Income Protection Claims Factsheet

This factsheet provides information about making a claim to receive Income Protection benefits from the fund.

 

What is an Income Protection benefit?

An Income Protection (IP) benefit provides regular monthly income to help compensate for your loss of income if you become sick or injured and are unable to work for a long period of time. When you make an IP benefit claim, you are making a request to receive these benefits from the fund.

 

When you can make a claim

To make a claim to access an IP benefit through the fund, you first need to meet certain eligibility criteria.

 

Who is eligible to claim an IP benefit?

Whether you’re eligible to claim an IP benefit will depend on several factors:

  • The type of insurance cover you hold with the fund
  • Any exclusions or limitations that apply to your cover
  • Whether or not you were regularly working at least 15 hours per week when you stopped working
  • If you are claiming any other existing Income Protection insurance cover
  • If your Worker’s Compensation benefit exceeds your IP benefit

As part of the claims process, we will look at the information available and perform an eligibility assessment to determine whether you’re eligible to claim an IP benefit.

 

How you can make a claim

If you’re thinking of making a claim, you or your legal representative will need to contact us to let us know of your intent to claim and the type of claim you wish to make. The sooner you contact us, the better.

Before you contact us, make sure you have the following information to help us determine whether you’re eligible to make an IP benefit claim:

  • Your member number
  • Your date of birth
  • The last date you were actively working
  • Personal details of your legal representative (if they are the key contact for the claim)

Once you contact us, a Member Care Case Consultant will walk you through the claims process and help you understand what to expect.

 

What to expect during the IP claims process

When you need to make an insurance claim, it can often be an emotional and stressful time. That’s why throughout the claims process, you can expect our team to handle your claim with deep empathy and care.

To help you know what to expect during the IP benefit claims process, below is a step-by-step guide of what happens when you make a claim.

 

Detailed claims process:

1. You contact us
  • Call or email us to let us know you’ve been sick or injured, unable to work and that you intend to claim.
  • We’ll outline the eligibility criteria and key steps in the claims process.
2. We contact you
  • A Member Care Case Consultant will be assigned to support you through the process and will send you the relevant form(s)* so we have the right information to process your claim.
  • You will be given contact details for your assigned Member Care Case Consultant to keep you informed and connected during the process.
3. You complete claim forms
  • You’ll complete the forms sent to you and return to us.
  • With the forms, you’ll need to send us supporting documents*, as indicated on the forms.
  • We’ll review the information you give us plus the information already available to determine whether you’re eligible to make a claim.
4. We’ll review your claim
  • If you’re eligible, we’ll review and process your claim.
5. Your claim is lodged with the insurer
  • If you held IP cover with the fund when you stopped working, we’ll lodge your claim with the insurer and notify you when we do.
6. Your claim is assessed
  • The insurer will review your claim and may ask for more information. If more information is needed to assess your claim, we’ll let you know. Sometimes, you or your doctor may receive these requests directly from the insurer.
7. Your claim is resolved
  • The insurer will let you know of their decision to either accept or decline your claim.
  • If the insurer accepts your claim, you’ll receive your first monthly income payment directly into your nominated bank account.
  • If the insurer declines your claim, we’ll review the insurer’s decision based on information collected during the claims process.
  • If we disagree with the insurer’s decision, we’ll consult with both you and the insurer to reach an agreement.
  • If your claim is denied after we’ve reviewed the insurer’s decision, we’ll tell you the reasons for the decision and how you can make a complaint if you’re not satisfied.

*Notes:

  • Relevant forms: Initial Claim form, Employer’s Statement form, Initial Medical Report form, Electronic Funds Transfer & Super Request form, and Tax File Number Declaration form.
  • Supporting documents: member’s certified proof of identification and any additional documents supporting the claim (e.g. payroll records).

 

How long is the claims process?

The length of the claims process depends on several factors and the circumstances of your claim. No two claims are the same. However, we will do all we can to process your claim as quickly as possible and keep you informed of its progress. To help us do so, we ask that you contact us as soon as you can if you plan to make a claim and respond promptly to any requests for more information.

 

What benefits are paid?

If your IP benefit claim is accepted, you’ll receive monthly income payments of up to 75% of your gross salary plus mandatory super contributions paid into your super fund account.

When you start receiving these payments depends on the waiting period (30, 60 or 90 days) that applies to your IP insurance cover with the fund.

You’ll continue to receive regular payments while you aren’t working for up to 2 years or, if you’ve selected it at the time you applied for IP cover, a maximum of 5 years or until age 65.

 

Who receives the benefits?

IP benefits are paid to you only as the sick or injured member unable to work.

 

Are taxes paid for benefits received?

You may need to pay tax on any IP benefits paid to you. The amount you receive will also be reduced by any other income you receive from sources such as Centrelink or workers’ compensation. To understand the financial impact and what taxes you may need to pay, please seek independent advice.

 

We’re here for you

If you have any questions or need support at any point during the claims process, we’re here to help.

To contact our in-house Member Care Team, click here.

Further information on our Income Protection insurance can be found in our Insurance Guide. If you would like a copy of our Group Income Protection Insurance Policy, please contact our Member Care Team.