What is Superannuation Insurance and How to Make a Claim

When you want to claim superannuation insurance benefits because you can't work due to illness or injury, you might question: What is superannuation insurance? And how do I make a successful claim? Our legal guide explains how it works.
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Guide to Superannuation Insurance Claims

Knowing about super Insurance claims

If you are lucky, you will have a happy and healthy life and never need to make an insurance claim. But if the unexpected happens, whether it’s an accident, physical injury, terminal illness or psychiatric disorder, and it impacts your capacity to work, you could have the opportunity to make one or more claims against insurance through super.

Many Aussies are unaware of insurance in super and the insurance claims they can make. To access your superannuation benefits, you must meet specific requirements in your terms and conditions. Once you meet these requirements, the insurance company might do what they promised – pay out your entitlements as a disability benefit so you can get on with your life, or they might challenge or dispute your claim.

What is superannuation insurance?

The insurance policies available through your a superannuation fund are known as superannuation insurance. They provide a financial safety net when you are unable to work because of a personal injury or mental illness. How much cover you have can depend on your super balance.

What superannuation insurance policies do I have?

In Australia, most superannuation funds provide default insurance for their members. The common types of insurance through super include:

 

For convenience, insurance premiums are automatically deducted from your super account.

What are the benefits of insurance through super?

There are several benefits of having insurance through your super, including:

  1. You can make a superannuation insurance claim and receive a monthly benefit or lump sum payout that helps pay the bills when you can’t work.
  2. Your employer’s super contributions and salary sacrifice payments are taxed at 15%, which is likely lower than your regular marginal tax rate.
  3. You can access default insurance cover through super even if you have a high-risk job or pre-existing conditions.
  4. An approved lump sum payment will top up your retirement savings.
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Four main types of superannuation insurance cover

If you are an Australian worker with an active super account balance, you could have one or more of these common kinds of insurance through your super.

When a super member dies, death benefits support their family and other financial dependents.

You can make a permanent disablement claim when you can’t work in your regular occupation because of an illness or injury. An approved TPD insurance claim provides a sizable lump sum payout.

When you are temporarily unable to work, you can make an income protection claim and receive monthly income protection payments. An income protection benefit usually pays 80% of your regular income for up to 2 years.  Later, you could make a TPD super claim.

Temporary disability cover pays a monthly deposit until you can work again.

How do I check my super insurance policies?

To see the insurances you hold, you can:

  • Contact your superannuation provider
  • Log into your account online
  • Read your super fund PDS

What does superannuation insurance work?

When you are living with an illness or injury that renders you unable to work, you can make a claim against your superannuation insurance policies. You request that the super fund insurer release your lump sum payment (or monthly payments) because your insurance plan covers your medical condition.

Once your lodge your case, an insurance investigator will review your claim to see if your circumstances match your coverage. You must provide compelling evidence that the claims you’re making are genuine and satisfy the conditions and terms of your insurance policy.

If your insurance company recognises your claim, they will pay your compensation into your superannuation account, which you can withdraw at any time.

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When can I make an insurance claim?

Most super insurance policies allow you to claim when you cannot work due to an illness, injury or mental illness. How you acquired your medical condition is of no consequence. Unlike a workers ‘ compensation claim, you do not need to be injured at work to qualify.

If you have stopped contributing to your superannuation account, you could still have insurance coverage. This requirement varies between super funds. If you have multiple super accounts, you may also be able to make multiple claims.

The main requirement is that you have coverage when you stop working. This prerequisite means you could still make a claim long after you stopped working.

Our experienced superannuation insurance lawyers will let you know if you can claim and how many claims you can make. This service is free.

The insurance claims process

Insurance companies say they like to make the claim process simple, but they are more interested in their bottom line. Paying out your benefit means reducing their profits. To have a successful claim, you must ensure you meet or exceed their rigorous expectations. An experienced insurance litigation lawyer can assist. They regularly deal with all the major insurers and understand their expectations for releasing funds.

How to Claim Superannuation Insurance

  1. Seek legal expertise for the superannuation claim process
  2. Your superannuation lawyer investigates your insurance policies to see what you can claim and how many claims you might make.
  3. Your lawyer notifies the insurer that you are lodging a claim
  4. Follow an organised, step-wise approach for smooth claim progress.

Check your superannuation insurance policies to see what you can claim. Understanding the legal requirements of insurers can be complex, and this is where your lawyer can assist. You want to be sure you are accessing all your entitlements.

Once you know you are entitled to make a claim, your superannuation lawyer will notify the insurer that you will seek an insurance payout. This action will trigger the claims process, and your legal team will start collating the information the insurance company needs to decide, including proof of loss and your supporting evidence.

Superannuation claims are lodged with your insurer following the investigation and claim preparation process. After you lodge a claim, they will then begin the evaluation procedure.

When your claim is submitted, the insurer will begin their assessment process. They will review your evidence, reports and medical assessments. Their investigation process can be lengthy, as they often seek a reason to deny your claim or minimise your payout.

Should the insurer decide they cannot make a reliable decision based on your existing submission, they are entitled to request more information. Your insurance solicitor would work with your insurance company to meet their expectations.

Once the insurer has completed their assessment process, they will provide an outcome of approval or denial. Simple cases might take a few weeks, and complex claims several months. Common rejection reasons include your not supplying accurate or honest information. This outcome is not likely if you have expert superannuation lawyers working with you.

How long does a super insurance claim take?

Insurers must review all claims promptly, paying out claims to those who meet the terms and conditions of their insurance policy.

Compliance with the General Insurance Code of Practice means your insurer has ten days to provide an initial response to approve or deny your case after reviewing your evidence. They can also request more information at this stage if they cannot make a decision based on your first submission.

Your superannuation lawyer or solicitor would already be aware of the type of evidence likely to give you a successful outcome, and they will ensure you meet or exceed your insurers’ requirements. This includes proof of your loss, medical evidence, and expert reports.

What is the role of an Insurance Claim Investigator?

It is usual for an insurer to assign a claim investigator to your case. In this case, they will advise on the amount of time they need to reach a decision. They must let you know within five working days of their decision to appoint an investigator and update you every 20 days on the progress of your case.

More complex claims take longer, and your insurer will negotiate a unique timeframe to resolve them. Challenging claims can sometimes lead to larger payouts.

You are allowed to see any evidence used to decide your case, except when your claim is being reviewed. Your insurance company must meet any reasonable appeal for information. Should you notice an error in their calculations, they must immediately rectify their mistake.

What if my superannuation insurance claim is denied?

If they reject your insurance claim, they must supply a written statement explaining their basis for denying your case and their process for challenging their decision. Your insurance lawyer would know what to do in this circumstance. We can reverse most decisions with the correct approach based on years of legal experience.

Get legal help with your insurance policies.

Every insurance policy is unique. To have a successful superannuation insurance claim, you usually need to be unable to work for between 3 and 6 months because of your temporary or permanent disability.

Your superannuation fund statement will probably show the insurance policies you hold, and these are likely to be Total and Permanent Disability Insurance (TPD) and Income Protection Insurance. If your insurances are outside held outside your superannuation, your private policy documents will detail your cover.

Our legal team will investigate your policies free of charge and advise you of your available insurance benefits.

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How an experienced Superannuation Lawyer Helps

Our expert superannuation lawyers are insurance claim legal specialists. In fact, Aussie Injury Lawyer’s solicitors have substantial expertise when it comes to helping you access all your entitlements. The proof is in our 99% success rate.

All our legal services are provided on a No Win, No Fee, No Risk basis. You only pay our fees and costs when you win and nothing if you lose. It’s free to understand how many superannuation insurance claims you can have and their value. Contact us now to get started.

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