onset cognitive impairment may not seem disabling to the average person, but in the context of high-stakes professions, they can be career-ending.
Book a confidential consultation with a Hood Sweeney Securities* Financial Planner today if you need support.
Author: Cooper McRae (Representative of Hood Sweeney Securities AFS Licence No. 220897) is a Financial Planner specialising in Life Risk Insurance.
*The information in this article contains general advice and is provided by Hood Sweeney Securities Pty Ltd AFSL 220897. This article has been prepared without taking your personal objectives, financial situation or needs into account. Before acting on this general advice, you should consider the appropriateness of it having regard to your personal objectives, financial situation and needs. Please refer to our FSG (available at https://www.hoodsweeney.com.au/services/financial-planning/how-we-service-our-clients/financial-services-guide) for contact information and information about remuneration and associations with product issuers.
