What these reports are for
Three insurance products generate requests to a treating psychiatrist, and they ask different questions.
Income protection pays a monthly benefit while the insured cannot work because of illness or injury. The claims assessor needs to know whether the person can perform the important duties of their own occupation now, what restrictions apply, what treatment is under way, and when a return is expected. The report is usually periodic, on the insurer's form, and the claim continues or stops on it.
Total and permanent disablement pays a lump sum, and the test is permanence: that the person is unlikely ever to work again, either in their own occupation or in any occupation suited to their education, training and experience, depending on the policy. Most TPD cover in Australia is held through superannuation and assessed under an any-occupation definition, by the insurer and then the fund's trustee.
Life and trauma policies rarely turn on a psychiatrist's opinion; where they touch psychiatry it is usually about history, disclosure at underwriting, or an exclusion. The psychiatrist's contribution is factual records rather than an opinion on capacity.
In every case the reader is a claims assessor, the test is the words of the policy rather than a statute, and the first thing to do is ask for those words: the definition of disability that applies, and the list of the insured's important duties as the insurer has recorded them. A report written against the wrong definition is a report written twice.
What it must contain
- The request and the policy. Who asked, the claim number, the definition of disability that applies (own occupation or any occupation, total or partial), and the duties list you were given. State these at the top so the assessor can see the report was written against the right test.
- Your standing. Treating psychiatrist since when, frequency, date last seen, documents reviewed.
- Diagnosis and onset. The condition, when it began, how it was diagnosed.
- The date the person ceased work, and why. Consistent with the records, with your account of the relationship between the condition and the cessation.
- Treatment history and adherence. What has been tried, for how long, with what result, and whether the person has followed it. For TPD this section carries the permanence argument.
- Current status. Symptoms and mental state now, with the date of examination.
- Capacity against the listed duties. For each important duty on the insurer's list: can perform, cannot perform, or can perform with a stated restriction, and why. This is the section the claim turns on; do not summarise it as "unfit for work".
- Prognosis. For income protection, the expected course and a realistic return-to-work horizon, with the steps (graded hours, restricted duties) and review dates. For TPD, the permanence statement: that the person is unlikely ever to return to work within the definition, with the treatment history that supports it.
- Non-medical factors, flagged as such. Where the barrier to return is partly the workplace, the labour market or a dispute, say so and separate it from the medical opinion.
- Consistency. Dates, diagnosis and capacity that match your earlier certificates and the clinical record. Where something has changed, say what and when.
Income protection: the periodic report
Ongoing claims are re-certified monthly or quarterly, and each certificate should lead with what changed since the last: treatment adjusted, response, capacity moved in either direction. Where the person can return to part of the role, say which duties and how many hours, so the insurer can assess a partial benefit rather than choosing between full benefit and none. Keep the date of disablement, the diagnosis and the duties list identical across certificates unless something genuinely changed, and if it did, say so in the certificate that first reflects it.
TPD: permanence, and "any occupation"
The TPD report is closer to the DSP and NDIS evidence in this library than to the income protection certificate, and shares their central hazard: a hedged prognosis defeats permanence. "Unlikely ever to work again" is the standard most policies use, and the report has to say whether, in your opinion, the person meets it, with the reasoning: the treatment exhausted, the course over time, and the functional picture. Under an any-occupation definition the reasoning must also address the person's education, training and experience and whether retraining is realistic, because the assessor will. Many policies require certificates from two medical practitioners, one usually a specialist; ask whether yours is one of them and what the other has said.
Where reports fall short
- The report never states which definition of disability it was written against, or was written against the wrong one.
- Capacity is "unfit for work" rather than an answer for each listed duty.
- The date of disablement, or the diagnosis, differs from an earlier certificate without explanation.
- The treatment history is thin, so a TPD permanence opinion has nothing to stand on.
- The prognosis hedges in a TPD report, or gives no horizon in an income protection one.
- Unrelated history is disclosed beyond the patient's authority, or relevant history is withheld and surfaces later.
- Workplace and labour-market barriers are presented as medical incapacity.
- The periodic certificate is late, and the benefit stops.
A skeleton that works
How PsychDispatch drafts these
The Insurance - Income Protection Support, Insurance - TPD Claim Support and Insurance - Life / Trauma Claim Support presets draft each report in the structure above, against the definition and duties you paste in from the insurer's request. Serial reports are where Patient Intelligence earns its place: each monthly certificate is drafted knowing what the last one said, so the date of disablement, the diagnosis and the duties stay consistent, and the "what changed" line is drawn from the record of consultations in between. Every claim is verified against the source before you sign, and the report goes out on your letterhead.