Understand the insurance claims process

MoneySmart
(ASIC)

www.moneysmart.gov.au

 

It’s easier to make a claim on your life insurance if you gather the right information for your insurer.

Who to contact to make a claim

To make a claim on your insurance, speak to the person or company you bought the policy from.

If you bought insurance through:

  • an insurer — contact the insurance company
  • an insurance broker or financial adviser — speak to them first
  • a superannuation fund — contact your fund
  • an employment arrangement — speak to your employer

Ask how the claims process works and what forms you need to fill out. Make sure you have your policy number available. If you’re struggling physically or emotionally, ask a trusted friend or family member for help with the claims process.

What information you need to provide

The insurer will ask for information to support your claim. Depending on the type of insurance, you may have to provide:

  • medical reports and medical test results from your doctor
  • details of your work duties, including physical requirements, and the number of hours you work each week
  • payslips and tax returns, or financial statements if you are self employed
  • if a person has passed away, a death certificate or medical report listing the cause of death

Your insurer may ask for permission to contact your doctor about your claim. You may also have to go to an independent medical examination with a specialist, who then reports to the insurer.

If illness or injury continues to affect your ability to earn an income, you may need to have regular assessments and complete progress claim forms.

How long the claims process takes

Depending on the circumstances, an insurer will let you know their decision for:

  • income-related claims — within 2 months of being notified about your claim, or 2 months after the waiting period has expired
  • other claims — within 6 months of being notified about your claim, or 6 months after the waiting period has expired

To find out the average time your insurer takes to finalise a claim, see the life insurance claims comparison tool.

The Life Insurance Code of Practice sets out what insurers should do when handling your claim, including timeframes for making a decision and keeping you updated. If they do not meet these standards you can complain to the insurer.

Complain about an insurer’s claims process or decision

If you’re not satisfied with the claims process or decision, make a complaint to the insurer or super fund. Do this as soon as you can.

If you can’t reach an agreement, contact the Australian Financial Complaints Authority (AFCA) to make a complaint and get free, independent dispute resolution.

Urgent financial help

If you need urgent financial help while a claim is being assessed, speak to the insurer or super fund. They will consider your circumstances and may be able to:

  • speed up the assessment and decision about the claim
  • make an advance payment to help you

You will have to provide your insurer with documents that support your need for urgent financial help. These could include bank statements or Centrelink statements. Payments for urgent financial help may reduce your claim payout.

See urgent help with money for more information on where to get support.

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