A woman who made a total and permanent disability claim but continued working has lost a dispute before the financial services ombudsman.

Insurer AIA rejected the woman’s claim on TPD cover that was held in her superannuation fund until May 2013.

The insurer argued the claimant did not become disabled before the cover ended and continued to work in jobs matching her education, training and experience (ETE) for years afterwards.

But in complaining to the Australian Financial Complaints Authority, the woman said although she was a part-time support worker from 2014 to 2017, she was totally and permanently unable to work within her ETE.

She had worked as a senior mediation and legal support officer before she became unwell in 2012. 

AFCA notes the woman had an extensive and varied work experience, in roles including registered general nurse, tutor and senior information officer.

She held a bachelor of science (nursing) degree and a post-graduate diploma in information and library services.

The woman argued support work was “many skill levels below her education, training and experience”, and she did it on doctors’ advice and for therapeutic reasons.

AFCA says there is nothing in the TPD definition or case law that requires work in a claimant’s ETE to be at the highest level of seniority, responsibility or capacity.  

It notes no tertiary qualification was needed for the senior mediation and legal support officer role she had before the injury, but relevant experience in the health industry or legal claims management was required.

The work did not appear to be at the highest level of responsibility or skill for which she was qualified.

AFCA finds the support work was within the woman’s ETE and she secured it on the open labour market, without needing retraining.  

She did a considerable amount of work after the date on which she said she became incapacitated, and the work was not significantly modified or restricted.

Read the ruling here.