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What to Expect When Making a Claim

Making a claim can be a daunting process, with a number of steps you will need to take. For Life or Death Cover claims the process is relatively simply. But for other claims such as Income Protection and Trauma insurance, the process can be long and drawn out so you will need to be patient but also know when to be assertive to get your claim resolved quicker.

We’ve put together this short guide to give you a better idea of what to expect throughout the process, timelines and payments. Remember if you’re making a claim, get in touch with a Wealth Smart advisor who will be able to help you through the process from start to finish.

How long will making my claim take?

Making a claim will take varying lengths of time depending on the type of claim you’re making and its complexity.

Generally it will take five working days for your claim forms to be assessed, and then a further two working days for the progress forms to be assessed. If you need a doctor’s report it could take up to four weeks or even longer for specialists to put your report together.

Waiting on reports is one of the main reasons for delays in claims being processed.

How do I speed up my claim?

There is no specific way to have your claim paid sooner, but there are a few ways to speed up the process. By being an active participant in the process you can make a big difference in the length of time it takes to process your claim. Here are a few helpful hints to get it sorted quickly:

  • Most insurers genuinely want to pay claims. But to do so, they need a lot of information. Be open and prepared for requests for a lot of detailed information. Provided the insurer has given you a good explanation for why they need the information, get it to them quickly. Use technology: most insurers will accept email requests and information. Scan and email progress claim reports or other required information. This can save you days (sometimes weeks) waiting on the postal service.
  • Be available. If an insurer requires you to attend an Independent Medical Examination, try to be available for the first appointment offered. Often a second appointment can be months later. This can significantly slow down the assessment time.
  • If you are aware that the insurer has written to your treating doctor for a report, ring your doctor and let them know that this is important information in the assessment of your insurance claim and ask if they would make it a priority.
  • Speak to your advisor if you think you may need to put in a claim. Ask them to explain the type and features of the policy again, as it may have been quite some time since you originally purchased the contract. Requirements may have changed.
  • For Income Protection claims, be prepared to obtain an endorsed Agreed Value contract, otherwise you will have to submit evidence of your current income with your claim form, so the insurer can verify your benefit level.

Receiving your payments

Depending on your policy and your waiting period you may need to complete a waiting period before receiving your payment. The benefits you receive may also be taxable, meaning you’ll need to keep records of your payments for tax time. It’s important you request a statement of payments each financial year from your insurer if you have received benefits in that time.

The table below summarises the process of receiving your benefits and your tax obligations.

Waiting Period Tax Obligations Other Important Information
Income Protection Generally 30 or 60 days depending on your policy Benefits are taxable at your normal rate. You will need to tell your accountant if you have received income protection benefits in the financial year. To simplify the process, talk to your accountant when you begin receiving payments to avoid a tax bill at the end of the year. If your waiting period expires before your claim is approved benefits will be paid monthly in arrears.
Total & Permanent Disability Insurance Generally 3 or 6 months depending on your policy. Depending on the severity of your illness or injury, payments may be made during the waiting period. TPD insurance is generally tax free unless owned by a super fund. Even if the waiting period has expired, the claim will not be paid until the assessment process is complete.
Trauma Insurance There is no waiting period on trauma insurance claims. Trauma insurance is tax free unless owned by a super fund. A 90 day exclusion period applies to Trauma insurance, so you cannot make a claim on trauma experienced in the first 90 days of your policy.
Death Cover There is no waiting period on Death Cover payments, and it is generally paid out when the insurer is satisfied with the claim. Death Cover is generally tax free unless it is owned by a superfund. Tax may be due if the benefit is paid to a non-dependant person. Death by suicide in the first 13 months of a policy is typically excluded from the policy.

Remember, as a customer of Wealth Smart we will be able to help you with the entire claims process, and make sure your claim is on the right track. If you have recently made a claim or need to make a claim on a policy purchased through Wealth Smart, contact us today!

Page last updated: January 16, 2015