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Trauma Cover and
medical guide
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Important information
This guide has been prepared by CommInsure, a registered business name of The Colonial Mutual Life Assurance Society Limited ABN 12 004 021 809 AFSL 235035
(CMLA), a wholly owned but non-guaranteed subsidiary of Commonwealth Bank of Australia ABN 48 123 123 124 AFSL 234945. This guide is for the use of advisers
and Commonwealth Bank of Australia employees only and is not to be issued, reproduced in whole or in part, or made available to members of the public.
This information is of a general nature only and is in no way meant to be a substitute for medical treatment and may not be construed as medical advice, diagnosis or
treatment. All reasonable efforts have been made to ensure that the information provided through this guide is accurate at the time of inclusion; however, CommInsure
makes no assurances as to the accuracy, currency or completeness of the content provided in this guide.
The layperson’s explanations are to be used as a guide only. Advisers should refer to the relevant life company documents for further clarification. All claims will be
assessed under the definitions as outlined in the Combined Product Disclosure Statement (PDS) and Policy.
Contents
2
Trauma cover
5
Heart disorders
9
Nervous system disorders
14
Body organ disorders
20
Blood disorders
22
Other events
23
Glossary of terms
28
Why CommInsure?
1
Trauma cover
Since its inception approximately thirty years
ago, trauma cover has enjoyed a considerable
rise in popularity, evolving from a little known
and poorly understood benefit, to one that
many advisers now specialise in selling.
Accompanying this increasing popularity is
the constant need for a high quality medicallayperson’s guide (which would be easily
understood by advisers and clients alike) that
provides explanations of medical definitions
and some related medical facts.
This guide accompanies CommInsure’s updated policy
definitions, which we have revised to keep in pace with recent
trends and developments in medical science.
History and background
Trauma insurance was first developed in South Africa in the
early 1980’s by Dr. Marius Barnard, brother of the acclaimed
cardiac surgeon Dr. Christiaan Barnard. Marius also assisted
Christiaan in the first ever heart transplantation surgery.
As a cardiothoracic surgeon, Christiaan’s job was to treat his
patients’ heart disease so that they could enjoy a longer life;
whereas Marius, by devising trauma cover, discovered a way to
ensure that they could afford the medical procedures despite
the significant setback to their health. His efforts resulted in the
creation of the first trauma cover policy, which provided a lump
sum benefit in the event that the insured client was diagnosed
with any one of a number of defined trauma (or critical illness)
conditions, or underwent a specified medical procedure.
With the increasing public and personal health burdens of noncommunicable diseases, including conditions such as cancer
and heart disease which have an impact on almost everyone in
society in some way, it is not surprising that the trauma cover
approach to risk protection has steadily increased in popularity
in recent times.
What is trauma cover?
Trauma cover may also be described as ‘dread diseases’ cover,
‘critical illness insurance’ or ‘living assurance’. As noted earlier,
this is a type of insurance that provides a lump sum benefit
in the event that an insured client is diagnosed with a specific
medical condition or undergoes a specified medical procedure,
as defined in the relevant policy document.
Examples of trauma cover conditions and procedures include
relatively common conditions such as cancer, heart attack
of specified severity, stroke and coronary artery angioplasty,
along with relatively less common yet still traumatic conditions
such as multiple sclerosis, muscular dystrophy or Parkinson’s
disease.
Trauma cover is becoming an essential tool in an adviser’s risk
planning arsenal, and is also an important consideration during
the assessment of a client’s future wealth protection needs.
By providing a lump sum benefit, trauma cover can help
alleviate financial pressure and stress resulting from a period
of significant illness, by assisting the client and their family
while they adjust to their changing circumstances and plan for
the future.
What are the chances of developing a critical illness in
Australia?
• Cancer causes the greatest burden of disease in Australia,
followed by cardiovascular disease.1
• In 2009, more than 3 in 5 people who had a heart attack
survived, compared with fewer than half in 1997.1
• Between 1989–90 and 2007–08, the overall prevalence of
diabetes among Australians more than doubled, increasing
from 1.5 to 4.1 per cent of Australia’s population.1
• Chronic kidney disease is more common than is widely
perceived, with recent research reflecting that this
condition affects (to varying extents of severity) 1 in
7 Australian adults.1
• According to a recent claims experience study, insured
males between the ages of 30 and 64 years had a 40 per
cent probability of suffering a traumatic illness, with a 25 per
cent probability reported for females in a similar age group.2
Trauma cover is about survival
CommInsure’s Trauma Cover could give your clients the
opportunity to create real options at a traumatic time. It pays
out a lump sum not because they are going to die, but because
they are going to live.
Australians are suffering an increasing incidence of cancer,
high levels of coronary heart disease and stroke. Continuous
advances in medical science mean that people have increasing
odds of surviving a serious medical condition. In certain
cases, survival periods can now be measured in several
years, for medical conditions that until very recently reflected a
bleak outlook.
Such improvements in patient’s survival rates are always
perceived as beneficial; however in certain cases extended
survival with poor health could detrimentally impact the patient’s
quality of life and also impact their immediate family and wider
community.
In certain cases, a patient could achieve a medical recovery
from a traumatic illness; however, the impact of the illness
on their finances could prove devastating and irrecoverable.
Most adults rely on the continued growth and success of their
career or business to achieve their long-term financial goals.
For example, although a female client’s doctors may advise her
of good odds of achieving a medical recovery from an invasive
breast cancer, her likelihood of making a full financial recovery
could be less certain, especially if she is unable to maintain or
resume employment in the short- to medium-term.
Trauma Cover can also make a contribution towards the
financial survival of families and businesses, by providing a
benefit payment which the client may use to address any
financial shortfall resulting from a period of serious illness.
1 AIHW 2012. Australia’s health 2012. Australia’s health no. 13. Cat. no. AUS 156. Canberra: AIHW.
2 Gen Re Life Health Australia 2008. Australian Critical Illness Survey 2008: A study of claims experience in 2001 to 2005.
2
Your clients could consider taking out a Trauma Cover policy if they:
• have a mortgage or other debt
• have a family/dependants and associated responsibilities
• have a business or business partners
• are company directors, key employees or are self-employed
• have insufficient cash reserves to cover the (often unexpected) medical and
ancillary expenses not otherwise covered by the public health system or private health insurance.
Summary
Trauma Cover
CommInsure’s Trauma Cover provides a lump sum benefit payment following the occurrence of a specified medical condition or
event, regardless of whether your client is prevented from working or not. It is available either on its own (standalone Trauma), or
in conjunction with Life Care, TPD Cover or both (please note however that Trauma Cover can’t exceed the amount of Life Care).
Your client also has the option of ‘flexi-linking’, meaning that they can bundle insurance inside or outside of superannuation across
two policies – potentially resulting in savings on policy fees.
Within Trauma Cover, the lump sum payment or ‘sum insured’ reflects the total amount for which your client is insured, or a proportion
of the total amount in the case of a Partial Trauma benefit.
Trauma Plus Cover
If your client selects Trauma Plus Cover, a Partial Trauma Cover benefit will be payable on the diagnosis of any one of 13 additional
Trauma Plus Cover conditions; specifically, diabetes complications, early-stage melanoma, early-stage cancer of the cervix uteri,
early-stage ovarian cancer, early-stage cancer of the fallopian tubes, early-stage cancer of the vagina, early-stage chronic lymphocytic
leukaemia, early-stage penile cancer, early-stage prostate cancer, surgical removal of hydatidiform mole, partial blindness, partial loss
of hearing or severe osteoporosis.
Child Cover
CommInsure also provides Child Cover to insure your child’s life on your own Life Care or standalone Trauma Cover policy, helping to
ease the financial strain and stress caused in the event of a child’s unexpected serious illness by paying a benefit if the child suffers
one of the Child Trauma conditions or dies. If your client has a child between the ages of two and 16 inclusive, they are able to apply
on his/her behalf for up to $250,000 worth of Child Cover. Your client can also cover more than one child, but each child must have
the same sum insured.
For all italicised terms not defined under the relevant medical sections in this document, please refer to the CommInsure
Combined Product Disclosure Statement (PDS) and Policy.
What is provided under Trauma Cover, Trauma Plus Cover and Child Cover?
Medical condition
Heart disorders
Heart attack of specified severity
Out of hospital cardiac arrest
Coronary artery disease requiring bypass surgery
Coronary artery angioplasty*
Coronary artery angioplasty – triple vessel
Repair and replacement of a heart valve
Surgery of the aorta
Cardiomyopathy
Primary pulmonary hypertension
Open heart surgery
Nervous system disorders
Stroke
Major head trauma
Motor neurone disease
Multiple sclerosis
Multiple sclerosis of limited extent
Muscular dystrophy
Paraplegia
Quadriplegia
Trauma Cover
Trauma Plus Cover
Child Cover
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4*
4
4
4
4
4
4
4
4*
4
4
4
4
4
4
4
4
4
4
4
3
Trauma cover
Medical condition
Hemiplegia
Diplegia
Tetraplegia
Dementia and Alzheimer’s disease
Coma
Encephalitis
Parkinson’s disease
Bacterial meningitis
Subacute sclerosing panencephalitis
Body organ disorders
Cancer
Early-stage melanoma
Early-stage chronic lymphocytic leukaemia
Early-stage cancer of the vulva or perineum
Early-stage breast cancer
Testicular cancer
Early-stage cancer of the cervix uteri
Early-stage cancer of the fallopian tubes
Early-stage ovarian cancer
Early-stage cancer of the vagina
Surgical removal of a hydatidiform mole
Early-stage prostate cancer
Early-stage penile cancer
Benign brain tumour
Blindness
Partial blindness
Chronic kidney failure
Major organ or bone marrow transplant
Placement on a waiting list for major organ transplant*
Severe burns
Loss of speech
Loss of hearing
Partial loss of hearing
Chronic liver disease
Chronic lung disease
Severe rheumatoid arthritis
Pneumonectomy
Severe osteoporosis
Blood disorders
Occupationally acquired HIV
Medically acquired HIV
Aplastic anaemia
Advanced diabetes
Diabetes complication
Other events
Serious injury*
Critical care*
Loss of limbs or sight
Loss of independent existence
Loss of one hand or one foot*
Trauma Cover
4
4
4
4
4
4
4
Trauma Plus Cover
4
4
4
4
4
4
4
Child Cover
4
4
4
4
4
4
4
4
4
4*
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4*
4*
4
4*
4
4*
4*
4*
4*
4*
4*
4*
4
4
4*
4
4
4
4
4
4
4*
4
4
4
4
4*
4
4
4
4
4
4
4
4
4*
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
The conditions and events marked with * on the previous page and above reflect a partial payment of the Trauma Cover benefit. For full details, please refer to the relevant
CommInsure Protection Combined Product Disclosure Statement (PDS) and Policy.
4
Heart disorders
Heart attack of specified severity
The death of part of the heart muscle (myocardium) as a result
of inadequate blood supply.
The diagnosis must be based on either:
• the following medical evidence:
–– elevation of cardiac enzyme CK-MB or
–– elevation in levels of Troponin I greater than 2.0 mcg/L or
Troponin T greater than 0.6 mcg/L or their equivalent
and
–– confirmatory new electrocardiogram (ECG) changes or
–– medical evidence satisfactory to us that the heart attack
reduced the Left Ventricular Ejection Fraction to below
50% when measured at least six weeks after the heart
attack
or
• any other medical evidence satisfactory to us which
demonstrates that myocardial damage has occurred to at
least the same degree of severity as would be evidenced by
the medical evidence required under the first bullet point.
In layperson’s terms
Coronary arteries carry oxygen-rich blood to the heart muscle.
A robust oxygen supply is essential not only to ensure an
individual’s survival, but also to maintain the good health and
optimal functioning of the heart.
During a heart attack, the blood supply to the heart muscle
becomes blocked or is significantly reduced, resulting in death
of a portion of the heart muscle due to a lack of oxygen. Below
are medical findings typically recorded during most heart
attacks.
• Damaged and/or dead muscle cells release enzymes (e.g.
CK-MB) and proteins (e.g. Troponins I and T) into the
bloodstream. Enzymes are complex proteins found in most
tissues of the body, which allow the normal metabolism and
functioning of those tissues, by catalysing biochemical
reactions. CK-MB is an isoenzyme, or a specific sub-type of
the enzyme creatine kinase (CK).
• An electrocardiogram (ECG) records the electrical activity of
the heart and typically reflects changes associated with
damage to the heart muscle during a heart attack. ECGs can
also reflect evidence of an old heart attack, for example,
permanent pathological Q waves.
• The heart may not be able to pump properly during and/or
after a heart attack. When a normal heart beats, it pumps out
more than 50 per cent of blood being held in the heart. When
it doesn’t pump properly, the heart is only able to pump out
less than 50 per cent of the blood held in the heart. The
amount of blood pumped out with each heart beat is called
the ejection fraction.
A Trauma claim will be paid if:
Quick facts
In 2009, an estimated 47,700 Australians aged from 40-90
years suffered a heart attack, of whom 63 per cent survived.
Although men were twice as likely as women to suffer a heart
attack, survival rates are similar for both genders.
Source: Australian Institute of Health and Welfare, 2012.
Out of hospital cardiac arrest
Cardiac arrest which isn’t associated with any medical
procedure and is documented by an electrocardiogram, occurs
out of hospital and is due to:
• cardiac asystole or
• ventricular fibrillation with or without ventricular tachycardia.
In layperson’s terms
Cardiac arrest occurs when the heart develops an abnormal
heart rhythm, or an arrhythmia, which causes it to stop
beating. As a result, the affected person collapses suddenly
into unconsciousness. Death occurs within minutes if cardiopulmonary resuscitation (CPR) is not administered urgently. In all
cases, a pulse cannot be felt during a cardiac arrest event.
Cardiac asystole means the heart has stopped beating
completely, an event sometimes described as ‘flat-lining’.
Ventricular tachycardia means the heart is beating regularly but
at a very rapid rate, causing an insufficient amount of blood to
be pumped with each heartbeat.
Ventricular fibrillation means the heart is beating irregularly
and at a very rapid rate, which can also result in an insufficient
volume of blood being pumped with each heartbeat.
For a Trauma claim to be considered, the relevant cardiac
arrest episode must have occurred outside of a hospital and
must also be documented on an electrocardiogram (ECG),
as several unrelated medical conditions (e.g. severe anxiety
causing a temporary loss of consciousness) can result in similar
symptoms, but are not as life-threatening as conditions that
cause cardiac arrest.
A cardiac arrest is not within the scope of this benefit if the event
occurs in hospital or is associated with any medical procedure,
as certain medical procedures can contribute to – or even
directly cause – a cardiac arrest.
Quick facts
According to a recent Australian medical study, 2,011 Sydney
residents suffered an out-of-hospital cardiac arrest during the
12-month period from 1 June 2004 to 31 May 2005. The overall
survival rate was relatively low, with only 24 per cent of patients
surviving past the day of the cardiac arrest; however, 11.5 per
cent of survivors were still alive a year later.
Source: Cheung W., Flynn M. & Thanakrishnan G., et al. Survival after
out-of-hospital cardiac arrest in Sydney, Australia. Critical Care and
Resuscitation, Volume 8, Number 4: Dec 2006.
• the CK-MB or the Troponins in the blood stream reach a level
high enough to be consistent with a heart attack, and
• the ECG shows a typical heart attack pattern, or the left
ventricular ejection fraction noted in an echocardiogram falls
to less than 50 per cent when measured at least six weeks
after the heart attack.
5
Heart disorders
Coronary artery disease requiring bypass surgery
Coronary artery angioplasty – triple vessel
The actual undergoing of bypass surgery (including saphenous
vein or internal mammary graft(s)) for the treatment of coronary
artery disease. Any other operations are specifically excluded
from this definition.
Undergoing in the same procedure coronary artery angioplasty
to three or more coronary arteries, where the procedure is
considered necessary by a cardiologist to treat coronary artery
disease.
In layperson’s terms
Coronary artery disease results in the narrowing of one or more
of the coronary arteries that supply blood to the heart. This
narrowing can progress to the extent that blood flow becomes
significantly reduced and is inadequate to sustain normal
functioning of the heart muscle, causing damage or death of
heart tissue, for example, following a heart attack.
In layperson’s terms
Coronary artery disease results in the narrowing of one or
more of the coronary arteries that supply blood to the heart. In
certain cases, coronary artery angioplasty is also an appropriate
treatment option for advanced coronary artery disease.
The key aim of coronary artery bypass graft (CABG) surgery
is to re-direct blood to the damaged heart muscle through an
alternate route, hence by-passing the blocked portion of a
coronary artery.
During a typical CABG procedure, the surgeon opens the chest
wall to directly visualise the heart, then identifies the blocked
coronary artery or arteries. The source of blockage is not
removed, as the surgeon takes a donor vein from elsewhere in
the patient’s body (e.g. from a leg) and connects it above and
below the blocked location in an artery, thereby bypassing the
blockage. During the procedure, the patient is kept alive by a
heart-lung machine and also requires blood transfusions.
In recent years, minimally-invasive keyhole or ‘mini-CABG’
procedures were developed and are becoming increasingly
available. These procedures require less invasive surgery and
usually result in a relatively quicker recovery when compared
to a conventional CABG. However, specific medical eligibility
criteria apply, as (currently) the mini-CABG procedure is not
suitable for all patients.
Following surgery, patients are usually encouraged to gradually
increase their physical activity levels, as the best long term
survival outcomes are usually reported in people who achieve
high activity levels after surgery.
Quick facts
In 2007-08, approximately 13,600 CABG procedures were
performed in Australian hospitals. Almost three-quarters of the
procedures were required by men suffering from advanced heart
disease.
The severity of coronary artery disease and narrowing of
arteries are typically established when a patient undergoes an
angiography procedure, hence the reference to ‘angiographic
evidence’ in the relevant benefit definition.
During angiography, a flexible tube called a catheter is inserted
along an artery until it reaches the main coronary artery, where
a dye is then released through the catheter. Images of the
dye are then recorded and provide visual evidence of fatty
deposits called plaques, which may be causing narrowing and
obstruction of the affected arteries.
Unlike the CABG procedure, it is not necessary for a surgeon to
open the chest wall during angioplasty. Rather, a small inflatable
balloon attached to a flexible catheter is inserted along an artery
until it reaches the blocked portion of a coronary artery. The
balloon is then inflated, hence stretching the narrowed portion of
the artery back to its normal diameter.
In certain cases, a fine metallic mesh tube called a stent is also
inserted into the artery to keep it open. The stent remains in
the artery after the balloon is deflated and removed. There are
different types of stents, including the self-explanatory bare
metal stents and the more modern drug-eluting stents, which
contain drugs that are slowly released after the stent is inserted
into the affected artery.
Quick facts
In 2007-08, a total of 35,000 coronary angioplasty procedures
were performed in Australian hospitals.
Source: Australian Institute of Health and Welfare, 2012.
Source: Australian Institute of Health and Welfare, 2012.
Coronary artery angioplasty
The undergoing of coronary artery angioplasty that is
considered necessary by a cardiologist to treat coronary artery
disease. The cardiologist’s opinion that the procedure is
necessary must be supported by angiographic evidence.
Saphenous
vein graft
Coronary bypass.
6
Internal mammary
artery graft
Repair and replacement of heart valve
Surgery of the aorta
Surgery to replace or repair heart valves, but doesn’t include
percutaneous valvuloplasty, trans-arterial procedures or other
non-surgical techniques.
Surgery to correct a narrowing, dissection or aneurysm of the
thoracic or abdominal aorta but not its branches.
In layperson’s terms
There are four one-way heart valves in a healthy heart which
prevent blood from flowing in the wrong direction. Unfortunately,
one or more heart valves can become narrowed and/or fail to
close properly. If this happens, blood circulation through the
heart can become impaired. This impairment can also gradually
worsen, eventually resulting in a need for surgery to repair or
replace the damaged valve to restore normal heart functioning.
In layperson’s terms
The aorta is the largest artery in the body. It carries blood from
the heart to all other parts of the body through a branching
system of arteries. The thoracic aorta starts from the chest and
continues down through the diaphragm – the muscle separating
the chest from the abdomen – into the abdomen, where it then
becomes the abdominal aorta.
• pulmonary valve.
Narrowing of the aorta means that the aorta becomes
constricted in one or more locations due to an accumulation
of fatty deposits or as a result of a blood clot forming on the
aortic wall. Such narrowing reduces blood flow to the lower
limbs, usually during periods of activity such as walking, which
can result in a patient suffering symptoms such as muscle pain
or cramping. Surgery is typically indicated to remove the fatty
deposits or bypass locations of narrowing, which helps address
related symptoms and prevent or delay potential complications.
This Trauma benefit specifically excludes a benefit payment for
minimally-invasive keyhole procedures such as percutaneous
valvuloplasty, where a small incision is made into the chest and
the diseased valve is then viewed and treated using a very small
camera and related instruments.
Dissection of the aorta is usually a medical emergency. It results
from the walls of the aorta suddenly splitting. Surgery is usually
aimed at releasing the build-up of pressure in the dissected
layers of the aorta, to help decrease the rate of progression of
the dissection.
Trans-arterial procedures are also minimally-invasive. These
typically involve a surgeon passing a very small camera into the
heart through an artery, to view and treat the diseased valve.
An aortic aneurysm reflects an area of weakening of the wall
of the aorta. This weakened area worsens and becomes
more prominent over time, sometimes reaching the size of
a grapefruit! Typically, surgery is required to repair larger
aneurysms to help prevent known potential complications, such
as the sudden rupture of an aneurysm – which is considered a
medical emergency.
Heart valve surgery may involve repairing or replacing one or
more of the following heart valves:
• mitral valve
• tricuspid valve
• aortic valve
Quick facts
A total of 10,350 heart valve procedures were carried out in
Australian hospitals during the reporting year ending in June
2010.
Source: AIHW National Hospital Morbidity Database, 2012.
Quick facts
A total of 4,011 surgical procedures relating to the aorta were
carried out in Australian hospitals during the reporting year
ending in June 2010.
Source: AIHW National Hospital Morbidity Database, 2012.
Aorta
Prosthetic valve
Aortic valve replacement.
7
Heart disorders
Cardiomyopathy
Primary pulmonary hypertension
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 (see page 26).
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 of the New York Heart Association
classification of cardiac impairment (see page 26).
In layperson’s terms
Blood is pumped out of the heart into the aorta, the largest
artery in the body. From there, oxygen-rich blood is transported
to all tissues of the body aside from the lungs. The heart
chamber that pumps out this blood is called the left ventricle.
Cardiomyopathy is a condition where the entire heart muscle (or
a large part of it) is weakened due to various causes, including
specific conditions, viral infections and in cases of severe
alcohol abuse. The resulting muscle weakening means that
the heart performs less efficiently over time, usually causing
symptoms such as shortness of breath, fatigue, palpitations
and chest pains in certain cases. Cardiomyopathy can progress
to an extent resulting in serious events such as heart failure or
sudden cardiac arrest.
There are four main types of cardiomyopathy – defined as
follows.
• Dilated cardiomyopathy is the most common type and
means that the cavity of the heart is enlarged and its walls
are stretched. The heart muscle is weakened to the extent
that it no longer pumps a normal volume of blood.
• Hypertrophic cardiomyopathy means there is enlargement of
the left ventricle’s muscle mass.
• Restrictive or infiltrative cardiomyopathy is a relatively rare
type where the walls of the heart have become more rigid,
making it harder for the heart muscle to relax normally or
pump blood effectively.
• Arrhythmogenic right ventricular dysplasia is another rare
type of cardiomyopathy, usually attributed to genetic causes.
Sometimes, it can lead to sudden cardiac arrest and death in
apparently healthy young individuals, even athletes.
Several other, less common types of cardiomyopathy also exist,
including some cases which may be described by cardiologists
as an ‘unclassified cardiomyopathy’.
Quick facts
Cardiomyopathy was the main diagnosis in approximately 4,600
hospitalisations in Australia during 2009-10.
Source: Australian Institute of Health and Welfare, 2012.
Left atrium
Right atrium
Right ventricle
An enlarged heart.
8
Left ventricle
In layperson’s terms
Primary (or idiopathic) pulmonary hypertension means that
the very small arteries in the lungs have become narrowed or
blocked due to an unidentified cause. This causes increased
resistance to the blood flowing through the lungs, hence
resulting in abnormally increased pressure or ‘hypertension’ in
the lung’s (or pulmonary) arteries. The condition may also be
described as idiopathic pulmonary arterial hypertension.
The terms primary or idiopathic mean that the underlying cause
is unknown in a specific case. The resulting abnormally-high
pressure means that the right ventricle of the heart needs to
work harder to pump blood into the pulmonary arteries. This
increased effort causes the right ventricle to become larger and
weaker over time, which eventually damages the right ventricle
leading to heart failure.
Fortunately, primary pulmonary hypertension is not very
common; however, it is a serious illness which remains incurable
at this time. In certain cases, both lung and heart transplantation
(or otherwise lung or heart transplantation in specific cases)
might be available and could help extend survival; however, as
at 2012, Australia continued to experience one of the lowest
organ donation rates in the developed world.
Quick facts
Primary pulmonary hypertension resulted in 283 hospitalisations
during the reporting year ending in June 2010.
Source: AIHW National Hospital Morbidity Database, 2012.
Open heart surgery
Open heart surgery for treatment of cardiac defect(s), cardiac
aneurysm or benign cardiac tumour(s).
In layperson’s terms
Open heart surgery is an operation where the chest wall is
opened to allow a surgeon to perform procedures on the heart.
In this context, the term ‘open’ refers to the chest wall and
not the heart itself, as the heart may or may not be surgically
‘opened’ depending on the type of disease and the procedure
involved. Open heart surgery includes surgery on the heart
muscle, its valves, arteries and other related structures.
A heart-lung machine is usually required during surgery to help
ensure that oxygen-rich blood continues to be supplied to the
heart, the brain and other vital organs. This machine not only
acts as a temporary blood pump, but also supplies oxygen to
(and removes carbon dioxide from) the circulating blood during
surgery.
Quick facts
Although many diseases can potentially result in open heart
surgery becoming indicated, benign tumours of the heart remain
relatively uncommon. Such tumours however still caused 118
hospitalisations in Australia during 2009-10.
Source: AIHW National Hospital Morbidity Database, 2012.
Nervous system disorders
Stroke
Major head trauma
A cerebrovascular accident or incident producing neurological
sequelae.
Injury to the head resulting in neurological deficit causing
either:
This includes infarction of brain tissue, intracranial and/ or
subarachnoid haemorrhage or embolisation from an
extracranial source.
• a permanent loss of at least 25% whole person function (as
defined in the edition of the American Medical Association’s
publication ‘Guides to the Evaluation of Permanent
Impairment’ current as at the preparation date of the
CommInsure Protection PDS) or
The following are excluded:
• Cerebral symptoms due to:
• the permanent and irreversible inability to perform without
the assistance of another person any one of the activities of
daily living (as defined under loss of independent existence
on page 22)
–– transient ischaemic attacks
–– reversible ischaemic neurological deficit or
–– migraine.
as certified by a consultant neurologist.
• Cerebral injury resulting from:
–– trauma
–– hypoxaemia or
–– vascular disease affecting the eye, optic nerve or
vestibular function.
In layperson’s terms
The phrase ‘cerebrovascular circulation’ describes blood
circulation to the brain. A cerebrovascular accident is an event
which has a significant effect on the cerebrovascular circulation.
Stroke is the general term typically used to describe such
events.
During a cerebral infarction, a blood clot cuts off the supply of
oxygenated blood to part of the brain, resulting in death of the
oxygen-starved brain tissue.
Another type of stroke is called a ‘cerebral haemorrhage’, which
means that there was a rupture of a blood vessel resulting in
bleeding either directly into the brain (intracerebral haemorrhage)
or the space surrounding it (subarachnoid haemorrhage).
Quick facts
Strokes caused 35,345 hospitalisations in Australia during
2009-10 and as at 2009, it was estimated that there were
375,800 stroke survivors among the general population.
In layperson’s terms
A strong blow to the head can directly damage the brain,
or otherwise cause the brain to move and hit the inside of
the skull, resulting in bleeding and the death of brain cells.
Accordingly, a serious head injury has the potential to cause
significant and permanent disability.
Depending on the damaged region of the brain, symptoms may
include:
• memory loss or impairment
• a loss of the sense of time and space
• behavioural disturbances, including changes in personality
• total paralysis or weakness of limbs
• changes in the senses (hearing, vision, taste, touch and
smell)
• difficulty with speaking and/or understanding speech.
In this benefit definition, the phrase ‘neurological deficit’ refers
to symptoms caused by damage to brain cells resulting from a
serious head injury.
The permanent loss of 25 per cent of whole body function is
typically assessed by a specialist neurologist using objective,
pre-established medical assessment guidelines to confirm the
permanence and extent of any impairment resulting from a
major head injury.
Source: Australian Institute of Health and Welfare, 2012.
Infarction of
brain tissue
Quick facts
In 2009-10, head injuries causing damage to the brain resulted
in 19,118 hospitalisations in Australia.
Source: AIHW National Hospital Morbidity Database, 2012.
Subarachnoid
haemorrhage
A stroke.
9
Nervous system disorders
Motor neurone disease
Muscular dystrophy
Motor neurone disease diagnosed by a consultant neurologist.
The unequivocal diagnosis of muscular dystrophy by a
consultant neurologist.
In layperson’s terms
Motor neurone disease (MND) is the name given to a group
of related diseases which affect the motor neurones which
control muscles. The motor neurones degenerate and cause a
progressive weakness and muscle wasting.
Motor neurones are nerve cells that allow our muscles to
function normally. There are two types of motor neurones. One
group (called upper motor neurones) run from the brain to the
spinal cord. The other group (called lower motor neurones) run
from the spinal cord to the muscles. These two groups link up in
the spinal cord.
There are three main types of motor neurone disease. In one
type, both the upper and lower neurones degenerate. In the
other two, just the upper or the lower neurones degenerate.
However, whatever the type, the end result is muscle wasting
and progressive weakness.
There is no specific test to diagnose MND, so in its early stages
it can be confused with other diseases. However, measuring the
electrical activity in a muscle and/or a muscle biopsy will usually
give the diagnosis. The cause is unknown.
In layperson’s terms
Muscular dystrophy (MD) includes a group of diseases (typically
of genetic origin) that cause progressive weakness and
degeneration of muscles which control movement. Some forms
of MD appear in infancy, while others do not appear until middle
age or even later. Sometimes, the heart and other major organs
are also affected.
Some forms of MD result in relatively mild symptoms and
progress very slowly, with affected patients possibly reaching a
normal life expectancy.
Quick facts
As at 2007, an estimated 3,457 Australians were suffering from
a muscular dystrophy.
Source: Access Economics. The cost of muscular dystrophy. 19th October
2007.
Quick facts
Motor neurone disease resulted in 1,292 hospitalisations in
Australia during 2009-10.
Source: AIHW National Hospital Morbidity Database, 2012.
Multiple sclerosis
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 us. There must have been more than one
episode of well-defined neurological deficit with persisting
neurological abnormalities.
Multiple sclerosis of limited extent
The unequivocal diagnosis of multiple sclerosis but without the
existence of persisting neurological abnormalities.
In layperson’s terms
In multiple sclerosis (MS), nerve cells lose their myelin coating,
which acts like insulation on electrical wiring. The myelin is
destroyed and replaced by hard scar tissue. When nerve
impulses reach a damaged area, they are blocked or delayed
in travelling to or from the brain. Symptoms vary depending on
where the damage is.
Early signs are blurred vision, numbness in hands or legs,
weakness, fatigue and loss of coordination and balance. The
disease may gradually worsen until there is loss of vision,
bladder problems, bowel problems and paralysis.
Quick facts
During 2009-10, multiple sclerosis caused 14,669
hospitalisations in Australia.
Source: AIHW National Hospital Morbidity Database, 2012.
10
Nerve
cell
Loss of myelin
coating in MS
Motor neurone disease.
Paraplegia
Diplegia
The permanent loss of use of both legs or
both arms, resulting from spinal cord
sickness or injury.
The total loss of function of both sides of the
body due to sickness or injury where such loss
of function is permanent.
Quick facts
In Australia, 160 hospitalisations were mainly caused by
paraplegia in 2009-10.
Source: AIHW National Hospital Morbidity Database, 2012.
Quick facts
Spastic diplegia is one of the more common forms of
cerebral palsy. It resulted in 462 hospitalisations in Australia
during 2009-10.
AIHW National Hospital Morbidity Database, 2012.
Quadriplegia
The permanent loss of use of both arms and both
legs resulting from spinal cord sickness or injury.
In layperson’s terms
If the spinal cord is injured or develops disease, the muscles of
both the arms and both the legs become paralysed, resulting in
quadriplegia. Motor vehicle accidents and sports injuries are just
two potential causes of spinal cord injury.
Quick facts
As at 2011, an estimated 15,000 Australians were living with
a spinal cord injury. At the time, the total cost to the Australian
economy of quadriplegia (caused by a spinal cord injury) was
also estimated at $1.3 billion.
Source: Spinal Cord Injuries Australia, Annual Report 2011.
Hemiplegia
The total loss of function of one side of the
body due to sickness or injury, where such loss
of function is permanent.
In layperson’s terms
Hemiplegia is the total paralysis of the arm, leg and trunk on the
same side of the body. The most common cause is a stroke,
usually in the elderly, but it can occur in babies or toddlers.
Other causes are blood vessel disease, wounds, tumours or
abscesses.
The onset of hemiplegia is usually very sudden in stroke
patients, who may not be able to move one side of the body
and are often also unable to speak. While certain patients
might make a complete recovery after a period of several days
or weeks, the majority achieve only a partial recovery and are
usually left with a permanent weakness on one side of their
body.
Quick facts
Hemiplegia was the direct cause of 1,402 hospitalisations in
Australia during 2009-10.
Tetraplegia
The total and permanent loss of use of both
arms and both legs, together with loss of head
movement, due to brain sickness or injury or
spinal cord sickness or injury.
Quick facts
Tetraplegia was the main cause of 127 hospitalisations in
Australia during 2009-10.
Source: AIHW National Hospital Morbidity Database, 2012.
Dementia and Alzheimer’s disease
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
treatments. Dementia related to alcohol, drug abuse or AIDS is
excluded.
In layperson’s terms
The cause of Alzheimer’s disease is still unknown. Symptoms of
Alzheimer’s disease are gradual memory loss, poor judgement,
an inability to perform routine tasks and personality and mood
changes. These symptoms gradually get worse over five to ten
years, until the patient needs constant supervision so that they
do not endanger themselves or others. Often the diagnosis is
only confirmed by examination of the brain tissue after death.
For a number of reasons, the brain can cease functioning
normally and, as a result, the patient is unable to look after
themselves or may be a danger to others. This is called
dementia. The cause can be unknown, as in Alzheimer’s
disease, or may be known, such as multiple strokes. The MiniMental State Examination is too detailed to reproduce in this
booklet. However, an excellent review of dementia, together with
details of this examination, is given in Pridmore S. Download of
Psychiatry. Chapter 20. Last modified 7 November 2006.
AIHW National Hospital Morbidity Database, 2012.
11
Nervous system disorders
Quick facts
Alzheimer’s disease caused 3,979 hospitalisations in Australia
during 2009-10, including 99 cases specifically identified to
reflect ‘early-onset’ disease, meaning that the affected patients
were diagnosed with the condition before reaching the age of
65 years.
Source: AIHW National Hospital Morbidity Database, 2012.
Coma
A state of unconsciousness with no reaction to external stimuli
or internal needs, resulting in a documented Glasgow Coma
Scale score of 6 or less, with continuous assisted ventilation
required for at least 72 consecutive hours.
Medically induced coma is excluded.
In layperson’s terms
Coma is perhaps best defined as a state of unresponsiveness
from which an individual cannot be aroused. It also represents
the final or lowest level of brain functioning, before brain death
eventuates. If a patient in a coma survives the first ten days
following a brain injury, long-term survival can be expected;
however, the patient may only achieve partial recovery of his or
her pre-injury level of brain functioning. Traumatic brain injury is
the most common cause of coma, with other causes including:
In layperson’s terms
Encephalitis is an acute inflammation of the brain itself and the
lining covering the brain, the meninges. The cause is usually
a viral infection, but it can also result from exposure to certain
bacteria, parasites, harmful chemicals or heavy metal poisoning.
In some cases, recovery from encephalitis is slow and
permanent brain damage occurs.
Based on the American Medical Association (AMA) guidelines,
illustrations of what constitutes 25 per cent whole person
impairment could be:
• inability to understand words or to produce understandable
language for daily activities
• someone who mentally requires constant supervision
• someone who, after head injury, develops frequent epileptic
fits, needing to be supervised
• reduced daytime alertness that significantly limits daily
activities and requires supervision.
Quick facts
Encephalitis resulted in 633 Australian hospitalisations during
2009-10.
Source: AIHW National Hospital Morbidity Database, 2012.
• diabetes
Parkinson’s disease
• abscesses
• stroke
The unequivocal diagnosis of Parkinson’s disease by a
consultant neurologist where the consultant neurologist
confirms that the condition:
• liver failure.
• is the established cause of two or more of the following:
• tumours
–– muscular rigidity
Quick facts
Head injuries were the main cause of 81,274 hospitalisations in
Australia during 2009-10.
Source: AIHW National Hospital Morbidity Database, 2012.
Encephalitis
The severe inflammation of brain substance which results in
significant neurological sequelae causing either:
• a permanent loss of at least 25% whole person function (as
defined in the 6th edition of the American Medical
Association publication ‘Guides to the Evaluation of
Permanent Impairment’) or
• the permanent and irreversible inability to perform without
the assistance of another person any one of the activities of
daily living (as defined under loss of independent existence,
see page 22)
as certified by a consultant neurologist.
Encephalitis as a result of HIV infection is excluded.
12
–– resting tremor
–– bradykinesia and
• has caused significant progressive physical impairment, likely
to continue progressing but for any treatment benefit.
The person must be under the established care and following
the advice and treatment of a specialist neurologist.
In layperson’s terms
Parkinson’s disease causes involuntary trembling of the
hands, legs, jaw and face at rest. Other symptoms include
stiffness of the limbs (muscle rigidity), slowness of movements
(bradykinesia) and progressive impairments of balance and
coordination.
Quick facts
During 2009-10, Parkinson’s disease was the main diagnosis
associated with 3,179 hospitalisations in Australia.
Source: AIHW National Hospital Morbidity Database, 2012.
Bacterial meningitis
The unequivocal diagnosis of bacterial meningitis resulting in a
neurological deficit causing permanent and significant
functional impairment. The bacterial meningitis must be
caused by a proven organism.
In layperson’s terms
Meningitis means inflammation of the membranes or meninges
lining the brain and spinal cord. There are many types of
meningitis and while the symptoms are often similar, the causes,
treatments and outcomes can vary greatly.
The organisms that usually cause meningitis include bacteria,
viruses, parasites and fungi.
Bacterial meningitis is the most common life threatening type
of meningitis and can cause death within hours. Most cases
of bacterial meningitis are caused by meningococcal and
pneumococcal bacteria.
Quick facts
Bacterial meningitis resulted in 1,012 hospitalisations in Australia
during 2009-10.
Source: AIHW National Hospital Morbidity Database, 2012.
Subacute sclerosing panencephalitis
The unequivocal diagnosis of subacute sclerosing
panencephalitis.
In layperson’s terms
Subacute sclerosing panencephalitis is a late complication
of measles, a viral infection which causes progressive brain
damage and death in some cases.
Quick facts
Fortunately, readily-available vaccination means that measles is
relatively uncommon; however, it still caused 24 hospitalisations
in Australia during 2009-10.
Source: AIHW National Hospital Morbidity Database, 2012.
13
Body organ disorders
Cancer
Any malignancy characterised by unlimited growth and which
expands locally by invasion, but excluding malignancies which
meet the following medical and/or histopathology
classifications:
• Pre-malignant conditions
• Carcinoma in situ, including intraepithelial neoplasia, but
not if:
–– the cancer is located in the breast and all breast tissue of
the affected breast is removed or
–– the cancer is located in a testis
• Cervical dysplasia, CIN1, CIN2 and CIN3
• Non-melanoma skin cancers, but not if the cancer has
spread to another part of the body
• Prostate cancers which remain classified as TNM T1a, T1b
or another equivalent or lesser classification, but not if the
Gleason Score is 6 or more
• Melanoma with a depth of invasion classified as Clark Level II
or less, or a Breslow thickness of 1.5mm or less
• Chronic Lymphocytic Leukaemia with a classification
equivalent to Rai Stage 1 or less.
In layperson’s terms
Cancer starts when a normal cell (or group of cells) changes
from being normal and begins to grow in an uncontrolled
manner. Such uncontrolled growth causes the initial tumour
to expand in its first (or primary) site, in the process causing
damage to normal, healthy cells and tissue.
When it becomes invasive, a tumour can spread elsewhere
in the body, for example, through the blood stream or the
lymphatic system. The tumours can then multiply and grow
further in their new location, resulting in metastatic cancer.
Today, many cancers are potentially curable if detected and
treated at an early stage, before metastatic tumours start to
develop.
Quick facts
Cancer is a leading cause of disease and death in Australia.
In 2008, 112,304 new cases of cancer were diagnosed in
Australia and this number was projected to increase by 7 per
cent in 2012. Approximately 41,500 deaths were caused by
cancer in 2009, reflecting 29 per cent of all deaths that year.
The five most commonly-diagnosed cancers among Australians
in 2008 were (in descending order) prostate cancer in men,
bowel cancer, breast cancer, melanoma and lung cancer,
which altogether accounted for 62 per cent of all cancer cases
that year.
Source: Australian Institute of Health and Welfare, 2012.
Testicular cancer
In layperson’s terms
Testicular cancer affects the male reproductive organs located in
the scrotum, or the testes. In Australian men between the ages
of 25 and 50 years, the most common type of testicular cancer
is called a seminoma, whereas non-seminoma tumours tend to
be relatively more common at a younger age.
Quick facts
In 2007, 698 Australian men were affected with testicular
cancer. The average age at diagnosis was relatively young at
35 years.
Source: Australian Institute of Health & Welfare, 2010.
Early-stage melanoma
The diagnosis of a malignant melanoma on biopsy, but
excluding melanoma in situ.
In layperson’s terms
Melanoma is cancer of the melanocyte cells, with most
occurring in the skin. Melanoma also happens to be the most
lethal form of skin cancer. As with most cancer types, early
detection of melanoma improves a person’s survival odds.
Quick facts
• Melanoma is a significant public health concern in Australia,
which has the highest incidence rate of melanoma
worldwide.
• In 2008, 11,057 Australians were diagnosed with melanoma.
• Melanoma of the skin is the most common cancer diagnosed
in Australian adults aged between 15 and 29 years.
Source: The Australian Institute of Health and Welfare, 2012.
Early-stage chronic lymphocytic leukaemia
The diagnosis of Chronic Lymphocytic Leukaemia (CLL)
classified as Rai Stage 1 or less.
In layperson’s terms
Leukaemia is a cancer of the white blood cells. Chronic
lymphocytic leukaemia is a slow-growing cancer where too
many white blood cells (or lymphocytes) are produced. These
abnormal, cancerous lymphocytes multiply very rapidly and live
longer than usual, resulting in too many lymphocytes circulating
in the blood stream.
When the malignant lymphocytes are found only in the blood
stream, this is known as a CLL classification of Rai stage 0.
When they are found in the blood stream and also cause
swelling of the glands that filter out infections (called lymph
nodes), this is known as Rai stage 1 disease. Higher Rai stages
are reported when other organs become affected by the
leukaemia, or when problems arise with the other cells formed
in the bone marrow.
Quick facts
In 2007, 595 Australian men and 364 women were diagnosed
with chronic lymphocytic leukaemia.
Source: The Australian Institute of Health and Welfare, 2010.
14
Early-stage cancer of the vulva or perineum
Early-stage cancer of the cervix uteri
Any tumour described by a histopathologist as carcinoma in
situ of the vulva or perineum, which meets the criteria for
classification as FIGO Stage I (including Stages IA and IB).
The diagnosis of Cervical Intraepithelial Neoplasia (CIN) of the
cervix uteri, with a classification of at least CIN 2/3 (not
including CIN 2 or less).
In layperson’s terms
Cancer of the vulva involves the external female sex organs.
Tumours are usually found in the inner edges of the labia majora
and the labia minora. Less often, tumours involve the clitoris or
the Bartholin’s glands of the vagina. Tumours can also affect the
perineum, the area of skin between the vulva and anus.
Quick facts
Cancer of the vulva is usually found in older women; however,
it also affects younger women. The outlook is usually positive in
women who are treated in the early stages of this cancer. For
example, successful treatment during the ‘localised’ tumour
stage is associated with a 5-year relative survival rate exceeding
90 per cent.
Source: National Cancer Institute, 2010. SEER Cancer Statistics Review,
1975-2007. Bethesda, MD.
Early-stage breast cancer
Diagnosis of carcinoma in situ of the breast.
In layperson’s terms
Carcinoma in situ of the breast is a disease that involves
changes in the cells in the lining of the ducts or lobules of
the breast. Although the changes are akin to those seen with
invasive breast cancer, a carcinoma in situ remains confined to
the ducts or lobules and does not invade surrounding tissues in
the breast, or spread to other organs in the body. There are two
types of carcinoma in situ of the breast:
1. Ductal carcinoma in situ (DCIS) is the most common type of
non-invasive breast cancer. Cancer cells remain inside the
ducts and do not spread through the duct walls.
2. Lobular carcinoma in situ (LCIS) is sometimes also described
as lobular neoplasia. Cancer cells remain in the lobules of
the breast and do not penetrate lobule walls. Left untreated,
LCIS may increase a woman’s risk of developing invasive
breast cancer.
Quick facts
Although DCIS can be found in women at any age, most
cases are diagnosed between the ages of 50 and 59 years.
In 2005, 1,558 new instances of DCIS were diagnosed in
Australian women and the condition was usually detected using
mammograms.
Source: Australian Institute of Health and Welfare, 2010.
In layperson’s terms
The cervix is the lower part of the uterus and is located in the
upper portion of the vagina. In cervical cancer, cells of the cervix
become abnormal and start to grow uncontrollably, resulting in a
malignant tumour.
Quick facts
In 2007, 739 Australian women were diagnosed with cervical
cancer, with an average age of 51 years at diagnosis.
Source: Australian Institute of Health and Welfare, 2010.
Early-stage cancer of the fallopian tubes
Diagnosis of carcinoma in situ (limited to tubal mucosa) of a
fallopian tube.
In layperson’s terms
The fallopian tubes form part of the female reproductive system
and serve the important function of carrying a woman’s ova
(eggs) to her uterus (womb). Fallopian tube cancer is a relatively
less common type of cancer that is usually found in middle-aged
women; however it can also occur in women of any age. The
most common type of fallopian tube cancer is called a papillary
serous adenocarcinoma.
Quick facts
Fallopian tube cancer is usually treated via surgery to remove
the tumour, with chemotherapy also required in some cases.
Source: Cancer Australia, 2012.
Early-stage ovarian cancer
Diagnosis of carcinoma in situ of an ovary.
In layperson’s terms
The ovaries are two small almond-shaped organs that play
an essential role in the female reproductive system. Ovarian
cancer arises when cells in one or both ovaries start growing
abnormally. The most common type of ovarian cancer affects
the epithelial cells of the ovaries, followed by less common
forms affecting germ cells and sex-cord stromal cells.
Quick facts
Ovarian cancer was diagnosed in 1,266 Australian women in
2007 and resulted in 848 deaths during that year.
Source: Australian Institute of Health and Welfare, 2010.
Early-stage cancer of the vagina
The diagnosis of a carcinoma in situ (or intraepithelial
neoplasia) of the vagina.
Early-stage prostate cancer
The diagnosis of prostate cancer classified as TNM T1a or
T1b, with a Gleason Score of 5 or less.
15
Body organ disorders
Early-stage penile cancer
Diagnosis of carcinoma in situ of the penis.
In layperson’s terms
Penile cancer is a malignancy that affects the penis, a male
reproductive organ. Squamous cell carcinoma is the most
common type of penile cancer.
Quick facts
The treatment of penile cancer depends on the size, location
and extent of invasion of the malignant tumour. Treatment
options include surgery, radiotherapy and/or chemotherapy.
Early diagnosis and treatment of the condition result in good
survival outcomes in most cases.
Source: National Cancer Institute, 2012.
In layperson’s terms
Brain tumours are usually known for the cell type from which
they arise. Brain tumours are either benign or malignant. A
benign tumour is not cancerous, hence unlikely to spread
elsewhere in the body; however, the tumour may continue
to grow in its original location. Some benign brain tumours
can cause problems by pressing against or even damaging
surrounding tissue in the brain. In most cases, surgeons can
successfully remove such tumours, especially when they start
to cause significant symptoms.
Quick facts
In Australia, 542 hospitalisations were caused by benign brain
tumours during 2009-10.
Source: AIHW National Hospital Morbidity Database, 2012.
Surgical removal of a hydatidiform mole
Blindness
Surgical removal of a hydatidiform mole.
The permanent loss of sight in both eyes due to sickness or
injury to the extent that:
In layperson’s terms
A hydatidiform mole usually reflects growth of an abnormal
fertilized egg; however, it can also mean abnormal growth of
placental tissue in some cases. In the former, an abnormal
egg develops into a hydatidiform mole rather than a foetus,
a condition described as a molar pregnancy. Possible
complications include haemorrhage, ovarian cysts, preeclampsia and recurrence of the mole in the future. In rare
cases, a hydatidiform mole could become cancerous and
spread to other parts of the body.
• visual acuity is 6/60 or less in both eyes or
• the visual field is reduced to 20 degrees or less of arc
whether aided or unaided, and all as certified by an
ophthalmologist.
Partial blindness
The permanent loss of sight in one eye due to sickness or
injury to the extent that:
• visual acuity is 6/60 or less in one eye or
Quick facts
Hydatidiform mole caused 518 hospitalisations in Australia
during 2009-10.
Source: AIHW National Hospital Morbidity Database, 2012.
Benign brain tumour
A non-cancerous tumour in the brain giving rise to
characteristic symptoms of increased intracranial pressure
such as papilloedema, mental symptoms, seizures and
sensory impairment as confirmed by a medical practitioner
who is a consultant neurologist. The tumour must result in
permanent neurological deficit:
• causing at least a permanent 25% impairment of whole
person function (as defined in the edition of the American
Medical Association’s publication ‘Guides to the Evaluation
of Permanent Impairment’ current as at the preparation date
of the CommInsure Protection PDS) or
• requiring cranial surgery for its removal.
The presence of the underlying tumours must be confirmed by
imaging studies such as a CT Scan or MRI. Cysts, granulomas,
malformations in or of the arteries or veins of the brain,
haematomas and tumours in the pituitary gland or spine are
excluded.
• the visual field is reduced to 20 degrees or less of arc
whether aided or unaided, and all as certified by an
ophthalmologist.
In layperson’s terms
95 per cent of blindness is caused by diseases such as:
• glaucoma
• macular degeneration
• diabetes
• cancer.
Injury to the eye or the brain may result in blindness.
Occasionally, blindness is caused by a genetic disorder,
e.g. retinitis pigmentosa.
Quick facts
A study published in the Medical Journal of Australia in 2005
estimated that 50,600 Australians were affected with blindness
in 2004, a number that was projected to double by the year
2024.
Source: Taylor HR, Keeffe JE and Vu HTV, et al. Vision loss in Australia. Med J
Aust 2005; 182 (11): 565-568.
Chronic kidney failure
End stage renal failure presenting as chronic irreversible failure
of both kidneys to function as a result of which regular renal
dialysis is instituted or renal transplantation is performed.
16
In layperson’s terms
When the kidneys fail to function properly, a build-up of toxic
substances in the blood results and the blood can become
very acidic. Currently, the only way these imbalances can be
corrected is through dialysis. Most cases of chronic renal failure
in adults result from:
• diabetic kidney disease
• high blood pressure
• glomerulonephritis.
Quick facts
Chronic kidney disease resulted in 8,417 hospitalisations in
Australia during 2009-10, including 5,497 cases attributed to
end-stage renal failure.
Source: AIHW National Hospital Morbidity Database, 2012.
Major organ or bone marrow transplant
The human to human transplant from a donor to the life
insured/insured child of:
• one or more of the following organs:
–– kidney
–– lung
–– pancreas
Quick facts
In 2010, 846 kidney transplants were performed in Australia and
1,135 people were waiting for a transplant as at 4 January 2012.
Source: Kidney Health Australia, 2012.
Severe burns
Tissue injury caused by thermal, electrical or chemical agents
causing deep (third degree) burns to:
• 20% or more of the body surface area as measured by the
age appropriate use of ‘The Rule of Nines’ or the Lund and
Browder Body Surface Chart or
• both hands, requiring surgical debridement and/or grafting or
• the face, requiring surgical debridement and/or grafting.
In layperson’s terms
The Rule of Nines chart is one method used by doctors to
determine the severity of a burn (refer to page 27). This divides
the skin into areas that represent about 9 per cent of the total
body surface. In general, the more of the body surface area
involved, the more severe the burn.
First-degree burn
Damage to the outer layer of skin (epidermis),
causing pain, redness and swelling.
–– heart
–– liver
–– small bowel or
• bone marrow.
The transplantation of all other organs or parts of organs or any
other tissue is excluded.
Placement on a waiting list for major organ transplant
The person must:
• be diagnosed with a sickness or injury which necessitates a
major organ or bone marrow transplant
• meet the Recipient Suitability Criteria of an Organ Allocation
Protocol of the Transplantation Society of Australia and New
Zealand and
• be on a waiting list for the transplant of the relevant organ for
at least six months
where ‘waiting list’ means the waiting list of a Transplantation
Society of Australia and New Zealand recognised transplant
unit.
The diagnosis, suitability and placement on a waiting list must
be certified by an appropriate medical specialist.
In layperson’s terms
Kidney transplant is considered the most successful treatment
for most patients with end stage renal failure. Liver transplant is
indicated in cases of end stage liver failure. Heart and/or lung
transplants are performed less often and are usually associated
with good survival outcomes. Pancreas transplants are typically
indicated in patients with insulin dependent diabetes mellitus.
Second-degree burn
Damage to both outer skin and underlying
tissue layers (epidermis and dermis), causing
pain, redness, swelling and blistering.
Third-degree burn
Damage extends deeper into tissues
(epidermis, dermis and hypodermis),
causing extensive tissue destruction.
The skin may feel numb.
Quick facts
In Australia, burns to the skin resulted in 8,228 hospitalisations
during 2009-10.
Source: AIHW National Hospital Morbidity Database, 2012.
Loss of speech
The total and irrecoverable loss of the ability to produce
intelligible speech as a result of sickness or injury which
causes permanent damage to the larynx or its nerve supply or
the speech centres of the brain. An appropriate medical
specialist must certify the loss.
In layperson’s terms
The loss of speech can be due to injury or disease in the brain
or in the throat. The speech centre in the brain is often affected
by a stroke.
17
Body organ disorders
Quick facts
The total loss of speech is regarded as a 35 per cent
impairment of the whole body.
Source: AMA Guides to Evaluation of Permanent Impairment 5th Edition,
2001.
Loss of hearing
Complete and irrecoverable loss of hearing from both ears as a
result of sickness or injury, as certified by a specialist we
consider appropriate. This definition isn’t met if the person’s
hearing has been restored through any natural or assisted
means, unless the assisted means is a device implanted in the
cochlea.
Partial loss of hearing
Complete and irrecoverable loss of hearing from one ear as a
result of sickness or injury, as certified by a specialist we
consider appropriate. This definition isn’t met if the person’s
hearing has been restored through any natural or assisted
means, unless the assisted means is a device implanted in the
cochlea.
In layperson’s terms
Brain injury or disease, or other damage to the ear, can cause
permanent loss of hearing. The nerve from the ear to the brain
is easily damaged by viral infections, which can result in total
deafness during childhood.
Quick facts
In 2009, an estimated one in six Australians were affected by
hearing loss, including approximately 30,000 Auslan users with
total hearing loss.
Source: Australian Network on Disability, 2009.
Chronic liver disease
Quick facts
End stage liver failure is irreversible and can only be treated by
liver transplant. During 2009-10, chronic liver failure resulted in
326 hospitalisations in Australia.
Source: AIHW National Hospital Morbidity Database, 2012.
Chronic lung disease
Permanent end stage respiratory failure with FEV1 test results
(see page 24) of consistently less than one litre, requiring
continuous permanent oxygen therapy.
Pneumonectomy
The medically necessary and appropriate removal of an entire
lung on the recommendation of a specialist physician.
In layperson’s terms
Disease or poisons in the air, for example smoke and other
gases, easily damage the delicate membranes in the lungs.
Once the lung is damaged, it does not fully recover and over
time will absorb less oxygen until a point is reached where extra
oxygen is required in the air breathed.
The lungs can fail when the:
• airway is blocked
• lung is damaged by disease
• muscles around the chest do not work properly.
Chronic bronchitis, emphysema and asthma can cause lung
damage. The chest muscles fail in multiple sclerosis, polio
and muscular dystrophy.
Quick facts
Each year lung disease causes 19,200 deaths in Australia, with
14 per cent of all deaths each year in Australia occurring as a
result of lung disease.
Source: Australian Bureau of Statistics, 2009.
Permanent liver failure resulting in permanent jaundice, ascites
and/or encephalopathy.
In layperson’s terms
The liver acts as a filter to remove toxins from the blood.
Common liver diseases include hepatitis, which is inflammation
of the liver. If left untreated for a long time, hepatitis can
eventually lead to liver failure. Hepatitis can be caused by:
• viral infections
• alcohol
• drugs
• bacterial infections.
In cirrhosis causing liver failure, the liver cells become replaced
by fibrous tissue, which then shrinks and hardens. As it shrinks it
damages more cells and the damage becomes irreversible. The
signs of liver damage include:
• Jaundice: liver damage causes the skin and eyes to become
yellow.
• Ascites: because the liver is not doing its job of breaking
down proteins, fluid builds up in the abdominal cavity.
• Portal hypertension: blood is unable to flow through the
damaged liver and pressure in the liver veins builds up and
causes further retention of fluid in the abdomen and legs.
• Encephalopathy: as toxins build up in the blood they cause
impairment of brain function.
18
The effect of smoking on the lungs.
Severe rheumatoid arthritis
Severe osteoporosis
The unequivocal diagnosis of severe rheumatoid arthritis by a
rheumatologist. The diagnosis must be supported by, and
evidence, all of the following criteria:
The person suffers at least two vertebral body fractures or a
fracture of the neck of femur due to osteoporosis and has a
bone mineral density reading with a T-score of –2.5 or worse
(i.e. 2.5 standard deviations below the young adult mean for
bone density). This must be measured in at least two sites by
dual energy x-ray absorptiometry (DEXA).
• at least a six week history of severe rheumatoid arthritis
which involves three or more of the following joint areas:
–– 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 overgrowth alone)
• typical rheumatoid joint deformity and at least two of the
following criteria:
–– morning stiffness
–– rheumatoid nodules
–– 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 arthritides are
excluded.
The person must suffer from this condition before they reach
their 50th birthday and must at the time be covered for this
condition.
In layperson’s terms
Osteoporosis is a condition in which the bones become fragile
and brittle, leading to a higher risk of fractures (breaks or cracks)
than normal bone. Osteoporosis occurs when bones lose
minerals such as calcium, and the body cannot replace these
minerals fast enough to keep the bones healthy. As a result,
bones become thinner and less dense.
Any bone can be affected by osteoporosis, but the most
common sites are bones in the hip, spine, wrist, ribs, pelvis
and upper arm. Fractures due to osteoporosis are known as
osteoporotic fractures. These can lead to changes in posture
(e.g. developing a stoop or Dowager’s hump in your back),
muscle weakness, loss of height and deformity of the area
affected. Fractures can lead to long term pain and disability, loss
of independence, and may even contribute to premature death.
In layperson’s terms
Rheumatoid arthritis is a disease in which inflammation (pain,
heat and swelling) affects the joints and sometimes other organs
of the body. It can affect people of all ages. Most people with
rheumatoid arthritis continue to lead full and active lives. This is
made easier if they understand rheumatoid arthritis, and learn
techniques to help manage it. Early diagnosis and treatment
is one of the key strategies in the management of rheumatoid
arthritis.
The definition of osteoporosis indicates that the likelihood of
fracture is ten times higher than normal. If you have severe
osteoporosis, the risk of fracture increases up to 25 times higher
than normal. The bone density strength in severe osteoporosis
is 2.5 times less than that found in normal bones.
Quick facts
Rheumatoid arthritis is an often serious joint disease that affects
around 400,000 Australians and is the second most common
type of arthritis, after osteoarthritis. The disease is more
common among females, and in older age groups.
Source: AIHW National Hospital Morbidity Database, 2012.
Quick facts
Osteoporosis was the main cause of 6,931 hospitalisations in
Australia during 2009-10, with just over half (52 per cent) of all
cases involving a bone fracture.
Source: Australian Institute of Health and Welfare, 2009.
19
Blood disorders
Occupationally acquired HIV
Infection with Human Immunodeficiency Virus (HIV) where all
of the following are satisfied:
• the HIV was acquired as a result of an accident, which
accident occurred while the person was carrying out their
normal occupational duties and while Trauma Cover applied
to them
We won’t pay a benefit for medically acquired HIV if, before
the accidental infection occurred, the Australian government
approved a medical treatment which if applied to the person
would:
• render their HIV inactive and non-infectious to others
• an HIV antibody test was taken by the person within seven
days after the accident and the test was reported to us in
writing within 30 days of the accident
• prevent them from developing AIDS or
• the HIV antibody test produced negative results
Aplastic anaemia
• sero-conversion indicating HIV infection occurred within six
months of the accident.
Bone marrow failure which results in anaemia, neutropenia and
thrombocytopenia requiring treatment, with at least one of the
following:
Payment of a benefit for occupationally acquired HIV is
subject to:
• us having access to all blood samples taken by the person
for the purpose of enabling us to conduct independent
testing and
• the person providing us with such additional samples as we
consider necessary.
We won’t pay a benefit for occupationally acquired HIV if:
• the infection with HIV is caused directly or indirectly by
sexual activity or recreational intravenous drug use or
• before the accident occurred, the Australian government
recommended an HIV vaccine for use in the occupation of
the person, which vaccine the person had not taken or
• before the accident occurred, the Australian government
approved a treatment which renders the HIV virus inactive
and non-infectious to others.
In layperson’s terms
HIV/AIDS is caused by a virus which is spread through contact
with an infected person’s body fluids. Medical professionals
have an increased risk of being in contact with body fluids
from patients infected with HIV during the course of their
employment.
Quick facts
Complications associated with HIV infection resulted in 205
hospitalisations in Australia during 2009-10.
Source: AIHW National Hospital Morbidity Database, 2012.
Medically acquired HIV
Accidental infection with Human Immunodeficiency Virus (HIV)
which we believe, on the balance of probabilities, arose from
one of the following medically necessary events:
• a blood transfusion
• transfusion with blood products
• organ transplant to the person
• assisted reproductive techniques, or
• a procedure or operation performed by a medical/
paramedical practitioner or dentist
where the relevant event occurred to the person in Australia by
a recognised and registered health professional.
20
Access to all blood samples taken is required for independent
tests, with the right to take additional samples as necessary.
• where they have developed AIDS, cure the AIDS.
• blood product transfusions
• marrow stimulating agents
• immunosuppressive agents or
• bone marrow transplantation.
In layperson’s terms
Blood cells are produced by bone marrow. Aplastic anaemia
is when the marrow stops producing enough blood cells. The
only ways it can be treated are to either make the bone marrow
produce cells again, or give blood transfusions until the marrow
recovers, or to have a suitable donor donate some of their
marrow (a bone marrow transplant). With successful treatment,
patients can lead a relatively normal life for approximately 10 to
15 years.
Quick facts
Aplastic anaemia resulted in 2,196 Australian hospitalisations
during 2009-10.
Source: AIHW National Hospital Morbidity Database, 2012.
Advanced diabetes
Severe diabetes mellitus (either insulin or non-insulin
dependent) as certified by a consultant endocrinologist and
resulting in at least two of the following criteria:
• Severe Diabetic Retinopathy resulting in visual acuity
uncorrected and corrected of 6/36 or worse in both eyes
• Severe Diabetic Neuropathy causing motor and/or
autonomic impairment
• Severe Diabetic Nephropathy causing chronic irreversible
renal impairment (as measured by a corrected creatinine
clearance below the laboratory/ies measured normal range)
• Diabetic Gangrene leading to surgical intervention.
Diabetes complications is excluded.
Diabetes complications
Diagnosis of Type 1 insulin dependent diabetes mellitus as
certified by a consultant endocrinologist and resulting in at
least two of the following criteria:
• urinary protein excretion of more than 300mg per day
• diabetic retinopathy with a minimum severity of at least
exudates and/or dot-blot haemorrhages
• persistent sensory neuropathy.
In layperson’s terms
Diabetes is a chronic disease that occurs when there is too
much glucose in the blood due to the body not producing
insulin, or being resistant to the effect of insulin on cells.
Insulin is a hormone needed for glucose to enter cells and be
converted to energy.
Quick facts
• Diabetes is the sixth highest cause of death by disease in
Australia.
• People with diabetes are almost three times more likely to
have high blood pressure, obesity or elevated blood fats,
e.g. cholesterol, triglycerides.
• People with diabetes are two to three times more likely to
have cardiovascular disease, e.g. heart disease or stroke.
• One in four Australian adults has either diabetes or impaired
glucose metabolism.
People with diabetes in 2005:
• 15 per cent were hospitalised with coronary heart disease.
• 38,700 Australians were hospitalised for eye complications
caused by diabetes.
• 90 per cent undergoing a lower limb amputation had a
history of ulceration.
• 3,400 had amputations (65 a day).
• 11 per cent of people with diabetes have had a heart attack.
• 23 per cent died from kidney disease.
Source: Diabetes Australia, 2009.
21
Other events
Serious injury
Loss of independent existence
An injury that has for the first time resulted in the person
being confined to an acute care hospital for a period of
30 consecutive days (24 hours per day) under the full time
care of a medical practitioner. Injury as a result of alcohol or
non-prescribed drug intake or other self-inflicted means is
excluded.
As a result of sickness or injury:
Critical care
A sickness or injury that has for the first time resulted in the
person requiring continuous mechanical ventilation by means
of tracheal intubation for ten consecutive days (24 hours per
day) in an authorised intensive care unit of an acute care
hospital. Sickness or injury as a result of alcohol or nonprescribed drug intake or other self-inflicted means is
excluded.
• there is permanent and irreversible inability to perform
without the assistance of another person any two of the
activities of daily living or
• the person suffers cognitive impairment that results in them
requiring permanent and constant supervision for a
continuous period of at least six months. The person’s
impairment must be established by a medical practitioner we
nominate.
Loss of independent existence due to alcohol or drug abuse or
AIDS is excluded.
Activities of daily living
Dressing – putting on and taking off clothing.
Loss of limbs or sight
Toileting – using the toilet, including getting on and off.
The person has sustained, as a direct result of sickness or
injury:
Mobilising – getting in and out of bed and a chair.
• the complete and irrecoverable loss of use of both hands or
Maintaining continence – having good control of bowel and
bladder function.
• the complete and irrecoverable loss of use of both feet or
• the complete and irrecoverable loss of use of one hand and
one foot or
Feeding – getting food from a plate into the mouth.
Domestic duties
• blindness or
All of the following duties:
the loss of one hand or one foot and partial blindness.
• cleaning the usual place of dwelling
In layperson’s terms
Loss of both lower limbs is commonly a result of blood vessel
disease brought about by diabetes or smoking, leading to poor
circulation, resulting in tissue death.
Quick facts
It is estimated that there are about 300,000 Australians who are
blind or vision impaired.
Source: The Association for the Blind of WA, September 2004.
Loss of one hand or one foot
The person has sustained, as a direct result of injury or
sickness, the complete and irrecoverable loss of use of one
hand or one foot.
• purchasing household food and items used for cleaning
• preparing meals for the household
• performing for the household laundry services such as
washing or ironing
• driving or transporting family to and from school, sport, work
or social events (where applicable)
• taking care of a child or family member dependents (where
applicable).
Quick facts
In 2009, an estimated 12 per cent (or 2.6 million) of all people
living in Australian households were also carers, providing
assistance to someone requiring help because of disability or
old age. Just under one in five Australians had reported being
affected with a disability in 2009.
Source: Australian Bureau of Statistics, 2010.
22
Glossary of terms
Term
Definition
Abdominal
Relating to the abdomen, the part of the body containing liver, kidneys and digestive tract.
Aetiology
Cause of diseases.
AIDS
Acquired Immune Deficiency Syndrome. AIDS is a chronic disease that damages and ultimately
destroys the immune system.
Alveolus
A small air sac which is the smallest component of the lungs.
AMA Guide
Guides to the Evaluation of Permanent Impairment 6th edition – produced by the American Medical
Association.
Anaemia
Too few red blood cells in the bloodstream, resulting in insufficient oxygen to tissues and organs.
Aneurysm
A bulge in an artery wall where a weakness has occurred. Aneurysms are at risk of bursting and
resulting in bleeding.
Angina
Chest pain due to reduced oxygen to the heart.
Angiogram
X-ray of the arteries supplying the heart using injected dye.
Angioplasty
Surgical treatment of a narrowed coronary artery using an inflatable balloon.
Antibody
Substance produced by the body to fight anything recognised as being foreign to the body.
Aorta
Main artery of the body.
Arteriosclerosis
Hardening of arteries by deposits of fat and calcium.
Artery
A blood vessel which carries blood away from the heart.
Ascites
Fluid in the abdominal cavity.
Asystole
Lack of heartbeat, otherwise known as cardiac arrest.
Athetosis
Repetitive abnormal movements of the limbs, such as can occur in cerebral palsy.
Atrial fibrillation
The heart beats in a very rapid and irregular fashion.
Bacterium
A cell which causes infection.
Basal cell carcinoma
A common form of skin cancer not usually fatal.
Benign
Will not cause death.
Breslow
A method of staging (measuring) melanoma:
• thin – less than 0.75mm depth of invasion
• intermediate – 0.76 to 3.99mm depth of invasion
• thick – 4mm or greater depth of invasion.
Cancer
All forms of uncontrolled abnormal growth of cells.
Carcinoma
A cancer that starts in the tissue that lines the skin and internal organs of the body.
Cardiac ejection
fraction
This is the percentage of the total amount of the blood that is pumped out with each heartbeat.
Cardiac enzyme
Enzymes produced by the heart muscle, elevated during a heart attack.
Cerebral
Relating to the brain.
Cerebrovascular
Blood supply to the brain.
Cervical
Relating to the cervix in females.
CIN-1, CIN-2, CIN-3
Cervical Intraepithelial Neoplasia (CIN). A form of grading of cells of the cervix which may indicate cancer.
The ventricle never pumps out all the blood in it; however, when the ejection fraction falls below
55 per cent, the heart is beginning to fail as a pump.
23
Glossary of terms
24
Term
Definition
Cirrhosis
Scarring and hardening of the liver.
CK-MB
An enzyme that is specific to the heart muscle and increases following a heart attack.
Cognitive
Relating to the thought process.
Coma
Deep loss of consciousness with reduced response to external stimulation.
Coronary occlusion
Blocked coronary artery.
Degeneration
Wear and tear of body tissue.
Dialysis
A medical procedure that in renal dialysis uses a machine to filter waste products from the
bloodstream during renal failure.
Disability
This is the reduction or loss of an ability to perform an activity as a result of a disease or injury.
Dissection
When an artery wall splits internally.
Dysfunctional
Not working properly.
Dysplasia
Condition of unusual or abnormal development of cells.
Dyspnoea
Shortness of breath.
Electrocardiogram
(ECG)
A tracing (recording) that provides a visual record of electrical activity in the heart.
Embolism
Foreign body, air, gas or clot in the bloodstream.
Emphysema
Lung disease characterised by over-inflation of the lungs and destruction of air sacs (alveoli)
in the lung walls.
Encephalitis
Inflammation of the brain tissue.
Encephalopathy
Disease or disorder of the brain.
Endoscope
A thin tube like a telescope, through which a surgeon can see and operate within the body.
Epidermis
Skin.
Expiration
Breathing out air from the lungs.
Extra-cranial
Outside the head.
FEV 1
FEV 1 (Forced Expiratory Volume in 1 Second). This is a test to measure the volume of air breathed
out in the first second of a forced expiration following a full inspiration.
Genetic
Inherited in the genes.
Glomerulonephritis
A disease affecting the filtration part of the kidney.
Haemorrhage
Bleeding, internal or external.
Heart
Muscular pump which pumps blood around the body.
HIV
Infection with Human Immunodeficiency Virus. AIDS can occur as a result of this virus.
Hyperkeratosis
An increase in a hard material in the skin, usually due to sun damage resulting in scaly areas in parts
of the body exposed to the sun.
Hypertension
High blood pressure.
Hypoxia
Low levels of oxygen supply to body tissues.
Immune system
Body’s defence mechanism.
Immunosuppressive
Substances which reduce the effectiveness of the immune system.
Impairment
The loss or loss of use of any body part, system or function.
Term
Definition
Incontinence
Inability to control bowel or bladder.
Infarct
Death of cells – usually from lack of oxygen supplied to cells.
Inflammation
A response by the body to tissue damage.
Inspiration
Breathing into the lungs.
Intra-arterial
Inside the artery.
Intracerebral
Within the brain.
Intracranial
Inside the head.
Ischaemia
Poor blood supply to an area resulting in reduced oxygen supply, which may cause damage or death
of tissue.
Jaundice
Yellowing of the skin and eyes.
Keyhole surgery
Surgery performed through a very small opening such as that made for an endoscope.
Laparotomy
A surgical operation to open the abdomen, through the abdominal wall.
Laser surgery
Using a very fine and powerful beam of light, which burns the area it touches.
Lateral
To one side.
Leukaemia
A disease which causes an abnormally large increase in the number of white cells in the blood.
Lund & Browder
und & Browder chart showing relative percentage of body surface areas (per cent Body Surface Area)
L
affected by growth and age.
0yr
1yr
5yr
10yr
15yr
Adult
a. 1/2 of head
9.5
8.5
6.5
5.5
4.5
3.5
b. 1/2 of thigh
2.25
3.25
4.25
4.25
4.5
4.75
c. 1
/2 of lower leg
2.5
2.5
2.75
3.0
3.25
3.5
Lymph
Fluid found in the tissues of the body that is drained by the lymphatic system.
Lymphatic system
A network of vessels carrying tissue fluid called lymph around the body.
Malignant growth
Abnormal uncontrolled cellular growth resulting in destruction of healthy body tissue.
Meninges
Membranes covering the brain and spinal cord.
Metastases
Cancer spread to other parts of the body.
Myelin
The fatty sheath of a nerve cell.
Myocardial infarction
Area of dead tissue in the heart resulting from lack of oxygen to the tissue. Commonly known as a
heart attack.
Neurological
Relating to the nervous system of the body.
Neurological deficit
Reduction or loss of function of part of the nervous system.
Neurology
The study of nerves in the body and diseases affecting them.
Neurone
A nerve cell.
Neuropathy
Disease of nerves in the body.
Neutropenia
Reduction of white cells in the blood.
25
Glossary of terms
Term
Definition
New York Heart
Association
Classification of
Cardiac Impairment
Reduction of white cells in the blood.
Class 1. Patients with cardiac disease but without resulting in limitation of physical activity. Ordinary
physical activity does not cause undue fatigue, palpitation, dyspnoea (shortness of breath) or anginal
(heart) pain. No objective evidence of cardiovascular disease.
Class 2. Patients with cardiac disease resulting in slight limitation of physical activity. They are
comfortable at rest. Ordinary physical activity results in fatigue, palpitation, dyspnoea or anginal pain.
Objective evidence of minimal cardiovascular disease.
Class 3. Patients with cardiac disease resulting in marked limitation of physical activity. They are
comfortable at rest. Less than ordinary physical activity results in fatigue, palpitation, dyspnoea or
anginal pain. Objective evidence of moderately severe cardiovascular disease.
Class 4. Patients with cardiac disease resulting in inability to carry on any physical activity without
discomfort. Symptoms of heart failure or the anginal syndrome may be present even at rest. If any
physical activity is undertaken, discomfort is increased. Objective evidence of severe cardiovascular
disease.
Organism
A living cell or collection of cells.
Palpitations
An awareness of a sensation of the heart beating either rapidly or irregularly.
Paralysis
Inability to move a muscle or muscle groups.
Parkinsonism
A group of symptoms similar to those seen in Parkinson’s disease.
Peripheral nerve
A nerve in any body extremity.
Permanent
impairment
Impairment that has become irreversible with or without medical treatment and is not likely to improve
despite medical treatment. The percentage of impairment is measured using the current edition of the
American Medical Association Guides to the Evaluation of Permanent Impairment.
Portal hypertension
Increased pressure in the veins going to the liver.
Premalignant growth
Abnormal changes to cells that are known to progress to cancer in some circumstances.
Primary
First.
Pulmonary
Relating to the lungs.
Rai
A system of staging chronic lymphocytic leukaemia.
Stage 0 Increased lymphocytes in blood and bone marrow only.
Stages I and II Increased lymphocytes and enlarged lymph nodes and enlarged spleen and possibly liver.
Stages III and IV Increased lymphocytes and anaemia and thrombocytopenia.
26
Sarcoma
A form of cancer that arises in soft tissue, cartilage or bone.
Secondary
Following on from.
Sequelae
What follows on afterwards, like a complication of a disease. For example with a stroke, this could
include the permanent weakness of one side.
Seroconversion
The production of antibodies in response to an infection.
Spastic
Muscles become very tight and movement awkward.
Squamous Cell
Carcinoma
A cancer made up of or arising from squamous cells that are found on the surface of the body.
Stent
A tube used to hold an artery open. Commonly used in angioplasty surgery.
Stroke
Loss of blood supply to part of the brain, resulting in death of brain tissue.
Subarachnoid
Under the arachnoid, one of the layers of tissue between the brain and the skull.
Term
Definition
Tachycardia
Very rapid heartbeat.
The Rule of 9
The Rule of 9 chart for estimating extent of burns on an adult.
Redrawn from the Treatment of Burns, ed 2. by CP Artz and JA Moncrief. Philadelphia, WB Saunders Company, 1969;
used with permission.
Thoracic
Relating to or affecting the thorax (chest).
Thrombocytopenia
A shortage of blood cells required for clotting, possibly leading to excessive bleeding.
Thrombosis
Clot in a blood vessel.
TNM Classification
A method of staging (measuring) cancers:
T = size of tumour
N = whether the tumour has spread to local nodes
M = metastases – spread to other parts of the body.
Toxin
Poison.
Transient ischaemic
attacks
A temporary paralysis, numbness or other neurological symptoms that start and end suddenly with full
recovery within 24 hours.
Transplant
The replacement of a diseased organ with a donor organ from another person.
Troponins
Enzymes found in muscle. Certain troponins are only found in heart muscle and are released following
heart muscle damage.
Tumour
Swelling or enlargement causes an abnormal growth of cells forming a mass.
Vaccination
Giving a vaccine to prevent disease or treat a disease process.
Valvotomy
A procedure that makes an opening into a heart valve, e.g. mitral valvotomy.
27
Why CommInsure?
Why CommInsure?
CommInsure is a leader in the Australian insurance industry
with over three million customers. With roots dating back
140 years, we have a history of financial strength, security and
reliability. We provide quality insurance products and pay all
legitimate claims.
Claims
In 2012, we paid a total of 702.8 million in retail and wholesale
claims:
• Life and terminal illness $302 million
• TPD and trauma $256.7 million
• Income protection $144.1 million
That equates to more than $13 million every week.
Awards
In recent years we’ve received a number of awards recognising
our excellent products and services, including:
Life Insurance Company of the Year
Australia and New Zealand Institute of
Insurance and Finance Awards 2011,
2010, 2007
Life Company of the Year
2010
Plan for Life & Association of Financial
Advisers 2010, 2009 and 2007
Income Protection Insurance Award,
Winner
Plan for Life 2012 and 2011
Service Quality Award, Winner
2010
Plan for Life & Association of Financial
Advisers 2010 and 2009
National Contact Centre of the Year
Australian Teleservices Association (ATA)
Awards 2012
Trauma Insurance Award, Winner
Plan for Life & Association of Financial
Advisers 2009, 2008 and 2007
28
1800 805 686
8 am - 8 pm (Sydney time)
Monday to Friday
https://adviser.comminsure.com.au
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