To make a life insurance claim, you will need:
- A completed claim form;
- Details about the condition including diagnosis and doctors’ appointments;
- Copies of any medical certificates, reports or tests; and
- For a claim in the event of someone’s death, you will need a copy of the death certificate.
Why do I speak about my claim?
- If you bought your insurance directly from an insurer:
Call the insurer as soon as possible to let them know you need to make a claim - If you bought your insurance through a financial adviser or planner:
Call the adviser or contact the insurer directly. The adviser can assist you to put your claim together - If you hold insurance through superannuation:
Speak to the super trustee in the first instance who can give you more information. The trustee can provide your claim information to the insurer on your behalf - If you hold insurance through an employment arrangement:
Speak to your employer in the first instance who can put you in touch with the insurer
How you can assist with your claim
Making a claim on a life insurance policy can be time-consuming if the appropriate steps are not taken. Consider the following:
- Check the policy documentation
Life insurance policies and procedures can vary between insurers, so before you do anything else, check your policy documents carefully. This is to make sure that you are aware of the process and that you have all of the relevant information that the provider is likely to ask for on hand.
- Make contact as soon as possible
It is critical that you begin the claim process as soon as possible so that you can get any early support you may need.
- Be organised, get all of the required documents and assessments asap
The insurer will require different types of documentation and may also require you to attend independent medical assessments. It is essential to be organised during this process so that you do not experience delays in receiving your benefits.
When you make a claim
The following information is contained in the Life Insurance Code of Practice.
Your insurer will keep in regular contact about your claim:
- Within 10 business days of the date your claim is received, your insurer will provide an explanation of your cover and the claims process, including all the relevant benefits under the policy you are claiming on and any waiting period that may apply.
- Your insurer will ask you for the information they reasonably need to make their assessment.
- While your insurer is making a decision on your claim, they will be in touch with you to give you an update at least every 20 business days.
- If you ask your insurer for information about your claim at any point, they will respond within 10 business days.
- Once the insurer has the requested information and has completed its enquiries, you will be told the decision on your claim within 15 business days.
Your insurer will not discourage you from making a claim. If you are having trouble providing the information your insurer needs, they will work with you to take steps to find a solution.
If you are unhappy with any aspect of your claim process, you can make a complaint to your insurer.
Insurers are there to pay legitimate claims - more than $7.8 billion is accepted and paid in claims each year.
Urgent financial need
If you are in urgent financial need of your life insurance benefits due to a condition that your policy covers, you can speak to your insurer about urgent access to your benefits. You may be asked for evidence of this urgent need.
You will be told what help the insurer can offer you within five business days of receiving all the evidence needed. This might be:
- prioritising the assessment and decision in relation to your claim; and/or
- advancing part of your claim payment.
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Income Protection claims
Notify your insurer, adviser or super trustee as soon as possible so that they can work with you and your doctors and employer to help you to recover and support you to get back to work where possible.
Income protection claims usually have a waiting period before benefit payments are made.
For the majority of claims, a decision will be made no later than two months after the date the claim is received, or two months after the end of the waiting period (whichever is later).
In a small number of claims where there are circumstances beyond the insurer’s control, such as delays in receiving specialist reports, your insurer will let you know before the end of this two-month period.
Income protection claims usually provide regular payments rather than the one-off lump sum payment that other types of life insurance pay. If your insurer offers to pay you a lump sum instead of ongoing payments in order to finalise your claim, they will suggest you obtain financial and legal advice before you make a decision.
If you are receiving regular payments for an income protection claim:
- Your insurer may need medical and financial information regularly to assess if you are entitled to ongoing benefits or calculate your benefit payments.
- If your payment is going to be delayed, for example, because you have not provided some necessary information, your insurer will get in touch with you beforehand to let you know the reason for the delay so that you have an opportunity to remedy this.
All other life insurance claims
If your claim is for total and permanent disability, there is usually a waiting period before benefit payments are made.
For the majority of claims, a decision will be made no later than six months after the date the claim is received, or six months after the end of the waiting period (whichever is later).
In a small number of claims where there are circumstances beyond the insurer’s control, for example where there is difficulty getting the required information, your insurer will let you know before the end of this six-month period.
If your claim is for total and permanent disability, your policy may require you to go through rehabilitation or retraining.
What happens if a claim is declined?
If an insurer decides to decline a claim, you will be given the reasons for this in writing. You also have the right to request the documents and information that the insurer has relied on to decide the claim.
If you disagree with the insurer’s decision, you can ask them to review the decision, and you can also access the insurer’s complaints process.