Claims Procedure

Firstly, don't panic, go to your Doctor.

It seems silly, but many people don't seek immediate medical advice. They wait some time (often in pain) thinking their 'condition' will go away. Don't delay. Go to your doctor and if your condition warrants it, treatment for it will start immediately. It will also be on record that your condition exists.

  1. Then ring our office - (02) 9633 5530
  2. Tell us what has happened. We will then advise you accordingly what we can do to facilitate a claim for you
  3. We will arrange for the appropriate forms to be sent you, by post the same day (it's a simple form for you and your Doctor to complete).
  4. When you get the form, if you have any problems just phone us and we will help you
  5. Once the form is completed - return it to the insurance company. (Unless we have advised you to send it to us for checking prior to sending it to them).

The insurance company will process your claim form, usually within 48 hours of receipt. The insurance company will notify you directly if any additional information is required. If this is necessary, the insurance company will tell you what is required, so there won't be any delays because you didn't know about the requirements.

If the additional information required is medical the insurance company will ask your medical practitioner to supply it.

Lump sum claims - such as Death, Total and Permanent Disability and Trauma cover are once-off payments; you supply the insurance company with the requested information and once they have assessed it in conjunction with your medical records you will be paid a lump sum either by cheque or directly to your nominated bank account.

Income Protection, is a 'drip feed' monthly payment it is regularly assessed. After the insurance company has the information it requires, your claim payments will commence after your waiting period has expired, 32 days in arrears. Once a month, you will be asked to provide the insurance company with a certificate confirming your disability so that your payments may continue. When you recover and return to work, you may be entitled to 'partial' benefits, if you start on light duties and there is a reduction in your pre-disability income. You may need some help with this, and we'll provide it. You'll also receive a payment for any additional days that you were still disabled after your last benefit payment was paid.

So that's it - don't panic and don't worry - let us help you and follow our instructions and your claim will be handled smoothly.

PS: For Income Protection do not assume you cannot make a claim if you have not met your waiting period choice, there are instances where you may be paid without the waiting period applying for example -

1. If you are hospitalised during your waiting period.
2. If you have had a Specific Injury - broken arm, collarbone etc.
3. If you have had a Specific Medical Condition e.g. Heart Attack or Stroke etc.

 

Will I get paid if I make a claim?

The most common question regarding claims is "I know that John, our neighbour, had a claim and they would not pay him" or "I saw this bloke on 60 Minutes and what he had to go through was incredible and even then they didn't pay out"

The facts:

  • Life Insurance Companies are governed by different legislation than that of General insurance companies like H.I.H. In fact, the Life Insurance industry is one of the most heavily-regulated and consumer-protective financial services bodies in Australia
  • Life Insurance Companies must have a certain level of reserves in place to pay claims otherwise they are not allowed to operate.
  • The reasons why people do not get paid is that they have not disclosed a pre-existing medical condition in their application - end of story.
  • "But this bloke broke his leg and it was definitely covered but they would not pay" - the real story revealed that the client did not disclose he had a malignant cancer removed from his back only 12 months before which would have caused the insurance company not to issue the policy in the first place - most companies will not consider a person for insurability up to 8 years or more after the occurrence of a cancer condition.
  • The reason why insurance companies sometimes pay a lesser amount than the originally insured amount is that the client incorrectly overstated their income (after expenses) or salary.