Making an insurance claim

To make a claim, you’ll need to meet the definitions of disablement set out below.

This means you are:

• unable to do at least one aspect of your income producing work
• not working in any capacity, for reward or otherwise
• under the regular care and following the advice of a medical practitioner.

You might be eligible for a partial disability benefit payment if you are:

• disabled for at least seven days out of the first 12 working days of the waiting period
• unable to work at full capacity because of your illness or injury
• working, but in a limited capacity
• earning a reduced monthly pay
• under the regular care and following the advice of a medical practitioner.

It’s worth taking the time to read and understand the terms of your policy. These are set out in our Insurance Guide.

1. Contact us – the best thing to do is give us a call on 1300 134 337 so we can talk you through the claims process and explain the documents and information you need to get started.
2. Complete the forms we send you – we’ll send you the forms you need to complete with a letter outlining the information you need to provide back to us, eg, paperwork from your doctor describing the nature and extent of your disability or illness, a certified copy of your birth certificate, driver’s licence or passport plus recent payslips to confirm your earnings and any medical reports you have. Our Insurer will rely on the information you provide when making their assessment, so it’s important to include all relevant medical evidence in your application.
3. Our Insurer will assess your application – when we receive this information from you, it‘ll be passed on to our Insurer who will assess your application. Along the way we’ll manage the progress of your application and let you know if the Insurer needs more information from you.
4. We’ll review your claim – once your claim has been reviewed, you’ll receive a letter from us outlining the decision or requesting further information.
5. Claim decision – when a decision is made, you’ll receive a letter letting you know the outcome of the claim.

You don’t need a lawyer but if you choose to it won’t guarantee a shorter assessment period, influence the outcome or the amount paid on a claim. You should also consider the cost involved in having your own lawyer. When it comes to assessing claims, one of our responsibilities is to ensure our members’ interests are front of mind at all times. This means we’ll make sure any decisions are fair and comply with the conditions set out in the fund’s insurance policies, our trust deed and relevant laws.

The claims process will start once we’ve received all the relevant documents and information requested.

The time it takes for an Income Protection claim to be decided varies depending on the complexity of the claim. We’ll be in touch to provide you with updates and progress of the claim.

You can help us shorten this time frame by including all relevant medical documents when you send us your application, and by responding to our requests for supporting information as soon as possible.

A death benefit is the money payable on the death of an Australian Ethical Superannuation member and is made up of the amount of super in the member’s account including any insured benefit – if not opted out (minus any fees and taxes).

There are strict guidelines and laws that super funds have to follow when paying a death benefit. This means only the deceased member’s dependants or their Legal Personal Representative (LPR) can apply for a death benefit.

If the deceased member didn’t have a will (or there was no executor named), the administrator of the deceased estate can apply. Australian Ethical can only pay the death benefit to another person if there are no dependants or LPR.

A dependant includes:

• a spouse (de facto or same sex partner)
• a child (stepchild, your de-facto’s child or an adopted child)
• a financial dependant (someone who is wholly or partially financially dependent on the deceased)
• a person the deceased had an interdependent relationship with (where two people have a close personal relationship and live together, and one or both persons provide the other with financial, domestic or personal support. There are some exceptions to these requirements, including whether one or both of them suffer from a physical, intellectual or psychiatric disability or they are temporarily living apart.)

Where a valid binding beneficiary nomination has been made, Australian Ethical will pay the benefit to the nominated beneficiary. See our Binding Beneficiary Nominations Form on our website for more information.

There are certain conditions that will need to be met for the binding death benefit nomination to be valid, so please read the information on the front page of the form before filling it in and be sure to follow the instructions on signing and witnessing – otherwise the application will be invalid.

A binding nomination will only be valid if it hasn’t expired and if the person nominated is a dependant or Legal Personal Representative (LPR) at the time of the members passing. It’ll be treated as a non-preferred (non-binding) nomination if the binding nomination has expired.

You should know there are tax implications of receiving a death benefit so it’s worthwhile getting advice from a licenced financial adviser.

We want to make the claims process as easy and convenient for you as possible so the steps are outlined below.

1. Contact us – the best thing to do is give us a call on 1300 134 337 so we can talk you through the claims process and explain the documents and information you need to get started.
2. Complete the forms we send you – we’ll send you the forms you need to complete with a letter outlining the information you need to provide back to us, eg, a certified copy of the member’s death certificate, a certified copy of the Will, and/or Probate (if applicable). If the member held a valid binding beneficiary nomination at the time of death, then we won’t need as much information. We’ll let you know if this is the case.
3. Our Insurer will assess the claim for the insured component – if the deceased member had insurance through their super, our Insurer will assess the claim. Along the way we’ll manage the progress of the claim and let you know if the Insurer needs more information from you.
4. We’ll review your application – when deciding who to pay, we’ll review and consider the deceased member’s circumstances, the relationships with the deceased member, any nominations in place or other documented wishes, and who relied on the deceased member for financial and/or other support at the date of their death.
5. Claim decision – when a decision is made, we’ll write to all the beneficiaries to let them know the outcome of the claim.

You don’t need a lawyer but if you choose to, it won’t guarantee a shorter assessment period, influence the outcome or the amount paid on a claim. You should also consider the cost involved in having your own lawyer.

When it comes to assessing claims, one of our responsibilities is to ensure our members’ interests are front of mind at all times. This means we’ll make sure any decisions are fair and comply with the conditions set out in the fund’s insurance policies, our trust deed and relevant laws.

The claims process will start once we’ve received all the relevant documents and information requested.

The time it takes for a death benefit claim to be decided varies depending on the complexity. We’ll be in touch to provide you with updates and progress of the claim.

A Terminal Illness insurance benefit is the amount of money you’ll receive if you’ve been medically diagnosed with less than 24 months to live. You can choose to receive your benefit as a lump sum or a pension.

If you’re not insured through your super account, you can apply to have your account balance released due to suffering a terminal medical condition.

You’ll need to meet the definition of a ‘terminal medical condition’ under the superannuation laws as outlined below.

You can apply for a payment if:

• a registered medical practitioner and a registered medical specialist have both certified, either jointly or separately, that you suffer from an illness, or have incurred an injury that’s likely to result in your death within a period (known as the certification period) and ends not more than 24 months after the date of the certification.
• the specialist is practising in the area related to your illness or injury
• the certification period hasn’t ended.

1. Contact us – the best thing to do is give us a call on 1300 134 337 so we can talk you through the claims process and explain the documents and information you need to get started.
2. Complete the forms we send you – we’ll send you the forms you need to complete with a letter outlining the information you need to provide back to us, eg, statements from two of your attending medical practitioners, one of whom is your attending specialist.
3. Our Insurer will assess the claim for the insured component – if you have insurance through your super, our Insurer will assess your claim to determine whether you satisfy the policy requirements. Along the way we’ll manage the progress of the claim and let you know if the Insurer needs more information from you.
4. Claim decision – when a decision is made, you’ll receive a letter letting you know the outcome of the claim. If your death occurs while your terminal illness claim is being processed, it’ll become a death benefit claim. It’s worth considering who you’d like to provide for if this happens so it’s a good idea to review or update your nominated beneficiaries. You can do this by logging into your account or completing the Binding death benefit nomination form on our website under the forms section.

You don’t need a lawyer but if you choose to it won’t guarantee a shorter assessment period, influence the outcome or the amount paid on a claim. You should also consider the cost involved in having your own lawyer.

When it comes to assessing claims, one of our responsibilities is to ensure our members’ interests are front of mind at all times. This means we’ll make sure any decisions are fair and comply with the conditions set out in the fund’s insurance policies, our trust deed and relevant laws.

For your own piece of mind, we prioritise Terminal Illness claims. Hopefully all the necessary information requested by us is provided with your claim, but if not, we’ll help you by getting in touch with you as soon as possible.

You can help us shorten this time frame by including all relevant medical documents when you send us your application, and by responding to our requests for supporting information as soon as possible.

When it comes to insurance it’s important to understand that strict rules apply to insured TPD payments. To receive an insurance benefit payment you’ll need to satisfy the eligibility criteria and the TPD definition in the insurance policy.

There are two aspects to a TPD claim you need to know of. These are:

• whether you meet the ‘permanent incapacity’ condition of release under superannuation law to access your super account balance
• whether you have TPD insurance in your super account and if you meet the conditions that apply.

Your ability to meet certain definitions at the start of the policy (such as, ‘active employment’) could affect your eligibility to claim so it’s worth taking the time to read and understand the terms of your policy. These are set out in our Important conditions and the Insurance definitions section of the Insurance Guide.

These types of benefits and their tax treatments can be complicated depending on your circumstances so you might want to speak to your financial and/or tax adviser. To understand these types of payments ad their implications in more detail, you can visit ato.gov.au.

1. Contact us – the best thing to do is give us a call on 1300 134 337 so we can talk you through the claims process and explain the documents and information you need to get started.
2. Complete the forms we send you – we’ll send you the forms you need to complete with a letter outlining the information you need to provide back to us, eg, paperwork from your doctor describing the nature and extent of your disability or illness, a certified copy of your birth certificate, driver’s licence or passport plus any medical reports you have. Our Insurer will rely on the information you provide when making their assessment, so it’s important to include all relevant medical evidence in your application.
3. Our Insurer will assess your claim – if you have insurance through your super, our insurer will assess your claim. Along the way we’ll manage the progress of the claim and let you know if the Insurer needs more information from you.
4. We’ll review your claim – once your claim has been reviewed, you’ll receive a letter from us outlining the decision or requesting further information. Claim decision – when a decision is made, you’ll receive a letter letting you know the outcome of the claim.

You don’t need a lawyer but if you choose to it won’t guarantee a shorter assessment period, influence the outcome or the amount paid on a claim. You should also consider the cost involved in having your own lawyer.

When it comes to assessing claims, one of our responsibilities is to ensure our members’ interests are front of mind at all times. This means we’ll make sure any decisions are fair and comply with the conditions set out in the fund’s insurance policies, our trust deed and relevant laws.

The claims process will start once we’ve received all the relevant documents and information requested.

The time it takes for a TPD claim to be decided varies depending on the complexity. We’ll be in touch to provide you with updates and progress of the claim.

You can help us shorten this time frame by including all relevant medical documents when you send us your application, and by responding to our requests for supporting information as soon as possible.