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 through the insurance contained within your superannuation.
Your insurance policies are there to help you when something goes wrong. However, many Aussies have limited knowledge of what insurance coverage they have through their superannuation and the insurance claims they can make. To access your 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 a superannuation insurance policy?
Superannuation insurance is the insurance policy provided for you by your superannuation provider. They act as a safety net if you cannot work because of a personal injury or mental illness.
What superannuation insurance policies do I have?
In Australia, most superannuation funds provide their members’ insurance cover for total and permanent disability (TPD) and life or death cover, and some offer income protection cover. Your insurance premiums are automatically taken from your super account.
What are the four main kinds of superannuation insurance?
If you are an Australian worker with a current super policy, you could have one or more of these common kinds of insurance.
- Life Insurance or death cover – provides financial support to your family when you die.
- Total and permanent disability (TPD) – provides a sizable lump sum payout when you can no longer work in your regular job due to a physical or psychological illness or injury.
- Income protection insurance – in most cases, this will pay 80% of your regular income for up to 2 years.
- Temporary Disability Insurance (TTD) gives you 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 is a superannuation insurance claim?
When you lodge a claim on a super-related insurance policy, you ask the insurer to release your insurance payout because you are suffering from a physical or mental disorder covered by your insurance plan.
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.
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. You do not need to be injured at work to qualify, as is the case with workers’ compensation claims.
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 had coverage when you stopped working. This prerequisite means you could still lodge a claim long after you stopped working.
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.
What are the steps to a successful insurance claim?
1) Seek legal expertise to support you through the process
2) Your lawyer investigates your insurance policies to see what you can claim and how many claims you might make.
3) Your lawyer notifies the insurer you are lodging a claim
To make your claim progress smoother, it helps to follow an organised, step-wise approach. Here are some tips for ensuring you don’t miss out on any critical stages in the claim approval procedure.
Before you claim
Check your 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.
Notifying your insurer
Once you know you are entitled to lodge a claim, your solicitor 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.
Submit your claim
Your claim is lodged with your insurer following the investigation and claim preparation process. They will then begin their evaluation procedure.
Assessing your claim
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.
Request for more information
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.
Insurance Claim Outcome
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 a competent lawyer working with you.
General Insurance Code of Practice
Every insurance company in Australia has standards and processes for resolving insurance claims. Most of these insurers are members of the Insurance Council of Australia and must meet or surpass the claim handling benchmarks set by their Code of Conduct.
This Code details how insurance companies deal with their clients, including claim resolution deadlines and the decision-making process. The Australia Financial Complaints Authority is tasked with monitoring compliance with the Code.
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 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 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 physical injury or mental health condition.
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.
File your claim quickly
Once you have collated everything you need, you should submit your claim. Early submission sometimes yields a more robust outcome. By filing a formal insurance complaint, you notify your insurer of your loss, and they can begin processing your claims. You can provide the necessary documentation later.
In some cases, time limits apply for lodging a claim. Delaying filing an insurance report could result in your insurance company denying coverage for any additional losses or damages caused by your deferred action.
How Aussie Injury Lawyers Can Assist
Aussie Injury Lawyers are insurance claim legal specialists. Our 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.