Making a personal insurance claim: what to expect

Insurance exists for the moment you need to claim. Knowing roughly what to expect can make that moment less stressful, for you or your family.

1. Start the claim

If you hold the cover personally, contact the insurer. If the cover is held through super, contact your super fund, which works with its insurer on the claim.

It's a good idea to start early. Some policies have time limits for telling the insurer about a claim, and income protection waiting periods usually start from when you stop work, not from when you contact the insurer.

2. Provide information

The insurer will tell you what it needs. Depending on the claim, this may include:

• claim forms and identification
• medical reports and records from your treating doctors
• for income protection, evidence of your income before and during the claim
• for life claims, a death certificate and information about beneficiaries

3. Assessment

The insurer assesses the claim against the policy's definitions. For some claims, especially TPD, this can take time, because the insurer needs to understand whether a condition is permanent. Insurers that subscribe to the Life Insurance Code of Practice have committed to standards for communication and timeframes during claims.

4. The decision

If the claim is accepted, the insurer pays the benefit, as a lump sum or monthly benefit depending on the cover. For cover in super, the insurer pays the fund's trustee, which then releases the money under super law.

If you disagree with a decision

Ask the insurer (or your super fund) for the reasons in writing, and use their internal complaints process. If you're still not satisfied, you can complain to the Australian Financial Complaints Authority (AFCA), a free, independent dispute resolution service: afca.org.au, 1800 931 678.