If you’re suffering from the effects of Lupus in Australia, you may be wondering what benefits you’re eligible for and how to go about the claims process. This chronic autoimmune disease occurs when the body’s immune system attacks its tissues and organs, leading to a wide range of symptoms that can affect patients’ ability to work, perform daily tasks, and maintain social functioning.
As a result, many individuals with lupus may be eligible to claim several different benefits and services to support themselves and their families. This blog post aims to explain what these benefits are and how lupus sufferers can navigate the process of claiming them.
Is Lupus Considered a Disability in Australia?
Yes, lupus can be recognised as a disability in Australia under certain conditions. Lupus, particularly in its severe form, can qualify you for disability benefits through programs like the Disability Support Pension (DSP). Lupus is widely recognised as a disabling condition due to its impact on multiple body systems. Lupus nephritis, for instance, can lead to severe kidney damage, while discoid lupus primarily affects the skin, causing scarring and hair loss. The Australian National Resource Centre outlines strict eligibility criteria for lupus cases when determining whether someone qualifies for benefits. These criteria assess not only the medical condition itself but also how it affects your ability to work, engage in social functioning, and perform daily tasks. They include:
- The severity of your symptoms (e.g., fatigue, joint pain, chest pain, memory loss)
- The impact on your ability to maintain employment and social functioning
- The effectiveness of your treatment plan and medications
It is essential to work closely with your treating doctor to include evidence of your lupus diagnosis and how it impacts your life. This evidence may include reports of flare-ups, treatment failures, and any other assessments.
What Lupus Disability Benefits Can I Claim?
In Australia, there are several insurance and government support options available, some of the key benefits include:
Total and Permanent Disability (TPD) Insurance
TPD insurance provides a lump-sum payment if you become permanently unable to work due to medical conditions like lupus. This payment is designed to support you with living costs and medical care, particularly if lupus affects your ability to maintain gainful employment. Many superannuation funds in Australia include TPD coverage, but the eligibility criteria can be strict.
The process of claiming TPD benefits for lupus requires evidence showing that your condition has reached the point where you cannot work in any job that you are reasonably qualified for. Lupus nephritis, for example, which affects the kidneys, or systemic lupus erythematosus (SLE) that involves multiple bodily systems, are examples of severe lupus symptoms that may meet the criteria for TPD claims.
Does NDIS cover Lupus?
The National Disability Insurance Scheme (NDIS) provides tailored support for people with lupus in Australia who experience significant, long-term impairments due to their condition. The NDIS can offer funding for various services and resources to help individuals manage their lupus and maintain independence in daily life. These services include personal care assistance, therapies and treatments, assistive technology, home modifications, and community participation support.
Eligibility for NDIS support is based on the level of functional impairment caused by lupus, and applicants must provide medical evidence to demonstrate the impact of the disease on their daily lives.
Disability Support Pension (DSP)
The Disability Support Pension (DSP) provides financial support to those who have a permanent medical condition, like lupus and are unable to work. To qualify, lupus sufferers must demonstrate that their condition significantly affects their ability to work at least 15 hours a week or engage in meaningful employment. This requires medical evidence, such as reports from a treating doctor, outlining the impact of lupus on their daily life and work capacity.
Income Protection Insurance
Income Protection insurance helps by covering a portion of your salary (usually up to 75%) if you cannot work temporarily due to lupus. Unlike TPD, this benefit is designed for shorter-term relief and provides regular payments over a set period, often while you are undergoing treatment or attempting to manage your symptoms.
Lupus can cause fluctuating symptoms with periods of remission and flare-ups. For those experiencing severe fatigue, joint pain, and chest pain, these episodes may temporarily prevent them from performing their job, making them eligible for Income Protection. Providing evidence of these flare-ups through medical records and documentation from your treating doctor can strengthen your claim.
Other Possible Claims
Life Insurance
Life insurance may be available to lupus sufferers to provide financial security to their families in the event of their passing. Although obtaining life insurance can be more complex for people with lupus due to their medical condition, some policies are accessible with the appropriate medical evidence.
Medicare and Healthcare Services
Lupus sufferers in Australia have access to Medicare benefits, which can cover the cost of doctor visits, specialist appointments, and essential medications. People with lupus may also be eligible for the Pharmaceutical Benefits Scheme (PBS), which subsidises certain medications used to manage lupus symptoms.
Concessions and Health Care Card
Those with severe lupus may be eligible for a Health Care Card or Pensioner Concession Card, which provides access to discounts on prescription medicines, healthcare, and utilities.
The Claims Process: The Importance of Medical Evidence
When claiming any of these benefits and services in Australia, you will be asked to provide evidence of your condition. Your treating doctor plays a central role in documenting your lupus diagnosis, symptoms, and treatment plan. This evidence is one of the most crucial elements to securing a successful claim for lupus, so it is important to understand what is involved when making a claim.
The key to claiming these benefits is providing sufficient medical evidence to prove that your lupus significantly impairs your ability to function on a day-to-day basis and prevents you from completing tasks required for employment. Medical evidence typically includes:
- Diagnosis: A formal diagnosis of lupus from a treating doctor or specialist.
- Detailed reports: Medical reports that outline the severity and nature of symptoms, such as joint pain, fatigue, or organ involvement (e.g., lupus nephritis).
- Treatment history: Records of treatments, medications, and therapies undertaken to manage lupus.
- Impact on functionality: Evidence might include assessments of mobility, cognitive function, and physical limitations.
- Residual Functional Capacity (RFC): For claims like TPD or DSP, this report evaluates what tasks the person can still perform despite their condition.
If your claim is initially denied, you may have the opportunity to appeal the decision before an administrative law judge, who can review your case and potentially overturn the denial – here is where we can help you.
Get The Support You Deserve
Sometimes, working through the claims process can be overwhelming. A disability lawyer can help you navigate the complex application process and ensure that you submit your claim promptly. Sometimes, you may need to appeal an initial decision if your claim is denied. With the right support and evidence, many people living with a lupus diagnosis can secure the benefits they need to manage their medical condition and maintain a good quality of life.
At Aussie Injury Lawyers, we specialise in helping individuals with chronic health conditions secure the compensation they are entitled to. When you’re exploring benefits, our experienced TPD lawyers can guide you through the application process and ensure your case is presented effectively.
You can also use our TPD Payout Calculator to know the value of your lump sum payment. Contact us for a free phone appointment to learn more about how we can assist you in securing the benefits you deserve. Call Now: 1300 873 252
