Understanding the claims process for income protection

At a glance:

• To be eligible for income protection insurance, you must be employed – whether that be full-time, part-time, self-employed, or own a business.
• Your documentation must be complete and accurate to support your claim.

 

 

When an illness or injury prevents you from working, income protection insurance provides financial support. There is some complexity involved in making a successful claim and understanding the requirements and procedures is important. Throughout this guide, you’ll learn how to file a claim, from eligibility requirements to common reasons for claim rejection and tips for success.

 

 

Eligibility requirements for claiming income protection insurance

There are several requirements you must meet in order to be eligible for income protection insurance:

• To be eligible for an income protection policy, you must fit into the age limits. These are usually in the range of 16 – 65, although some policies will insure you until you turn 70.
• To be eligible for income protection insurance, you must be employed full-time or part-time, self-employed, or own a business.
• Applicants for income protection insurance must be permanent residents of Australia.
• It is mandatory for you to serve a waiting period of 14, 30, 60, or 90 days before you can file a claim. Your policy’s cost will be affected by the waiting period you choose.
• There are benefit periods to choose from, usually 52, 104, and 260 weeks. When you are unable to work, the benefit period determines how long you will receive a benefit.
• When applying for insurance, some insurers ask you to disclose any pre-existing medical conditions you may have. It is possible for insurers to exclude or limit coverage for certain conditions based on their nature and severity.
• You are entitled to the maximum amount of coverage, depending on your income. Generally, Aspect UW income protection policies provide a monthly benefit of 50%, 75%, and 85% of your pre-disability income.

 

Here are the questions you’ll be asked when making a claim for income protection.

During the income protection insurance claim process, it is important to be honest and truthful when answering the questions asked by your insurer. These are some of the common questions you can expect to be asked:

• Has your doctor confirmed that you are expected to be off work for longer than the waiting period?
• Have you previously experienced this or a related condition in the past?
• What specific duties do you perform in your occupation, and the approximate amount of time spent performing each?
• Do you plan to return to work with the same employer once you have recovered?

 

The importance of documentation in claiming income protection insurance

 

Why is documentation important?

Documentation is essential for you as well as your insurer. Your documentation must be complete and accurate in order to support your income protection claim. To assess the validity of a claim and determine how much compensation to pay out, insurance documentation is crucial.

Here are the documents you’ll need to provide when filing an income protection insurance claim:

 

Claim form: Your medical history, employment information, and details of your illness or injury will be included on the claim form.

 

Medical certificate: If you have been treated by a doctor or specialist, you’ll need to provide a medical certificate detailing the symptoms you are experiencing and the expected duration of your illness.

 

Proof of income: You must provide proof of your income, such as recent payslips or tax returns, to support your claim for lost income.

 

Other documents: You may need to provide additional documentation depending on the nature of your claim, including police reports, accident reports, and witness statements.

 

Providing accurate and complete documentation will ensure your claim is processed smoothly and efficiently. Documentation tips to help you:

• Make sure you read the claim form carefully and provide all the information requested.
• Document all medical records and invoices associated with your illness or injury.
• You should provide your insurers with up-to-date income statements, including payslips and/or tax returns.

 

Common reasons for claim rejection and how to avoid them?

 

The process of filing an income protection claim can be a challenging one, and being rejected can be frustrating. Preparing a successful claim starts with understanding why claims get rejected.

 

Pre-existing medical conditions

A pre-existing medical condition is often cited as a reason for claim rejection. A claim may be denied if you fail to disclose a pre-existing medical condition when applying. If you have any medical conditions, it is better to disclose them upfront than to risk your claim being denied later.

 

Insufficient documentation

It is another common reason for claim rejection. Insufficient or inaccurate documentation could lead to your claim being rejected. Ensure that all the required documentation is provided when filing your claim, including the claim form, the medical certificate, and proof of income.

 

Waiting Period Not Met

Before benefits are paid out under most income protection policies, there is a waiting period. You may be denied a claim if you file it before the waiting period has elapsed. Ensure you understand the waiting period before filing a claim.

 

Ineligibility for Total Disability

Benefits are paid out only if you meet the definition of total disability under some income protection policies. Your claim may be rejected if you do not meet the definition of total disability. To support your claim, ensure you understand the definition of total disability for your policy.

 

Fraudulent information

Lastly, fraudulent information will mean your claim is rejected. You may face legal consequences if you file a fraudulent claim.

 

 

How long does it take to process an income protection insurance claim?

 

A common question when filing an income protection claim is how long will it take to process it. A number of factors can influence the answer, including how complex the claim is, whether documentation is complete and whether the insurer is responsive.

 

Initial assessment

Initial assessments are the first step in the processing of an income protection insurance claim. As part of the review process, medical certificates and income proof, as well as the claim form, are typically reviewed. In the initial assessment, the insurer determines if the claim is covered.

It may take a few days or a few weeks to assess the claim, depending on its complexity and how responsive the insurer is. A thorough assessment will be completed on time if all essential documentation is provided upfront.

 

Further investigation

Insurers may request additional documentation or arrange for independent medical examinations if the initial assessment indicates further investigation is needed. A delay in making a claim decision can be caused by the insurer waiting for the results of the investigation.

Medical professionals’ availability and the complexity of the claim determine the length of further investigation. Investigations can take weeks or months in some cases.

 

Claim Decision

Upon gathering all required information, the insurer will decide whether to pay the claim. When the claim is approved, the insurer usually pays out the benefit within a few weeks. A written explanation will be provided if the claim is rejected by the insurer.

 

 

How much can you claim with income protection insurance?

 

Benefit amount

Under your income protection policy, you can claim a maximum benefit amount each month. Typically, this amount is 85% to 75% of pre-disability income. For instance, you can claim up to $8,500 per month if your pre-disability income is $10,000 per month and your policy has an 85% benefit amount.

 

Waiting period

Benefits are not paid until after the waiting period begins. Most policies have 30-, 60-, or 90-day waiting periods. Suppose you become unable to work on January 1, but there is a 60-day waiting period, so you cannot receive benefits until March 1.

 

Benefit Period

Benefit periods refer to the amount of time you can receive income protection benefits. Policies vary in benefit periods, but most are 1, 2, or 5 years.

 

 

What to do if your income protection insurance claim is rejected?

 

Review

Your first step should be to review the reasons for the rejection of your claim. Understanding this will enable you to appeal the decision.

 

Additional information

After understanding the rejection reason, gather any additional information you can use to support your claim. Medical records, doctor’s reports, and other evidence proving your inability to work should be included.

 

Appeal the decision

Notify your insurer of your intention to appeal. You should ask what the appeal process is and what steps you need to take. You should keep in mind that the appeal process can take a lot of time, and additional documentation or evidence may be needed.

 

Lodge a complaint with regulatory bodies

The Australian Financial Services Commission oversees insurance companies and ensures compliance with set standards. You can lodge a complaint with these regulatory bodies if you believe your insurer has acted unfairly or inappropriately.

 

Seek legal advice

The final option available to you is to seek legal advice if your claim is still rejected after the appeals process. It is important to consult a lawyer with experience in handling insurance claims in order to understand your legal rights and determine if further legal action may be necessary.

 

 

Tips for successful income protection insurance claims

• Understand your policy
• Keep accurate records
• Report your illness or injury promptly
• Follow medical advice
• Be honest and accurate
• Work with a professional

 

 

How to make a claim for your Income Protection Insurance with Aspect UW?

 

• Visit our website to download a claim form as soon as possible.
• Complete the claim form and describe the incident as concisely as possible.
• Support your claim form with the following materials:
• Passport scans or photographs, or another form of identification with a photo
• A copy of your most recent pay slip or your tax return and assessment notice from last year
• Medical certificates or notes may be required.
• Send the claim form and supporting materials to us
• We’ll review your claim and contact you if we require any further information or documentation.

 

Purchasing income protection insurance?

With Aspect UW, you can get dependable and affordable income protection insurance, some of which may be tax-deductible in Australia. Take advantage of Aspect’s income protection online quote, and your coverage can be ready within ten minutes. Protect yourself and your income with Aspect UW today. For more information and to purchase a policy, please visit our website.