OUR SERVICES
Claims Education
Education and understanding are paramount when it comes to approaching any process that will potentially impact you emotionally and financially. At Claims Advocacy, we empower everyday Australians with knowledge, guidance and support regarding all aspects of risk insurance claims. We break the process down, so you have a clear understanding of your options regarding the covers you have in place — and even provide advice about what to do after claims have been knocked back.
We break down and simplify the process to provide education regarding:
- Eligibility to claim
- The claims process
- Technical jargon
- Tax implications
- Your options before making a claim
- Your options after a claim is rejected
Suppose you are unable to work due to injury, illness, or any form of disability. In that case, you may be eligible for Income Protection, and Total & Permanent Disability (TPD) cover. Many Australians — especially those in an industry superannuation fund — have an automatically applied default level of these insurances. We analyse your situation and any cover you have, to assess your eligibility to claim. We are with you every step of the way to take care of the lodgement and management of your claims.
With our industry expertise, ‘no win, no fee’ option, and success rate in extraordinary circumstances, we are the perfect team to have behind you when it comes to making a claim. We make risk insurance claims easy.
Claims Management
When your life has been significantly impacted by sickness, injury or disability, you don’t need the added stress of dealing with call centres, messing around with paperwork and trying to chase up your insurance claims. We manage the claims process so that you can be with your loved ones and focus on your recovery.
Providing a complete advocacy solution, we manage the entire process from start to finish. Beginning with assessing your eligibility, we are with you to handle the submission of paperwork, supporting documents and the whole administration of your claim. We stay right by your side, providing regular updates along the way to keep you informed and feeling secure. For any undesirable outcomes, we jump straight back in to fight for your claim — and our success rate in extraordinary cases means you’ll have the best possible chance at winning.
We can assist you with the following insurance claims:
Life/Terminal Illness
Life insurance claim is payable upon death or terminal illness. If it is through a superannuation fund, the trustee will determine who would receive those benefits, unless you have nominated a valid beneficiary to receive these benefits.
Whether there is any tax payable would be dependent on several factors. Please refer to “Super Death benefits” for more details.
If the insurance is held outside super the proceeds will be paid to your estate unless you have nominated a beneficiary, in which case the proceeds will bypass your estate.
There will be no tax payable if self-owned.
Total & Permanent Disability
It is generally payable where you are Totally & Permanently disabled and cannot ever work again.
There are generally 4 TPD definitions – “Own”, “Any”, “Home Duties” and “Not working”.
If your TPD cover is through super, the applicable definition is generally “any” occupation. This means that you should be unable to work in “any” occupation that you are reasonably suited to by education, training and experience.
If you are under the age of 60, the tax payable can be up to 22% depending upon your age at the time of disability and how many years are left to the normal retirement age of 65.
If it is outside super, it can be either “any” or “own”. If it is “own” occupation, then you are eligible to make a claim if you are unable to work in your own occupation only.
There is no tax payable if this is self-owned.
Home duties and Not working — you receive a lump sum if you are no longer able to perform home duties.
Generally, two doctors need to certify that you are unable to work ever again.
Income Protection
Income protection is payable if you are unable to work due to accident, sickness, or any form of disability.
Generally, there is a “waiting period” you must serve before the insurer starts paying the benefits.
The claim would be paid on a monthly basis until the earlier of when you are fit enough to work, or your maximum benefit period (could be two years, five years, up to age 60/65/70) depending upon your policy.
This can be either through a super fund or self-owned.
Generally, the policies through super are basic policies with “indemnity” benefit, which means your income is assessed at the time of claim to determine how much cover you are entitled to.
If it is outside of super, then it can be an “indemnity” policy or “agreed/guaranteed” policy. With an “agreed/guaranteed” contract, the insurer would generally pay the amount you are insured for regardless of your income at the time of claim.
Regardless of whether the claim is paid via super or outside super, the proceeds are generally added to your taxable income and taxed at your marginal tax rate.
Trauma/Critical Illness
This is payable if you are diagnosed with a specific medical condition such as cancer, heart attack, stroke etc. There are generally 45-65 listed conditions depending upon the provider and the level of your cover.
It is always held outside super, and there is no tax payable on the proceeds
Early Release of Super
In the event of Terminal Illness of Total & Permanent Disability, you may be entitled to the early release of your super.
Claims Disputes & Escalations
Our expert knowledge and industry experience allow us to achieve success with tricky claims that simply wouldn’t have been successful had we not been involved in the process. Unfortunately, not all insurance cases are black and white; this can mean claims are rejected or drawn out over a long period. But we are here to help! We expertly handle claim disputes, escalations and negotiations to swiftly achieve the result you’re looking for.
Denied Insurance Claim
An insurer is obligated to assess your claim fairly and reasonably in a prompt manner. All decisions regarding claims are to be made in good faith. However, there are many instances where an insurer can deny an insurance claim, including but not limited to:
- Non-disclosure
- Medical reasons
- Exclusions
- Work history is not suitably proved
- Policy definitions are not met
- Pre-existing conditions
A refused claim doesn’t necessarily mean it’s the end of the line. You may have recourse to appeal the decision. We are experts regarding the ins and out of all thing’s insurance, specialising in achieving successful outcomes by appealing claims decisions with the internal dispute resolution or the Ombudsman.
If you have been waiting on a decision for more than six months regarding a lodged TPD claim, we may be able to help. Failure of the insurer to make a decision before six months can be deemed as a refusal to pay the claim. We can have your TPD claim escalated and resolved promptly.
When disputing a claim decision, there are strict time limits that apply. Seeking help urgently following a claim rejection is the best course of Action — especially when it is through a super fund..
Policy cancelled without your knowledge
If your risk insurance policy has lapsed due to non-payment just before a claimable event, we might be able to help you. With our expertise, we can review your options and may be able to have the policy reinstated so that you are able to make a claim.
There is legislation regarding insurance inside super that could see you have your insurance covers cancelled if your super balance drops below a certain amount or your fund is inactive for a period of time. If you thought you had insurance through super but discover it has gone when you need it most, all hope is not lost — Let us explore your options.