Making an insurance claim

 

We appreciate that if a time comes when you need to make a claim, you will be going through a difficult time, so we want our claims process to be as simple and hassle-free as possible.

 

While each claim is unique, there are some steps that we need to take and information we’ll need to collect from you. In some cases, this may take some time to complete, given the need to collect details such as medical reports, but we’ll try to work with you as quickly as we can and keep you up-to-date along the way.

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 will act as your advocate, and ensure any decisions are fair and comply with the conditions set out in the fund’s insurance policies, our governing trust deed and any relevant laws.

 

Do you need a lawyer to start your claim?

Generally, engaging a lawyer does not generally reduce the time to assess a claim (and can actually increase it in some cases), nor does it influence the outcome or amount paid on 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.

We’re here to help you through the claims process and pay all genuine and eligible claims. Dealing directly with you means we’ll be able to turn around any requests more efficiently (rather than interacting with a third party) and we’ll also have a more detailed understanding of your circumstances.

 

Common myths when making insurance claims

MYTH! We understand that making a claim is likely to be at a difficult for many people and our aim is to work with the insurer to progress the claims process as quickly as possible.

Like any claim process, however, 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 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.

MYTH! 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.

MYTH! The amount payable for any accepted claim is not a discretionary or negotiable amount. If a claim is accepted by the insurer, an amount equal to the member's amount of insurance cover is payable

 

The Claim process step by step

  • Step 1: Call us for information and a claims pack
    • The information and process for a claim can vary depending on the type of insurance cover, so please contact us in the first instance on 1800 023 928 (8am to 7pm Sydney time, Monday to Friday) (or +61 2 9267 5392 if calling from overseas).

      Our claims team will help you understand what insurance cover you have, how to make a claim and what to expect during the process.

  • Step 2: Complete and lodge your claim
    • 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 for some reason you are unable to lodge your claim over the 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 you may have and periodically provide you with updates about your claim.

  • Step 3: Your claim is reviewed
    • 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, there may be occasions where we need to obtain some additional information from you. Your claims assessor will work with you through this process.

  • Step 4: Notifying you of a decision
    • Once this review process is complete, we’ll notify you of the decision.

      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 other third parties) and the trustee will then advise you in writing of its decision.

      If you remain unhappy about this outcome, you can lodge a complaint with the Superannuation Complaints Tribunal (SCT), an independent body established by the government to help resolve certain complaints. The SCT 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 claims, a complaint must be lodged with the SCT within set timeframes from the fund’s original decision on the claim. For more information you can contact the SCT on 1300 884 114 or visit www.sct.gov.au.

 

Top tips to avoid unnecessary delays with your claim

While everyone involved in your claim will do their best to make things happen quickly, there are some things that can slow down or pause your claim’s progress:

  • Try to complete or provide as much information as possible – this helps make sure we have the right information, and enough information to review your claim. If there is information you don’t have or can’t get, let us know as soon as possible.
  • If we’ve arranged any medical appointments on your behalf, it’s important to attend these (or let us know if you need to re-schedule) – this helps to make sure any reports are received in a timely manner
  • If you’ve engaged a third party, such a lawyer, to act on your behalf in the early stages of a claim, it can sometimes take longer to make and receive requests through this process rather than dealing directly with you in the first instance.