Download Trauma Cover Guide.

Trauma Cover
Guide.
Dr John Clubb
Dr John Clubb is the Chief Medical Officer
of Life Underwriting at CommInsure.
Dr Clubb is highly respected throughout the
medical and life insurance industries. He joined
CommInsure on a full-time basis in 2006,
having worked as a general practitioner for over
40 years, combining this with 31 years as both
senior and chief medical officer roles for various
life insurance companies.
Dr Clubb provides valuable contributions in the
following areas:
• development of underwriting philosophy
and guidelines
• training and mentoring of underwriters
• acts as a referral point for all medical
technical issues within underwriting
• as an active member of the
product committee.
Important information
This information is provided 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.
Layperson explanations are to be used as a guide only. All claims will be assessed under the definitions outlined in the Policy Document.
Issued by: The Colonial Mutual Life Assurance Society Limited ABN 12 004 021 809. This guide is for the information of advisers and
Commonwealth Bank Group employees only.
Contents
2
Trauma Cover
5
Heart Disorders
9
Nervous System Disorders
15
Body Organ Disorders
22
Blood Disorders
24
Other Events
25
Glossary of terms
30
CommInsure’s credentials
1
Trauma Cover
The rise in popularity of Trauma Cover has been
considerable over the last ten years; it has evolved from
a little known and understood benefit to one that many
advisers now specialise in selling. Accompanying this
popularity have been never-ending requests for a guide
that provides layperson definitions and relevant sales facts
which are easily understood by adviser and client alike.
This guide accompanies CommInsure’s extensively revised
policy definitions, which keep pace with new developments
in treatments and diagnoses in medical science.
History and background
Trauma insurance was first developed in the early 1980s by
Marius Barnard, brother of the acclaimed cardiac surgeon,
Dr Christiaan Barnard. Christiaan’s job was to make sure that
people survived heart disease; Marius’ job was to make sure
they could afford to survive!
This resulted in the creation of a policy that paid a lump sum
if the life insured contracted any one of a number of defined
‘critical’ conditions.
With diseases such as cancer and heart disease now touching
almost everyone in some way, this new approach to ‘risk
protection’ has steadily grown in popularity.
What is Trauma Cover?
Trauma Cover, also known as critical illness insurance or
living assurance, pays a lump sum in the event of a specified
medical condition. Examples of critical illness include cancer,
Parkinson’s disease, heart attack and stroke.
Trauma Cover is an important tool in wealth protection and risk
planning and should be considered as part of a client’s needs.
It can alleviate financial pressure in a period of intense shock
and trauma, giving the client and their family time to adjust to
the crisis and rethink their future.
What are the chances of contracting a critical illness?
•A stroke occurs every eleven minutes in Australia1.
Trauma Cover is about survival
Trauma Cover gives 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 and
we are still experiencing high levels of heart disease and stroke.
Due to advances in medical science, we have greater chances
of surviving a serious medical condition. In many cases this
survival period can be measured in years.
It is important to understand that where in the past a serious
medical condition often led to a swift death, this is no longer
the case – with consequential effects on lifestyle, family
and work.
While the critical condition sufferer may recover medically,
the impact on their finances can be devastating. Many people
depend on the continued success of their career or business
to achieve their financial goals. Whilst many people make some
sort of medical recovery, the likelihood of making a financial
recovery is less certain, especially if they are unable to continue
to work in their previous employment, or if they are forced to
stop work completely for medical reasons.
Trauma Cover can make a significant contribution towards the
financial survival of families and businesses by providing cash
for the insured to use as they see fit.
Your clients need to consider Trauma Cover if:
• they have a mortgage or other debt
• they have a family and associated responsibilities
• they have a business or business partners
• they are company directors, key employees
or self-employed
• they have insufficient cash reserves to cover unexpected
medical and hospital bills.
•Approximately 44,000 Australians suffer a stroke each year,
with strokes being the leading cause of long-term disability
in adults1.
•Males have a two in five chance of suffering a critical
illness between age 30 and 642.
•Females have a one in four chance of suffering a critical
illness between age 30 and 642.
•It has also been shown that one in three men and one
in four women will contract cancer before age 753.
•The leading cause of death for Australians is cardiovascular
disease (heart, stroke and blood vessel disease) at 39%,
followed by cancer (30%)4.
1Source – Australian Institute of Health and Welfare (AIHW) – Heart, Stroke and Vascular Diseases: Australian‑Facts 2004.
2 General Cologne Life Re Australia, 2002.
3AIHW and Australasian Association of Cancer Registries, Cancer in Australia 2001, 2004.
4 AIHW, 2002 and Heart Foundation of Australia, November 2003.
2
Summary
Trauma Cover Option
Trauma Cover provides a lump sum on the occurrence of a specified medical condition, regardless of whether you are prevented
from working or not. It is available either on its own (stand-alone Trauma), or in conjunction with Life Care (but cannot exceed the
amount of Life Care). The lump sum is the amount for which you are insured.
Trauma Plus Cover Option
If you select this option, a partial Trauma Cover benefit will be payable for an additional ten trauma conditions, namely Diabetes
Complication, Melanoma, Carcinoma in situ of the Cervix Uteri, Carcinoma in situ of the Vulva or Perineum of limited extent,
Carcinoma in situ of the Vagina, Chronic Lymphocytic Leukaemia, Hydatidiform Mole, Partial Blindness, Partial Loss of Hearing
and Severe Osteoporosis.
Child Cover Option
CommInsure also provides the option to attach a Trauma Cover policy on your child’s life to your own Life Care or stand-alone
Trauma policy, helping to ease the financial strain and stress caused in the event of a child’s illness.
If you have a child between the ages of two and 16 inclusive, you are able to apply for up to $100,000 worth of Child Cover for
that child. You can cover more than one child under this option, but each child must be insured for the same amount.
What is provided under Trauma Cover, Trauma Plus Cover Option and Child Cover Option?
Medical condition
Trauma Cover
Additional
Trauma Plus Cover
Child Cover
Heart Disorders
Heart Attack
4
4
Out of Hospital Cardiac Arrest
4
4
Coronary Artery Disease Requiring By-pass Surgery
4
4
Coronary Artery Angioplasty
4
4
Coronary Artery Angioplasty – Triple Vessel
4
4
Repair and Replacement of a Heart Valve
4
Surgery of the Aorta
4
4
Cardiomyopathy
4
4
Primary Pulmonary Hypertension
4
Open Heart Surgery
4
4
Stroke
4
4
Major Head Trauma
4
4
Motor Neurone Disease
4
Multiple Sclerosis
4
Multiple Sclerosis of limited extent
4
Muscular Dystrophy
4
4
Paraplegia
4
4
Quadriplegia
4
4
Hemiplegia
4
4
Diplegia
4
4
Tetraplegia
4
4
Dementia and Alzheimer’s Disease
4
Coma
4
4
Encephalitis
4
4
Parkinson’s Disease
4
Nervous System Disorders
Bacterial Meningitis
4
Subacute Sclerosing Panencephalitis
4
3
Trauma Cover
Medical condition
Trauma Cover
Additional
Trauma Plus Cover
Child Cover
Body Organ Disorders
Cancer
4
Melanoma
4
4
Chronic Lymphocytic Leukaemia
4
Cancer of the Vulva or Perineum
4
Removal of Carcinoma in situ of the Breast
4
Carcinoma in situ of the Cervix Uteri
4
Carcinoma in situ of the Vulva or Perineum of limited extent
4
Carcinoma in situ of the Vagina
4
Hydatidiform Mole
4
Benign Brain Tumour
4
Blindness
4
Partial Blindness
4
4
4
Chronic Kidney Failure
4
4
Major Organ or Bone Marrow Transplant
4
4
Placement on a Waiting List for Major Organ Transplant
4
4
Severe Burns
4
4
Loss of Speech
4
4
Loss of Hearing
4
4
Partial Loss of Hearing
4
Chronic Liver Disease
4
4
Chronic Lung Disease
4
4
Severe Rheumatoid Arthritis
4
4
Severe Osteoporosis
4
Blood Disorders
Occupationally Acquired HIV
4
Medically Acquired HIV
4
4
Aplastic Anaemia
4
4
Advanced Diabetes
4
Diabetes Complication
4
Other Events
4
Serious Injury
4
4
Critical Care
4
4
Loss of Limbs or Sight
4
4
Loss of Independent Existence
4
Loss of One Hand or One Foot
4
4
Heart Disorders
Heart Attack
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:
i)elevation of cardiac enzyme CK-MB, or
ii)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
iii)confirmatory new electrocardiogram (ECG) changes, or
iv)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.
Layperson’s explanation
Coronary arteries carry blood to the heart muscle. This
blood is rich in oxygen, needed for the good health of the
heart. In a heart attack, the blood supply to the heart
muscle is reduced. As a result, some of the heart muscle
dies. There may be only a small amount of heart muscle
that dies. If this is the case, the medical evidence for such
a heart attack doesn’t fulfil the criteria given below for a
Trauma claim to be made. However, in most heart attacks,
three things may result, namely:
• T
he dead muscle releases enzymes into the blood
stream. These enzymes are called CK-MB and
Troponins. Enzymes are proteins that occur in most
tissues of the body and allow the metabolism of those
tissues to perform normally.
• A
n electrocardiogram (ECG), which records the
electrical activity of the heart.
• The heart may not be able to pump properly. When a
normal heart beats, it pumps out more than 50% of
blood being held in the heart. When it doesn’t pump
properly, the heart is only able to pump out less than
50% of the blood held in the heart. The amount of
blood pumped out with each heart beat is called the
ejection fraction.
Quick facts
During hospital stays for heart attacks, about one in
eight of these patients proceed to also have coronary
artery angioplasty (see page 6) and one in 20 need
coronary by-pass surgery.
Source: Australian Institute of Health and Welfare, September 2002.
Out of Hospital Cardiac Arrest
Cardiac arrest which is not 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.
Layperson’s explanation
Cardiac arrest means the heart is not able to pump out
blood sufficiently to maintain life. As a result, the person
collapses suddenly into unconsciousness and without
resuscitation within minutes will die. In all cases the pulse
cannot be felt.
Cardiac asystole means the heart has stopped beating
completely.
Ventricular tachycardia means that the heart is beating
regularly but at such a very fast heart rate that each beat
is insufficient in pumping out blood.
Ventricular fibrillation means that the heart is beating
irregularly and very fast so that each beat is insufficient
in pumping out blood.
It is necessary for the episode to be proven by an
electrocardiograph. This is because there are other
changes in the rhythm of the heart that can also produce
unconsciousness and difficulty in recording a pulse but
which are not as life threatening as those listed causing
cardiac arrest.
Quick facts
In patients with ventricular fibrillation, there is a high
success rate with immediate defibrillation but for every
minute of delay, 10% of patients who might have been
saved are lost. By having defibrillators readily available in
cardiac arrest, the survival rate can go up 40% to 50%.
Source: New England Journal of Medicine, 26 October 2000.
A Trauma claim will be paid if:
• e
ither the CK-MB or the Troponins reach a certain high
level in the blood stream indicative of a heart attack,
and
• either the electrocardiogram shows a classical heart
attack pattern or the ejection fraction noted in an
echocardiogram falls to less than 50%.
5
Heart Disorders
Coronary Artery Disease Requiring By-pass Surgery
The actual undergoing of by-pass 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.
Layperson’s explanation
Coronary artery disease means that there is a narrowing of
one or more of the coronary arteries that supply blood to
the muscle of the heart. This narrowing reaches a degree
where the blood flow is insufficient to maintain normal
vitality of the heart muscle so that the heart muscle is
damaged or actually dies. By-pass surgery is designed to
send blood to the damaged heart muscle by another route.
In by-pass surgery, the surgeon opens into the chest
and can therefore directly visualise the heart. The surgeon
identifies the blockage or blockages causing the heart
attack. The blockages are not removed. Rather, a vein is
taken from a lower limb and connected above and below
the blockages, thus by-passing the blockage. Sometimes,
instead of using a vein, an artery that lies behind the
breastbone is used in the same way. Up to four new
routes may be needed.
Coronary Artery Angioplasty – Triple Vessel
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.
Layperson’s explanation
The degree of coronary artery narrowing is determined
by coronary artery angiography (this is what is meant
by angiographic evidence). A catheter (flexible tube) is
continuously fed through an artery (usually in the groin
but may be in the arm) until it can be passed into the main
coronary artery and a dye is then passed through this
catheter. Photographs are then taken of this dye and
these give an excellent picture of the inside of the arteries,
demonstrating the extent of plaques of fat that are causing
obstruction in the coronary arteries.
After surgery, patients are encouraged to gradually
increase their exercise level. Those who achieve a high
level of activity have the best long-term results. Patients
in sedentary office jobs can be back at work in four to
six weeks.
With angioplasty, it is not necessary for the surgeon to
open into the chest. Rather, a small inflatable balloon on a
long flexible catheter is continuously fed through an artery
(usually in the groin but may be in the arm) until it can be
passed into the blocked coronary artery that is preventing
the heart muscle from receiving adequate blood. The
balloon is then inflated and the narrow artery stretched
back to its normal diameter. Sometimes the artery is kept
open by placing a fine metallic mesh tube into the artery.
This tube is called a stent. It is left in place when the
balloon is deflated and removed.
Quick facts
The patient, after angioplasty, stays in hospital for up to
one day usually, and is then allowed to go home.
In 2003–2004, there were 15,321 coronary artery by-pass
graft operations carried out in Australia.
Quick facts
Source: Australian Institute of Health and Welfare, 2005.
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.
In 2003–2004, there were 30,906 coronary angioplasty
procedures performed in Australia.
Source: Australian Institute of Health and Welfare, 2005.
Saphenous
vein
graft
Coronary by-pass.
6
Internal
mammary
artery
graft
Repair and Replacement of Heart‑Valve
Surgery to replace or repair heart valves but does not
include percutaneous valvuloplasty, trans-arterial
procedures or other non-surgical techniques.
Layperson’s explanation
There are four one-way heart valves in the heart.
They stop the blood flowing in the wrong direction.
Unfortunately, one or more of the heart valves can become
narrowed or fail to close properly. If this happens, the
circulation of the blood through the heart can become
impaired. This impairment gradually worsens so that
eventually surgery has to be undertaken. This may involve
repairing or replacing one of these four valves completely:
• mitral
• tricuspid
• aortic
• pulmonary.
It does not include key-hole surgery techniques. In these
cases, a minimal hole is made into the chest and indirect
visualisation via a camera is used to operate on the valve
(percutaneous valvuloplasty). Similarly some valve repairs
are carried out with the surgeon passing a camera into
the heart via an artery and indirectly visualising the valve
(trans-arterial procedure). Again, payment is not made for
such a procedure.
Quick facts
Approximately 300,000 people worldwide have heart
valve repair or replacement surgery each year.
Source: Medical-News.net, 15 March 2005.
Surgery of the Aorta
Surgery to correct a narrowing, dissection or aneurysm
of the thoracic or abdominal aorta but not its branches.
Layperson’s explanation
The aorta is the biggest artery in the body and carries
blood from the heart to all parts of the body via a system
of branching arteries. The thoracic aorta is in the chest
and continues through the diaphragm (the muscle that
separates the chest from the abdomen) into the abdomen,
where it is called the abdominal aorta.
Narrowing: This means the aorta is narrowed in one or
more places by an accumulation of fatty deposits or by
a blood clot on its wall. Because this causes decreased
blood flow to the lower limbs, usually on walking or
exercising, the client usually complains of pain or cramping
at these times. Surgery is used either to remove the fatty
plaques or to by-pass the blockages.
Dissection: This is a sudden emergency when the wall
of the artery can split. Surgery is designed to release the
pressure building up in the dissected layers, and to try
to avoid a progression of the dissection.
Aneurysm: This is a weakening in the wall of the artery
which slowly bulges, even to the size of a grapefruit. Larger
aneurysms are surgically repaired to avoid complications.
A sudden rupture of an aneurysm may also occur, when
urgent surgery will again be needed.
Quick facts
The aorta is the most common major vessel to be injured
following blunt chest trauma.
Source: Diseases of the Aorta in the Critically Ill, M. Chinthamuneedi,
Intensive Care Unit, St Andrew’s Hospital, Adelaide, South Australia, 2000.
Aorta
Prosthetic
valve
Aortic valve replacement.
7
Heart Disorders
Cardiomyopathy
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 28).
Layperson’s explanation
Blood is pumped out of the heart into the largest artery in
the body (the aorta) and from there is carried to all the
tissues of the body (except the lungs). The chamber of the
heart that pushes out this blood is called the left ventricle.
A cardiomyopathy affects the muscle of this left ventricle,
causing it to perform less and less efficiently. The amount
of blood the left ventricle pumps out with each beat is
called the ejection fraction and in a normal heart is 50% or
more of the blood held in the left ventricle. As the heart
pumping action fails with the cardiomyopathy, this ejection
fraction falls more and more.
Three different types of cardiomyopathy are recognised:
• D
ilated cardiomyopathy is the most common. The cavity
of the heart is enlarged and the walls are stretched. The
heart is so weak it does not pump normally.
• H
ypertrophic cardiomyopathy – the muscle mass in the
left ventricle enlarges.
• Restrictive cardiomyopathy – the walls of the heart
become rigid and hard to move. This type is usually
caused by another disease process.
Quick facts
Cardiomyopathy may be inherited or can be caused by viral
infections; heart attacks; alcoholism; long-term, severe high
blood pressure; or by other reasons not yet known.
Primary Pulmonary Hypertension
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 28).
Layperson’s explanation
The word ‘primary’ means that the underlying cause of
this rare disease is unknown.
Primary pulmonary hypertension means that the very small
arteries in the lungs become narrowed or blocked. There
is therefore a resistance to the flow of blood through the
lungs. As a result, there is a bank-up of blood in the larger
arteries in the lungs (pulmonary arteries) as these larger
arteries try to push harder and harder against these small
blocked arteries. As a result, there develops hypertension
(high pressure) in the larger pulmonary arteries. This high
pressure finally affects the chamber of the heart which
delivers blood to the pulmonary arteries. This chamber is
called the right ventricle. Finally this chamber, which has
become bigger and bigger as it works harder and harder,
weakens and is unable to pump properly. Finally it fails
altogether and then a transplant is the only cure available.
Quick facts
Despite doctors’ inability to cure primary pulmonary
hypertension, advances in its treatment over the past
decade have markedly improved survival and the quality
of life for sufferers.
Source: American Heart Association. Primary or Unexplained Pulmonary
Hypertension, 2000.
Open Heart Surgery
Open Heart Surgery for treatment of cardiac defect/s,
cardiac aneurysm or benign cardiac tumour/s.
Source: Department of Cardiology, Henry Ford Hospital, Detroit,
September 2004.
Layperson’s explanation
Open heart surgery is any surgery where the chest is
opened and surgery is performed on the heart. The term
‘open’ refers to the chest, not the heart itself (which may or
may not be opened depending on the type of surgery).
Open heart surgery includes surgery on the heart muscle,
valves, arteries or other structures.
Left
atrium
Right
atrium
Left
ventricle
A heart-lung machine (also called heart-lung by-pass)
is usually used to help provide oxygen-rich blood to
the brain, heart muscle and other vital body areas.
It pumps the blood, supplies oxygen to the blood and
removes carbon dioxide from the blood.
Quick facts
Right
ventricle
Between 2001 and 2002, there were 23,279 procedures
which required open heart surgery in Australia.
Source: AIHW, Heart, Stroke and Vascular Diseases; Australian Facts 2004.
An enlarged heart.
8
Nervous System Disorders
Stroke
A cerebrovascular accident or incident producing
neurological sequelae. This includes infarction of brain
tissue, intracranial and/or subarachnoid haemorrhage,
or embolisation from an extracranial source. The following
are excluded:
• Cerebral symptoms due to:
– transient ischaemic attacks
Major Head Trauma
Injury to the head resulting in neurological deficit
causing either:
•a permanent loss of at least 25% whole person function
(as defined in the edition of the American Medical
Association publication ‘Guides to the Evaluation of
Permanent Impairment’ current as at the preparation
date of the Personal Insurance Portfolio PDS), 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 on page 24), as certified by
a consultant neurologist.
– r eversible ischaemic neurological deficit
– migraine.
• Cerebral injury resulting from:
– trauma
– hypoxaemia
Layperson’s explanation
– vascular disease affecting the eye, optic nerve
or vestibular function.
Neurological deficit here refers to symptoms that may
result from damage to brain cells as a result of an injury
to the head.
Layperson’s explanation
The blood circulation to the brain is called the
cerebrovascular circulation. A cerebrovascular accident
does not relate to any injury but rather to a clot cutting off
the blood supply to part of the brain, resulting in partial
brain death (cerebral infarction), or to a rupture of a blood
vessel, causing bleeding either into the brain (cerebral or
intracranial haemorrhage) or into the space surrounding
the brain (subarachnoid haemorrhage). Whatever type of
cerebrovascular accident occurs, we call it a stroke.
Quick facts
Each year, over 40,000 Australians have a stroke, with 70%
of these being first ever strokes.
Source: Australian Institute of Health and Welfare, 2006.
Loss of 25% of whole body function is determined by a
neurologist who has detailed tables as to what constitutes
25% loss of total body function.
A blow to the outside of the skull can result in the brain
moving and hitting the hard skull or tearing. Both cause
bleeding and bruising, resulting in damage to brain cells.
Major head injury may result in permanent disability.
Fatigue and headache are by far the most
common complaints.
Depending on which area in the brain is damaged there
can be:
• memory loss
• loss of time and space sense
• behaviour disturbances and personality changes
• paralysis or weak limb movements
• changes in hearing, vision, taste, touch and smell
Infarction of
brain tissue
• speech problems and/or difficulty
understanding speech.
Improvements in function can occur up to two years
following the injury.
Quick facts
• Motor vehicle crashes account for 50% of all Traumatic
Brain Injuries (TBI). This includes autos, trucks,
motorcycles, bicycles and pedestrians hit by vehicles.
Subarachnoid
haemorrhage
• The leading causes of TBI vary by age: falls are the
leading cause of TBI among persons aged 65 years and
older; transportation is the leading cause of TBI among
persons under the age of 65 years.
Source: International Brain Injury Association, 2003.
A stroke.
9
Nervous System Disorders
Motor Neurone Disease
Motor Neurone Disease diagnosed by a consultant neurologist.
Layperson’s explanation
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.
Quick facts
Multiple sclerosis is twice as common in women than
men and can affect people as early as age 20. The cause
is still unknown.
Source: Mayo Clinic, United States, 2000.
An estimated 2.5 million people in the world have the
disease MS. The National Health Survey of 2001 indicated
that there were approximately 15,000 Australians with MS.
Source: MS Australia, 2003.
Muscular Dystrophy
The unequivocal diagnosis of Muscular Dystrophy by
a consultant neurologist.
Layperson’s explanation
Muscular dystrophy is a group of diseases, usually genetic,
that cause progressive weakness and degeneration of
muscles that control movement. Some forms appear in
infancy and others do not appear until middle age or later.
Sometimes the heart and other organs are involved.
Some forms of muscular dystrophy are mild, and are
only very slowly progressive, and sufferers may have a 
normal lifespan.
Quick facts
Quick facts
The cause is unknown. There is no cure. Clients with this
disease need physical and psychological support with aids
to help them overcome disabilities. The average life
expectancy is three to four years from diagnosis, although
some patients have survived 20 years.
There is no specific treatment. All therapy is aimed
at stopping the affected muscles from shortening around
joints. Corrective orthopaedic surgery may be necessary.
Source: NINDS Muscular Dystrophy Information, page 27, June 2000.
Source: Neurological Resource Centre, United States, 2000.
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 as defined
above but without the existence of persisting neurological
abnormalities.
Layperson’s explanation
In multiple sclerosis (MS), nerve cells lose their myelin
coating, which acts like the 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.
10
Nerve
cell
Loss of myelin
coating in MS
Motor neurone disease.
Paraplegia
The permanent loss of use of both legs or
both arms, resulting from spinal cord sickness
or injury.
Hemiplegia
The total loss of function of one side of the
body due to sickness or injury, where such
loss of function is permanent.
Quick facts
Layperson’s explanation
There are more than 8,000 people with spinal cord injuries
in Australia, at a cost to the community of $470 million
each year. One eighth are children.
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.
Source: Spinal Research Fund of Australia Inc., 2003.
Quadriplegia
The permanent loss of use of both arms and both
legs, resulting from spinal cord sickness or injury.
The onset of hemiplegia is usually very sudden in stroke
patients, and as well as not being able to move one side of
the body, they are often unable to talk. Some patients can
make a complete recovery after several days or weeks.
The majority make only a partial recovery and are left with a
severe weakness on one side for the rest of their lives.
Layperson’s explanation
If the spinal cord is injured or develops disease,
the muscles of both the arms and both the legs
become paralysed.
Quick facts
The most common cause of hemiplegia is a stroke.
Source: Merck Manual, 1999.
The main causes of spinal cord injury are:
• motor vehicle accidents
44%
• violence
24%
• falls
22%
• sport
8%.
Diplegia
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
Quick facts
There are more than 8,000 people living with spinal cord
injuries in Australia.
Spastic Diplegia is one of the most common forms of
cerebral palsy1. In children, cerebral palsy is the most
common cause of disability2.
Source: Spinal Cord Injuries Australia, 2003.
Sources:
1. The Children’s Hospital at Westmead – Parents and
Cerebral Palsy 2006.
2. The Spastic Centre, Cerebral Palsy fact sheet 2006.
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.
11
Nervous System Disorders
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 life insured’s Mini-Mental State Examination scores to
24 or less, and deterioration would continue but for any
effective treatments.
Layperson’s explanation
Dementia related to alcohol, drug abuse or AIDS is excluded.
By far the most common cause of coma is head injury.
Other causes can be:
Layperson’s explanation
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 Mini-Mental 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 (and easily brought up on the Internet):
Pridmore S. Download of Psychiatry. Chapter 20.
Last modified 7 November 2006.
Quick facts
More than 162,000 Australians have a diagnosis of
dementia, with perhaps as many again in the early stages
of dementia. The average length of time a person will live
with dementia is ten to 14 years.
Source: Alzheimer’s Australia, 2003.
12
Coma
A state of total unconsciousness with no reaction to external
stimuli or internal needs, requiring continuous assisted
ventilation to maintain life for at least 72 consecutive hours.
Coma is best defined as a state of unresponsiveness from
which an individual cannot be aroused. If a patient in a
coma survives the first ten days following an injury to
the brain, then long-term survival can be expected.
Recovery can be partial or complete. Partial recovery
occurs frequently after head injury.
• diabetes
• abscesses
• tumours
• stroke
• liver failure.
Coma represents the last and lowest level of function of
the brain prior to death.
Quick facts
Head injuries are the most common cause of coma.
Transportation accidents involving automobiles,
motorcycles, bicycles and pedestrians account for half
of all head injuries.
Source: National Institute of Neurological Disorders and Stroke,
October 2002.
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 edition of the American Medical
Association’s publication ‘Guides to the Evaluation of
Permanent Impairment’ current as at the preparation
date of the Personal Insurance Portfolio PDS), 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 24), as certified by
a consultant neurologist.
Encephalitis as a result of HIV infection is excluded.
Layperson’s explanation
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% whole
person impairment could be:
Parkinson’s Disease
The unequivocal diagnosis of Parkinson’s Disease by a
consultant neurologist where the consultant neurologist
confirms that the condition:
• is the established cause of two or more of the following:
– muscular rigidity
– resting tremor
– bradykinesia
• has caused significant progressive physical impairment, likely
to continue progressing but for any treatment benefit.
The life insured must be under the established care and
following the advice of a specialist neurologist.
Layperson’s explanation
Parkinson’s disease causes trembling in hands, legs, jaws
and face at rest; stiffness of limbs (called muscular rigidity);
slowness of movements (called bradykinesia); and
impaired balance and coordination.
Quick facts
At present there is no cure for Parkinson’s disease.
However, there are a number of drugs which can control
symptoms. As time goes on, the drugs gradually lose their
effect and the patient becomes progressively impaired.
Source: American Parkinson’s Disease Association, 2000.
• inability to understand words or to produce
understandable language for daily activities
• someone who mentally requires constant supervision
• s omeone 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
Dengue fever is one of the most prevalent airborne
diseases in the world today and can cause encephalitis.
There has been an increase in Australian cases in recent
years, but the disease is more prevalent in New Zealand.
Source: New Zealand Ministry of Health, November 2002.
13
Nervous System Disorders
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.
Layperson’s explanation
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
Death occurs in about 5% to 15% of cases of bacterial
meningitis and, in addition, about 20% of patients are left
with a permanent disability including cerebral palsy, limb
amputation, deafness or a learning difficulty.
Source: The Meningitis Centre (Australia), the Meningitis Research
Foundation and The Meningitis Trust (UK), April 2005.
14
Subacute Sclerosing Panencephalitis
The unequivocal diagnosis of Subacute Sclerosing
Panencephalitis.
Layperson’s explanation
Subacute Sclerosing Panencephalitis is a late complication
of measles, which causes progressive brain damage
and death.
Quick facts
Ten out of every 1 million children may experience SSPE.
Source: National Health and Medical Research Council. The Australian
Immunisation Handbook, Commonwealth of Australia, 2003. 8th edition.
Canberra: Australian Government Department of Health and Ageing, 2003.
Body Organ Disorders
Cancer
Any malignant tumour characterised by the uncontrolled
growth and spread of malignant cells that requires treatment
by surgery, radiotherapy, chemotherapy, biological response
modifiers, or any other major interventionist treatment and
includes cancers that are completely untreatable.
Layperson’s explanation
The following are included:
Cancer starts when a cell or group of cells changes from
being normal and begins to grow in an uncontrolled
fashion. The uncontrolled growth expands in the first site,
damaging normal tissue, and cells can spread via the
blood stream or the lymphatic system to other parts of the
body, where they can multiply.
• Leukaemia
Many cancers can be cured if detected early.
• Hodgkin’s Disease
• Malignant lymphoma
Quick facts
• Malignant bone marrow disorders
Cancer is a leading cause of morbidity and mortality in
Australia. Excluding skin cancers other than melanoma,
there were 85,231 new cancer cases and 35,466 deaths
due to cancer in Australia in 2000.
• Melanomas which have a depth of invasion of Clark
Level 3 or 1.5mm or more in Breslow thickness
• Carcinoma in situ of the breast which results directly in
the removal of the entire breast (with or without removal
of lymph nodes). The procedure must be performed
specifically to arrest the spread of malignancy and be
considered the appropriate and necessary treatment.
The following are excluded:
• Tumours showing the malignant changes of ‘carcinoma in
situ’ or which are histologically described as premalignant.
The following are examples of tumours categorised as either
being carcinoma in situ or premalignant and are excluded:
i) Cervical dysplasia, CIN1, CIN2 and CIN3
ii)all non-melanoma skin tumours and cancers unless there
has been evidence of metastatic spread
• Any colorectal cancer classified as TNM (Tumour, Nodes,
Metastases) Stage 0 (Tis, NO, MO)
• Prostatic cancers which remain histologically described as
TNM Classification T1a or T1b or are of another equivalent
or lower classification
• Prostatic cancers which remain histologically described as
TNM Classification T1c unless curative intent therapy has
been administered in connection with such cancer
• All AIDS-related malignancies
• Tumours treated by endoscopic procedures alone
• Chronic Lymphocytic Leukaemia (as defined on page 16)
• Removal of Carcinoma in situ of the Breast (as defined
on page 16)
• Melanoma (as defined on this page)
• Hydatidiform Mole (as defined on page 17)
• Carcinoma in situ of the Cervix Uteri (as defined on page 16)
• Carcinoma in situ of the Vagina (as defined on page 17)
• Carcinoma in situ of the Vulva or Perineum of limited extent
(as defined on page 17).
The last seven exclusions do not apply to Income Care Plus.
Even allowing for the fact that a person may have more
than one cancer, at the incidence rates prevailing in 2000,
it would be expected that one in three men and one in four
women will be diagnosed with a malignant cancer in the
first 75 years of life.
Source: Australian Institute of Health and Welfare, 2000.
Melanoma
A melanoma which has a depth of invasion of:
• Clark level 2, or
• more than 1.25mm, but less than 1.5mm, in Breslow
thickness
as determined by histological examination. The malignancy
must be characterised by the uncontrollable growth and
spread of malignant cells and the invasion and destruction
of normal tissue.
Layperson’s explanation
Melanoma is cancer of melanocyte cells and the vast
majority occur in the skin. Melanomas are the most lethal
form of skin cancer and, as with most forms of cancer,
earlier detection of melanoma gives patients a better
chance of survival.
Quick facts
• Melanoma is a major Australian health problem.
Every year over 8,000 Australians are diagnosed
with melanoma and more than 1,000 Australians
die from melanoma.
• Australia has the highest incidence of melanoma in the
world. Melanoma is the most common cancer in males
aged 25-54 and in females aged 15-29 years. It is the
second most common cancer in women 30-54 years of
age and in the overall population of Australia, melanoma
now ranks as the third most common cancer.
Source: http://www.health.nsw.gov.au/cancer_inst/statistics/index.html.
NSW statistics and figures are from the Cancer Institute NSW.
15
Body Organ Disorders
Chronic Lymphocytic Leukaemia
The presence of chronic lymphocytic leukaemia diagnosed
as Rai stage 0 or 1, which is defined to be in the blood and
bone marrow and/or lymph nodes only.
Layperson’s explanation
Leukaemia is a cancer of the white blood cells. Chronic
lymphocytic leukaemia is a slow growing cancer that
produces too many white cells that are called lymphocytes.
These cancerous lymphocytes multiply too quickly and
live too long so that there are too many of them circulating
in the blood stream.
These malignant lymphocytes may just be found in the
blood stream. This is known as Stage Rai 0. When they are
found not only in the blood stream but also cause swelling
of the glands that filter out infections (called lymph glands),
this is called Stage Rai 1. When other organs are affected
by the leukaemia or when there are problems with other
cells formed in the bone marrow, then we have higher
Rai stagings.
Cancer of the Vulva or Perineum
Any lesion described by a histopathologist as carcinoma of
the vulva or perineum that meets the criteria of either Stage
3 or 4 (tumour of any size with contiguous invasion of local
organs) of the 1998 International Federation of Gynecology
and Obstetrics (FIGO) surgical staging system.
Layperson’s explanation
Cancer of the vulva may involve any of the external female
sex organs. The most common areas for it to develop are
the inner edges of the labia majora (two outer larger lips)
and the labia minora (two inner smaller and thinner lips).
Less often, vulva cancer may also involve the clitoris or the
Bartholon’s glands (small glands, one on each side of the
vagina). It can also affect the perineum (area of the skin
between the vulva and the anus).
Quick facts
Cancer of the vulva usually occurs in postmenopausal
women in peak incidence between the ages of 65
and 75. However, 15% of the cases occur in women aged
40 or younger.
Five-year survival rates in women who are diagnosed and
treated in the early stages of vulva cancer can be excellent
(more than 90%).
Source: www.lifespan.org/adam/healthillustratedencyclopedia/1/000902.html,
2006.
Removal of Carcinoma in Situ of the Breast
Surgical removal of a carcinoma in situ of the breast,
where the carcinoma in situ of the breast:
• is characterised by a focal autonomous new growth of
carcinomatous cells which has not yet resulted in the
invasion of normal tissues
• does not result in the removal of the entire breast, and
•is classified as Tumour Nodes Metastasis (TNM) stage
Tis or International Federation of Gynecology and Obstetrics
(FIGO) stage 0.
The procedure must be performed specifically to arrest the
spread of malignancy and be considered the appropriate
and necessary treatment.
Layperson’s explanation
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 like those seen in
breast cancer, carcinoma in situ stays confined to the
ducts or lobules and does not invade surrounding fatty
tissues in the breast or spread to other organs in the body.
There are two types of breast carcinoma in situ:
Ductal carcinoma in situ (DCIS): The most common type
of non-invasive breast cancer. Cancer cells inside the
ducts do not spread through the walls of the ducts into the
fatty tissue of the breast.
Lobular carcinoma in situ (LCIS): Also called lobular
neoplasia. It begins in the lobules, but does not penetrate
through the lobule walls.
If left untreated, it may increase the chances that a woman
will develop an invasive breast cancer.
Quick facts
Carcinoma in situ can be found in women at any age;
however, most women are between 50 and 59 years old.
It can also develop in men, although this is very rare.
About 1,200 women are diagnosed with DCIS each year
in Australia.
Source: National Breast Cancer Centre, 2004.
Carcinoma in Situ of the Cervix Uteri
Confirmation by biopsy of localised pre-invasive cancer
in the cervix uteri at severe dysplasia of the level of CIN 3
grading where cancer cells do not penetrate the basement
membrane nor invade the surrounding tissues or stroma. For
the purposes of this definition, ‘invade’ means to infiltrate
and/or destroy the tissue of origin or surrounding tissue.
Layperson’s explanation
The cervix is the lower part of the uterus and sits in the
upper part of the vagina. Cancer of the cervix is a disease
in which the cells of the cervix become abnormal and start
to grow uncontrollably, forming tumours.
16
Quick facts
• Cancer of the cervix is the fifth most common cancer
in women.
• T
he development of cancer of the cervix is slow. First
there are pre-cancer changes in the cells. Eventually
they turn into cancer, but initially this cancer remains
localised (carcinoma in situ). If this localised cancer isn’t
treated, it will start invading surrounding tissues
(invasive carcinoma).
• A sexually transmitted virus (known as the human
papilloma virus) is the cause of many cases of cancer
of the cervix.
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 Personal Insurance Portfolio PDS), or
•requiring cranial surgery for its removal.
Carcinoma in Situ of the Vulva or Perineum of
limited extent
Any lesion described by a histopathologist as carcinoma or
intraepithelial neoplasia of the vulva or perineum that meets
the criteria of either of the following stages of the 1988
International Federation of Gynecology and Obstetrics
(FIGO) surgical staging system:
•Stage 0. Carcinoma in situ; intraepithelial neoplasia
•Stage 1A, 1B or 2 where the cancer is confined to the vulva
or perineum.
The presence of the underlying tumours must be confirmed by
imaging studies such as 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.
Layperson’s explanation
Brain tumours are usually known for the cell type
from which they arise. Brain tumours are either benign
or malignant.
Carcinoma in Situ of the Vagina
Any lesion described by a histopathologist as carcinoma or
intraepithelial neoplasia of the vagina that meets the criteria
of Stage 0, (carcinoma in situ; vaginal intraepithelial
neoplasia) of the 1988 International Federation of
Gynecology and Obstetrics (FIGO) surgical staging system.
A benign tumour is not cancerous and unlikely to spread.
Some benign brain tumours can cause problems by
pressing on and damaging the tissue around the brain.
These, however, can often be successfully removed.
Hydatidiform Mole
The surgical removal of a Hydatidiform mole as confirmed by
a histopathologist.
There are almost 1,400 new cases of malignant brain
tumours each year in Australia and many more benign
brain tumours that can be just as deadly if the tumour is in
a vital area of the brain. More than 1,200 people die each
year from malignant and benign brain tumours.
Layperson’s explanation
A hydatidiform mole is growth of an abnormal fertilized egg
or an overgrowth of tissue from the placenta. Most often,
a hydatidiform mole is an abnormal fertilized egg.
The abnormal egg develops into a hydatidiform mole rather
than a foetus (a condition called molar pregnancy).
Possible complications include haemorrhage, ovarian
cysts, pre-eclampisa (toxaemia of pregnancy),
and recurrence of the mole. Most often a woman has a
miscarriage and passes the mole from her body, or it may
need to be removed by D&C (dilatation and curettage).
In some rare cases the mole can become cancerous and
spread to other parts of the body.
Quick facts
Source: Statistics on Incidence, Survival Rates and Mortality Associated
with Brain Tumours in Australia, Information Paper for the Australian Brain
Tumour Advocacy Group, Denise Chang, June 2003.
Quick facts
Hydatidiform mole occurs in approximately one in
1,500 pregnancies.
Source: Sydney Gynaecological Oncology Group Sydney Cancer Centre,
www.cs.nsw.gov.au/cancer, 2007.
17
Body Organ Disorders
Blindness
The permanent loss of sight in both eyes, whether aided or
unaided, due to sickness or injury to the extent that visual
acuity is 6/60 or less in both eyes, or to the extent that the
visual field is reduced to 20 degrees or less of arc, as
certified by an ophthalmologist.
Partial Blindness
The permanent loss of sight in one eye, whether aided or
unaided, due to sickness or injury to the extent that visual
acuity is 6/60 or less in one eye, or to the extent that the
visual field is reduced to 20 degrees or less of arc, as
certified by an ophthalmologist.
Layperson’s explanation
95% of blindness is caused by diseases such as:
Major Organ or Bone Marrow Transplant
The human to human transplant from a donor to the
life insured of:
• one or more of the following organs
– kidney
– lung
– pancreas
– heart
– liver
• bone marrow.
The transplantation of all other organs or parts of organs
or any other tissue transplant is excluded.
• macular degeneration
Layperson’s explanation
Kidney transplantation is considered the most successful
treatment for most patients with end stage renal failure.
• diabetes
Liver transplant is the treatment for end stage liver failure.
• cancer.
Heart/lung transplants are performed less often, but still
have remarkable survival rates.
• glaucoma
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
Sight loss is one of the most common causes of disability
in Australia, affecting one in 60 Australians. It is estimated
that almost 300,000 people across Australia are blind or
vision impaired.
Pancreas transplants are performed in patients with
insulin-dependent diabetes mellitus.
Quick facts
There were 540 kidney transplant operations performed in
Australia and New Zealand in 2001. Of patients on the
active kidney transplant list, 41% are under the age of 65.
Source: The Australian and New Zealand Dialysis and Transplant Registry
(ANZDATA), Annual Report, 2002.
Source: Royal Blind Society Australia, 2003.
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.
Layperson’s explanation
When kidneys fail, there is a build-up of poisonous
substances in the blood and the blood can become very
acidic. The level of some salts, such as potassium, can be
high enough to cause sudden cardiac arrest. The only way
these imbalances can be corrected is by dialysis.
75% of adult renal failure is caused by:
• diabetic kidney disease
• high blood pressure
• glomerulonephritis.
Quick facts
You can lose up to 90% of kidney function before even
feeling sick.
Source: The Australian Kidney Foundation, June 2003.
18
Placement on a Waiting List for Major Organ Transplant
The life insured must:
• be diagnosed with a sickness or injury which necessitates
a Major Organ or Bone Marrow Transplant (as defined
above) and
• 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.
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 &
Browder Body Surface Chart
•both hands, requiring surgical debridement and/or
grafting, or
•the face, requiring surgical debridement and/or grafting.
Layperson’s explanation
Doctors use ‘The Rule of Nines’ to determine how severe
a burn is (refer to page 27). This divides the skin into areas
that represent about 9% of the total body surface.
The more of the body surface involved, the more severe
the burn.
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.
The loss must be certified by an appropriate medical specialist.
Layperson’s explanation
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.
Quick facts
Total loss of speech is regarded as a 35% impairment
of the whole body.
Source: AMA Guides to Evaluation of Permanent Impairment
5th Edition, 2001.
Quick facts
More than 150,000 people in Australia each year seek
medical help for a burn injury. 7,000 people per year are
hospitalised and 400 die as a result of their injury.
Loss of Hearing
Complete and irrecoverable loss of hearing, both natural and
assisted, from both ears as a result of sickness or injury, as
certified by a specialist we consider appropriate.
Source: AIHW, Australia’s Health 2004.
Partial Loss of Hearing
Complete and irrecoverable loss of hearing, both natural and
assisted, from one ear as a result of sickness or injury, as
certified by a specialist we consider appropriate.
First-degree burn
Damage to the outer layer of skin
(epidermis), causing pain, redness
and swelling.
Second-degree burn
Damage to both outer skin and underlying
tissue layers (epidermis and dermis),
causing pain, redness, swelling
and blistering.
Layperson’s explanation
Brain injury or disease, or damage to the ear, can cause
loss of hearing. The nerve from the ear to the brain is easily
damaged by viral infections and can mean total deafness
right from childhood.
Quick facts
At least one in five Australians report they have a significant
hearing loss.
Source: Australian Hearing, November 2002.
Third-degree burn
Damage extends deeper into tissues
(epidermis, dermis and hypodermis),
causing extensive tissue destruction.
The skin may feel numb.
19
Body Organ Disorders
Chronic Liver Disease
Permanent liver failure resulting in permanent jaundice,
ascites and/or encephalopathy.
Layperson’s explanation
The liver acts as a filter to remove toxins from the blood.
Common liver diseases include hepatitis, which is
inflammation of the liver, and if it goes on for a long time
it can eventually cause the liver to fail. Hepatitis can be
caused by:
Chronic Lung Disease
Permanent end stage respiratory failure, with FEV1 test
results (see page 26) of consistently less than one litre,
requiring continuous permanent oxygen therapy.
• viral infections
Layperson’s explanation
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.
• alcohol
The lungs can fail when the:
• drugs
• airway is blocked
• bacterial infections.
• lung is damaged by disease
Cirrhosis causing liver failure is usually attributed to
alcoholism. 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:
• 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.
• J
aundice
Liver damage causes the skin and eyes to
become yellow.
Quick facts
Over five million Australians suffer from
respiratory diseases.
• A
scites
Because the liver is not doing its job of breaking down
proteins, fluid builds up in the abdominal cavity.
Source: The Australian Lung Foundation, 2003.
• P
ortal 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.
Quick facts
Endstage liver failure is irreversible and can only
be treated by liver transplant.
Source: Medilink (NZ) Ltd, 2000.
The effect of smoking on the lungs.
20
Severe Rheumatoid Arthritis
The unequivocal diagnosis of severe rheumatoid arthritis by
a rheumatologist.
The diagnosis must be supported by, and evidence, all of
the following criteria:
•at least a six-week history of severe rheumatoid arthritis
which involves three or more of the following joint areas:
i) proximal interphalangeal joints in the hands
ii) metacarpophalangeal joints in the hands
iii)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 arthritidies
are excluded.
Layperson’s explanation
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
their arthritis. Early diagnosis and treatment is one of the
key strategies in the management of rheumatoid arthritis.
Quick facts
Almost 438,000 Australians are reported to have rheumatoid
arthritis. These self-report based estimates are much higher
than those reported from other parts of the world.
Source: AIHW, Arthritis & Musculoskeletal Conditions in Australia 2005.
Severe Osteoporosis
The life insured 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). The
life insured must suffer from this condition before he or she
reaches his or her 50th birthday and must at the time be
covered for the condition.
Layperson’s explanation
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.
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
• Every eight minutes, someone is admitted to an
Australian hospital with an osteoporotic fracture.
This is expected to rise to every three to four minutes
by the year 2021.
• In 2002, 1.9 million people in Australia had osteoporosis.
This number is expected to rise to 2.2 million by the year
2006 and to 3 million by the year 2021.
Source: Osteoporosis Australia web site (www.osteoporosis.org.au), 2007.
21
Blood Disorders
Occupationally Acquired HIV
Infection with Human Immunodeficiency Virus (HIV) where it
was acquired as a result of an accident occurring during the
currency of the policy.
The accident must occur during the course of carrying out
normal occupational duties, with seroconversion indicating HIV
infection occurring within six months of the accident. Infection
in any other manner, including sexual activity or recreational
intravenous drug use, is specifically excluded.
An HIV antibody test must be taken within seven days after the
accident and reported within 30 days and produce negative
results. Access to all blood samples taken is required for
independent tests, with the right to take additional samples
as necessary.
Medically Acquired HIV
Accidental infection with HIV which we believe, on the
balance of probabilities, arose from one of the following
medically-necessary events which must have occurred to
the life insured in Australia by a recognised and registered
health professional:
•a blood transfusion
•transfusion with blood products
•organ transplant to the life insured
•assisted reproductive techniques, or
•a procedure or operation performed by a medical/
paramedical practitioner or dentist.
The benefit will not apply if:
Access to all blood samples taken is required for independent
tests, with the right to take additional samples as necessary.
•before the injury, the Australian Government has
recommended an HIV vaccine for use in the occupation
of the life insured but the life insured has not taken this
vaccine, or
A Trauma Cover benefit will not be payable in respect of
Medically Acquired HIV if, before the accidental infection
occurred, the Australian Government approved a medical
treatment which if applied to the life insured would:
•the Australian Government has approved a treatment which
renders the HIV virus inactive and non-infectious to others.
•render the life insured’s HIV inactive and non-infectious
to others
Layperson’s explanation
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
HIV is a lifelong infection. Combinations of drugs can delay
the progression from HIV to AIDS to death. Some HIV
infected patients progress to full blown AIDS quickly
while others can remain healthy for ten years or more.
Source: United States Federal Drug Administration Consumer magazine,
July–August 1999.
•prevent the life insured from developing AIDS, or
•where the life insured has developed AIDS, cure the AIDS.
Aplastic Anaemia
This means bone marrow failure which results in anaemia,
neutropenia and thrombocytopenia requiring treatment, with
at least one of the following:
•blood product transfusions
•marrow stimulating agents
•immunosuppressive agents, or
•bone marrow transplantation.
Layperson’s explanation
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 give some of their marrow – a bone
marrow transplant.
With successful treatment patients can lead a relatively
normal life for 10 to 15 years.
Quick facts
People between the ages of 15 and 30 are most at risk.
Source: Bone Marrow Donor Institute, Australia, September 2003.
22
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
•diabetic gangrene leading to surgical intervention
•severe diabetic nephropathy causing chronic irreversible
renal impairment (as measured by a corrected creatinine
clearance below the laboratory/ies measured normal range).
Diabetes Complication (as defined below) is excluded.
Diabetes Complication
Diagnosis of Type 1 insulin dependent diabetes mellitus, as
certified by a consultant endocrinologist and resulting in at
least two of the following criteria:
i) urinary protein excretion of more than 300mg per day
ii) diabetic retinopathy with a minimum severity of at least
exudates and/or dot-blot haemorrhages
iii) persistent sensory neuropathy.
Quick facts
• Diabetes is the sixth highest cause of death by disease
in Australia.
• P
eople with diabetes are almost three times more likely
to have high blood pressure, obesity or elevated blood
fats, e.g. cholesterol, triglycerides.
• P
eople with diabetes are two to three times more likely
to have cardiovascular disease, e.g. heart disease
and stroke.
• O
ne in four Australian adults has either diabetes or
impaired glucose metabolism.
People with diabetes in 1999 to 2000:
• 19% were hospitalised with coronary heart disease.
• 15.4% had retinopathy.
• 90% undergoing a lower limb amputation had a history
of ulceration.
• 3,404 had amputations.
• 12% over the age of 25 had a heart attack; 9% of these
had a stroke.
• 22.6% died from kidney disease.
Source: www.diabetesnsw.com.au. Diabetes Australia and partner
organisations, AusDiab, AIHW-2002, NDSS, Diabcost September 2002,
Vision Australia Foundation and International Diabetes Federation.
Layperson’s explanation
Diabetes is a chronic disease that occurs when there is
too much glucose in the blood because the body is not
producing insulin or not using insulin properly. Insulin is
a hormone needed for glucose to enter the cells and be
converted to energy.
23
Other Events
Serious Injury
An injury that has, for the first time, resulted in the life
insured 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 registered medical practitioner.
Injury as a result of alcohol or non-prescribed drug intake or
other self-inflicted means is excluded.
Critical Care
An injury or sickness that has, for the first time, resulted in
the life insured 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.
Injury or sickness as a result of alcohol or non-prescribed drug
intake, or other self-inflicted means is excluded.
Loss of Limbs or Sight
This means the life insured has sustained, as a direct result
of injury or sickness:
Loss of Independent Existence
As a result of sickness or injury:
• there is permanent and irreversible inability to perform without
the assistance of another person any two of the ‘Activities of
Daily Living’ or all of the ‘Defined Home Duties’, or
• the life insured suffers cognitive impairment that results
in the life insured requiring permanent and constant
supervision for a continuous period of at least six months.
The life insured’s impairment must be established by a
medical practitioner nominated by us.
Loss of Independent Existence due to alcohol or drug abuse
or AIDS is excluded.
Activities of Daily Living:
1. Dressing – putting on and taking off clothing.
•the complete and irrecoverable loss of use of both hands or
2. Toileting – using the toilet, including getting on and off.
•the complete and irrecoverable loss of use of both feet or
3. Mobilising – getting in and out of bed and a chair.
•the complete and irrecoverable loss of use of one hand and
one foot or
4. Maintaining continence – having good control of bowel
and bladder function.
•blindness in both eyes, whether aided or unaided or
5. Feeding – getting food from a plate into the mouth.
•the complete and irrecoverable loss of use of one foot and
blindness in one eye, whether aided or unaided or
•the complete and irrecoverable loss of use of one hand and
blindness in one eye, whether aided or unaided.
For the purpose of this definition ‘blindness’ means the
permanent loss of sight to the extent that visual acuity is 6/60
or less, or to the extent that the visual field is reduced to 20
degrees or less of arc.
Layperson’s explanation
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 people
who are blind or vision impaired in Australia.
Source: The Association for the Blind of WA, September 2004.
24
Loss of One Hand or One Foot
The life insured has sustained, as a direct result of injury or
sickness, the complete and irrecoverable loss of use of one
hand or one foot.
Defined Home Duties:
• Cleaning the usual place of dwelling.
• Purchasing household food and items used for cleaning.
• Preparing meals for the household.
• Performing for the household laundry services such as
washing or ironing.
Quick facts
In 2003, 2.3 million people with a disability living in
households reported needing assistance to cope with
the activities of everyday life.
Source: ABS, 4430.0 Disability, Ageing and Carers, Australia: Summary
of Findings, 2004.
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.
The ventricle never pumps out all the blood in it; however, when the ejection fraction falls below
55%, the heart is beginning to fail as a pump.
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 Intra Epithelial Neoplasia (CIN). A form of grading of cells of the cervix which may
indicate cancer.
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.
25
Glossary of terms
Term
Definition
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.
26
Impairment
The loss or loss of use of any body part, system or function.
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.
Term
Definition
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
A)‘The Rule of 9’ chart for estimating
extent of burns on an adult.
B)Lund & Browder chart showing relative percentage of body
surface areas (% BSA) affected by growth and age.
0yr
a. 1/2 of head
9.5
1yr
8.5
5yr
6.5
10yr
5.5
15yr
4.5
Adult
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
Redrawn from the Treatment of Burns, ed 2. by CP Artz and JA Moncrief.
Philadelphia, WB Saunders Company, 1969; used with permission.
Term
Definition
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.
27
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 0Increased lymphocytes in blood and bone marrow only.
Stages I and IIIncreased lymphocytes and enlarged lymph nodes and enlarged
spleen and possibly liver.
Stages III and IVIncreased lymphocytes and anaemia and thrombocytopenia.
28
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, which is one of the layers of tissue between the brain and the skull.
Tachycardia
Very rapid heartbeat.
Thoracic
Relating to or affecting the thorax (chest).
Thrombocytopenia
A shortage of blood cells required for clotting, possibly leading to excessive bleeding.
Term
Definition
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.
29
CommInsure’s credentials
Who is CommInsure?
CommInsure is a leader in the Australian insurance industry
and is the insurance arm of the Commonwealth Bank Group.
The CommInsure name was first introduced in 1999. Although
the name is relatively new, CommInsure’s roots within the
Australian insurance industry go back well over 130 years.
CommInsure’s operations today are a combination of the
insurance business of the Commonwealth Bank Group and
the Colonial Group, which merged in March 2000.
CommInsure helps to protect the lifestyles of Australians.
We offer an extensive range of insurance products at
affordable premiums and even offer valuable rewards to
loyal policyholders, with a fresh approach to insurance
through innovation, simplicity, competitive products and
responsive service.
Our approach has been recognised with a range of
industry awards including:
CommInsure is a registered business name of The Colonial
Mutual Life Assurance Society Limited which has a Standard &
Poor’s AA credit rating.
CommInsure’s claims philosophy is simple: we pay all genuine
claims promptly and efficiently. Our claims history substantiates
our adherence to this philosophy. For the 2006 calendar year,
the following volumes in claims were paid:
• Total and Permanent Disability/Trauma
$34.8 million
• Death $63 million
• Income Protection $44.5 million
CommInsure’s product range
Life Risk Insurance
Personal Insurance
• Life Care
Best Income Protection
Money Magazine Best of the Best 2007 Awards
• Total and Permanent Disability Cover
Most Innovative Income Protection Product
Asset Magazine Awards, 2006
• Income Care Plus
Life Insurance Company of the Year
Australia and New Zealand Institute of
Insurance & Finance Awards 2005
• Business Overheads Cover
Best Life Insurance Company
Australian Banking & Finance Insurance Awards 2005
Best Life Insurance Product
Australian Banking & Finance Insurance Awards, 2005
Term Life Product of the Year
Personal Investor Magazine Awards for
Excellence in Financial Services 2005
Trauma Product of the Year
Personal Investor Magazine Awards for
Excellence in Financial Services 2005 (joint winner)
Best Call Centre
Australian Banking & Finance Insurance Awards 2005
30
CommInsure’s financial strength and claims capability
provide peace of mind to policyholders.
• Trauma Cover
• Income Care
Group
• Life Care
• Salary Continuance
Guaranteed Annuities
Lifestream Guaranteed Income
• Short Term (one to five years)
• Long Term (six to 30 years or lifetime)
•Complying (similar to Long Term but helps
maximise pension payments)
Guaranteed Index Tracked Annuity
• Short Term (one to five years)
• Long Term (six to 25 years)
• Complying (similar to Long Term but helps maximise
pension payments).
Notes
31
Notes
32
1800 671 040
8 am–8 pm (Sydney time)
Monday to Friday
https://adviser.comminsure.com.au
Manager, Customer Communication, CommInsure Life Insurance, PO Box 320, Silverwater NSW 2128
CIL127 010208