If a time comes when you need to make a claim, we appreciate that you'll be going through a difficult situation, so we want our claims process to be as simple as possible.
It’s important that you or your representative notify us as soon as possible after becoming aware of a claim or potential claim.
While each claim is unique, there are steps we need to take and information we need to collect. In some cases, this may take some time to complete if we need to collect details such as medical reports, but we try to work with you as quickly as we can.
One of our responsibilities is to ensure that your interests are front of mind when making any decisions regarding a claim. From an insurance perspective, this means we ensure any decisions are fair and comply with the conditions set out in our insurance policies, trust deed and any relevant laws.
We’re here to help you through the claims process and pay all genuine and eligible claims. Generally, engaging a lawyer does not reduce the time to assess a claim, nor does it influence the outcome or amount paid on a claim. In some cases, it may increase time to collect information and assess a claim. And remember, legal fees may end up reducing any benefit that you ultimately receive.
If you are lodging a claim with us, we recommend you talk to us directly in the first instance. Dealing directly with you means we’ll be able to respond to your request more efficiently than going through a third party, and we’ll also have a more detailed understanding of your circumstances.
We understand that making a claim is likely to be at a difficult time for many people and our aim is to work with the insurer to progress the claims process as quickly as possible.
The insurer does need to collect certain information before making a decision, and in the case of medical information, this may take time. Depending on the type of insurance cover and the type of disability, there may also be a waiting period before a claim can be assessed. These steps must be completed regardless of who initiates a claim, in order for the insurer to make a decision based on all relevant information.
If, on the basis of medical information that is provided, a claim meets the conditions of super laws and the insurance policy then it will be accepted, regardless of who initiated the claim.
The amount payable for any accepted claim is not a discretionary or negotiable amount.
If a claim for death, terminall illness or TPD is accepted by the insurer and the trustee, an amount equal to the member's amount of insurance cover is payable.
For a Salary Continuance claim, your actual income immediately before your date of disablement must be taken into account, regardless of the amount of insurance cover you have. If your pre-disability income is less than your amount of cover, your payment is based on the lower pre-disability income amount.
The information and process for a claim can vary depending on the type of insurance cover, so please contact us in the first instance.
Our claims team will help you understand what insurance cover you have, how to make a claim and what to expect during the process.
To make things as easy as possible you can lodge your claim over the phone with one our claims officers, and they will collect the initial information required for lodgement. They will also send you a claim pack that will outline any other information that we’ll need to collect from you before we are able to transfer your claim to the insurer.
If you are unable to lodge your claim by phone, you can still provide the information to us by completing our claim form(s) which will be included in the claim pack you receive from us.
It’s important to provide as much information as you can at the start of the process – this will help lessen any chances of delays in assessing your claim. If there is information that you don’t have or can’t get, please let us know as soon as possible so we can work through this with you. Some other good tips to avoid delays are outlined below.
Once we have received all of the initial information your claim will be transferred to the insurer. You will then be provided with direct contact details for the person who is assessing your claim, and this person will be your dedicated contact point. They will work closely with you and any other parties throughout the entire claims process. They will be on hand to answer any questions, and provide you with updates.
Depending on the type of claim, the information you provide may be reviewed and assessed by various parties. Generally this will be the fund’s insurer and the trustee. From time to time, we may also seek assistance from specialist advisers to help in our review if needed.
During this review period, we may occasionally need to obtain some additional information from you. Your claims assessor will work with you through this process.
Once this review process is complete, we’ll notify you of the decision and next steps where appropriate.
In the event your claim is declined
You will be informed in writing of the trustee’s decision, including the reason the claim was declined.
We’ll help you understand the options and next steps that may be available to you. For example, medical conditions can be complex, and opinions and prognoses may change. If your circumstances change, or if new or different medical information becomes available, your claim can be reviewed.
If you disagree with the decision, or if you are not satisfied with the way your claim has been managed, you can lodge a complaint via our complaints procedure.
Your claim will be reviewed again by the trustee and/or insurer, and possibly by third parties where required, after which the trustee will then advise you in writing of its decision.
If you remain unsatisfied with the outcome, you may choose to escalate your complaint to the Australian Financial Complaints Authority (AFCA), an independent government dispute resolution body. AFCA will only accept your complaint if you have first sought to resolve the matter under your fund’s complaints procedure. There are time limits that apply in some circumstances. For example, for complaints related to a death or TPD claim, a complaint must be lodged with AFCA within set timeframes from the fund’s original decision on the claim. For more information you can contact AFCA on 1800 931 678 or visit www.afca.org.au.
Everyone involved in your claim will do their best to make things happen quickly, however there are some things to keep in mind that can help avoid delays with your claim’s progress: