There’s a good deal of important information, you as a customer, should be aware of with regarding claiming on your insurance policy or policies. Unfortunately, many people, when taking out a policy, have a limited understanding of the ins and outs of the claiming process. Many just assume that claiming must just be a fairly generic process across different policies and companies—in reality this is not the case.
Firstly, here’s the basics of putting in a claim. You will need:

  • A completed claim form.
  • Details about the medical condition concerned, including diagnosis and a record of any medical appointments.
  • Copies of any medical certificates, reports or tests.
  • In the event of someone’s death, you will need a copy of the death certificate.

There are a number of things you can do to make the claims process as simple and stress free as possible. Check over your policy documentation, as insurance policies and claiming procedures can vary greatly between companies. Make sure you are aware of your particular insurers policies and have the information they will request on hand before you contact them.
Your insurer may require you to supply various types of documentation and they may also need you to attend independent medical assessments. Being organised and making yourself available during this process means you will speed up the time in which you will receive your benefits.

Now let’s address some frequently asked questions around claims.

  • Although it is a good idea to put in your claim as soon as possible, there is no time limit on claiming for policies such as life insurance, income protection, TPD or Trauma. So don’t be concerned if for some reason you can’t act immediately.
  • It is unusual for a life insurance company to deny a claim, but yes it does happen from time to time. Usually this will be because a customer has misrepresented information during the application process, and the manner of death has shown they presented a far greater risk in terms of their actual occupation, health or lifestyle.
  • Do insurance companies investigate claims? Yes, of course they do. And in doing this they may look at medical records, and any other documentation that shows a customer has misrepresented, or been dishonest in making their initial application. Even if you think an application may be rejected, or a higher premium will be asked for, be one hundred percent honest and upfront about your medical history, lifestyle, occupation, and indeed in your answers to any questions during the application process. In doing so you will be saving yourself potential headaches going forward.
  • A claim can also be denied if a policy lapses. So always make sure you are up to date with your insurance renewals. But, and this is an important point, if your cover was still current at the time of the claimable event, you would still be able to make a claim.

Interestingly in 2016 ASIC (the Australian Securities and Investments), produced report 498 entitled: Life Insurance Claims—an industry Review. This report identified that, on average, industry wide, when a decision had been made, 90% of claims were paid in the first instance, and this rose to 96% for death claims.

The report also found that: “For consumers, the intrinsic value of an insurance product is in the ability to make a successful claim when an insured event occurs. Not being able to successfully claim on life insurance in these circumstances can be financially devastating for the consumer and/or their family.”

Additionally, it was determined that decline rates were highest for TPD (Total and Permanent Disability) and Trauma Cover, and policies declined were highest for policies that had been distributed directly, for example, on a non-advised basis. Policies that are non-advised are typically direct insurance or group insurance products.

Although we provide general advice at SMSF Insurance Partners. The types of products we specialise in are retail insurance policies. Meaning we find out everything we need to know about you and your occupational and income details during the application phase. We also collect all the necessary medical information from you and we fully disclose all aspects of any policies you are purchasing, including terms and conditions, exclusions, and loadings. Our aim is to make sure you have adequate cover and keep any surprises to an absolute minimum come claim time. Our attitude is that customers diligently pay their insurance policies and maintain adequate levels of cover, often over many years—the last thing they should have to deal with is any untoward difficulties in the advent of a claim.

If you would like us to help you please contact one of our team on (07) 3064 0413, or leave a message on the Contact Us section of our website.