Sick or injured PSSap customers

PSSap customers may have access to lifePLUS cover insurance, including income protection and total and permanent disability benefits, and could claim their super if they are permanently incapacitated.

PSSap customers can apply for benefits where they are unable to perform their duties because of a physical or mental incapacity. There are usually two components:

  • Insurance within PSSap - known as lifePLUS cover.
  • PSSap - superannuation.

LifePLUS cover

Your employees in PSSap can generally choose to have default lifePLUS Death, Total and Permanent Disability (TPD) or Income Protection (IP) cover. They can also choose to tailor the amount and type of insurance cover they hold under PSSap lifePLUS to meet their specific needs, and at a premium cost that their comfortable with. Your employee may also choose to hold no insurance cover at all.

If your employee lodges an IP claim, you will receive a request for an employer statement. This means that you always be aware if an employee has lodged a PSSap lifePLUS IP claim.

For more information about PSSap LifePLUS cover refer to the Insurance and your PSSap super booklet.

Income Protection and TPD Insurance claims in PSSap

  2018-19 2019-20 2020-21
TPD claims assessed 82 132 93
IP claims assessed 423 427 342

CSC has a 97.40% TPD and a 97.80% Income Protection claims acceptance rate as at 30 June 2021.

 

Insurance claims process

For privacy reasons, we must generally have authority from your employee to discuss their specific insurance matters with you. Please ask your employee to sign our Third Party Authority form. Once you receive the third party authority it will allow us to provide you with any information needed on the insurance options available to your employee.

Encourage members to talk to us early

It’s important that a sick or injured PSSap customer contacts us as early as possible about claiming on their insurance, even if they have an existing employment process or a compensation claim underway. We will help our customer understand what insurance options are available to them, and guide them through the process of how and when to make a claim.

lifePLUS Cover

Invalidity retirement

Your employee may be eligible for super benefits from PSSap if they’re permanently incapacitated and retire on medical grounds. Either you or your employee must apply for an Invalidity Retirement Certificate (IRC) if your employee is under age 60 and is to be medically retired because they are unlikely to be engaged in gainful employment for which they are qualified for because of ill health. If we issue an IRC, this will provide confirmation that your employee meets the definition of being permanently incapacitated and is able to access their super benefits.

We’re unable to issue an IRC to any employees over age 60. Instead, they can claim their super once they’ve ceased employment. Their benefit will be tax free regardless of how their employment ceases. Your employee simply needs to complete the Withdrawing your super form and send it to formsandapplications@pssap.com.au for processing.

How CSC and our insurer can help your employee if they make a claim

The following services are provided direct to customers making an insurance claim, where they’re relevant to the customer’s needs.

  • Back on track

    How can we help?
    • Crisis management
    • Community resources and social support
    • Housing assistance
    • Guidance and resources to navigate Centrelink
    • Welfare rights
    • Financial counselling
    • Navigating accessible treatment options
  • Back to wellness

    How can we help?
    • Pain coaching
    • RESTORETM the AIA mental health program
    • CaRe MovementTM the AIA cancer recovery support program
    • Cancer Aid for our members undergoing cancer treatment
    • Graded exercise programs to increase or stabilise function
    • Telehealth wellbeing coaching
  • Back to life

    How can we help?
    • Graded return to work plans
    • Workplace assessment
    • Work trials
    • Volunteer work
    • Transferable skills assessment
    • Vocational counselling
    • Job seeking assistance
    • Re-training and up-skilling
    • Functional upgrading programs
  • Back to me

    How can we help?
    • Ensuring ongoing access to community resources and support
    • Understanding how to navigate accessible long-term treatment options
    • Financial counselling
    • Job seeking advice
    • Social work support

Early intervention, wellbeing and return to work programs

Return to work pathway
  • Early intervention 

    • Encourage the customer to get in touch with CSC early. Earlier notification equals a higher chance of success.
    • CSC can assist before the waiting period ends.
  • Communication 

    • Employer engagement is critical for success.
    • Keep an open dialog with the employee whilst they are off - the more engaged the employee is, the more likely they will return to work.
  • Expert advice

    • Rehab consultants direct customers to the relevant services which they may find difficult to find themselves
    • CSC can provide support to the employer and customer on the process and what to expect

Timing is everything

In terms of physical conditions, if the person is off work for:

20 Days

the chance of ever getting back to work is 70%.

45 Days

the chance of ever getting back to work is 50%.

70 Days

the chance of ever getting back to work is 35%.

Common questions answered

CSC shares PSS Invalidity claim information with me for my impacted employees, why can’t you do the same with PSSap lifePLUS cover insurance claims?

The invalidity benefit associated with the PSS Defined Benefit product is an employment benefit funded by you as the APS employer, and is administered by CSC. Because this is a specific employment benefit that you as the employer fund, and that CSC administers on your behalf, CSC is allowed to provide relevant information on the administration of invalidity claims impacting your employees in PSS.

PSSap lifePLUS is very different to the PSS invalidity employment benefit. It is instead an insurance sub-policy where insurance premiums are deduced directly from the balance of your employees PSSap Super Account, and is an insurance policy held by your employee in their name, under an overall Master Policy that CSC holds with our insurer AIA. It is not an employment benefit, nor is it in anyway directly funded by you as the employer

PSSap lifePLUS is little different to the insurance another of your employees might hold as part of Super account with any other, non CSC, Super Fund. If you were to ask another Super Fund to share specific information about an insurance claim being made with them by one of your employees, they would very likely have the same answer as CSC, and would not under privacy rules be allowed to share such information with you, without the explicit permission of your employee. The insurance policy, whether with CSC, or another Super Fund, is a policy held by the employee in their name under an arrangement between the Super Fund and the insurer.

How do I know if my employee has PSSap lifePLUS Income Protection (IP) Insurance?

Whilst we cannot disclose details of the PSSap lifePLUS cover held by your employee for privacy reasons, if your employee makes a PSSap lifePLUS insurance claim, you will receive a request to complete an employer statement. This means that you always be aware if an employee has lodged a PSSap lifePLUS IP claim.

If CSC was to provide you as the employer with information about an employee’s PSSap lifePLUS insurance cover, without the employee’s explicit permission, we would potentially be in conflict with CSC’s privacy commitment to our customers, per “We will only share your personal information where necessary for providing superannuation services to you”.

How do I know if my employee has lodged a claim on their PSSap lifePLUS Income Protection (IP) Insurance?

When your employee lodges an IP claim, you will receive a request to you complete an employer statement. This means that you always be aware if an employee has lodged a PSSap lifePLUS IP claim. For privacy reasons, we cannot share any specific information about this claim, such as if the claim was successful and whether the employee is now receiving an insurance benefit (and for how long will it be paid).

If CSC was to provide you as the employer with information about an employee’s PSSap lifePLUS insurance cover, without the employee’s explicit permission, we would potentially be in conflict with CSC’s privacy commitment to our customers, per “We will only share your personal information where necessary for providing superannuation services to you”.

I’d like to commence the invalidity retirement certificate (IRC) process for an employee so I can cease their employment. Is approval of the IRC impacted if my employee has submitted an PSSap lifePLUS Income Protection (IP) or TPD insurance claim?

No. When you commence the IRC process for an employee in PSSap with our administrator Mercer, Mercer will let your employee know, that you as the employer have lodged an IRC application, and Mercer will begin the IRC assessment process. Even if a customer is making an IP or TPD claim you can still complete the IRC process, so long as the employee meets the standard IRC criteria.

If a customer is making an IP claim, the IP claim process will continue no matter the status of the IRC process, so long as the customers health event causing the IP claim occurred prior to the IRC process commencing. Once an IP benefit is approved, the customer will continue to receive this benefit (for up to 5 years, dependant on their cover details) for as long as they meet the terms of the insurance policy (re temporary disablement), no matter the status of the IRC process.

Note: At a certain point during the IP claim our insurer may make a decision that the employee has moved from having a temporary incapacity (hence receives income via their IP cover) to being permanently incapacitated (hence they may move to making a TPD insurance claim). In this instance our Administrator Mercer will commence the IRC process, assuming the employee is happy to do so, and will engage you as part of this process.

My employee is off sick, I’d like to see what I can do to assist my employee to return to work and recover from their health issue. How can CSC assist me to do that if my employee has an PSSap lifePLUS IP or TPD claim in progress?

Where an employee is off work sick and is receiving a PSSap lifePLUS Income Protection benefit, rest assured that if CSC’s insurer AIA assesses that your employee is at an appropriate point in their recovery journey, where a return to work (or a graduated return to work) program may be appropriate, AIA will contact you to try and arrange such a return, and to see how they can support the employees return to work with you.

Research shows that the rehabilitation programs customers have access to through their PSSap lifePLUS Income Protection cover (if held) may assist an employee’s return to work. Returning to work in nearly all cases is the best way to maximise an employee’s long term physical and psychological health.

Will the medical information provided to CSC by the employers medical experts as part of the IRC process, be used as part of the assessment of a PSSap lifePLUS insurance claim?

No, our insurer will not use the medical information provided as part of the IRC evidence. When assessing a claim, AIA will always seek evidence from the customers treating doctor/specialist. AIA may also seek evidence from relevant independent medical experts (as recommended by AIA’s Chief Medical Offer-CMO).

When an employee lodges a PSSap lifePLUS insurance claim, will we request relevant evidence from the employer as part of the insurance claim process?

Yes. At the point when an employee lodges a PSSap lifePLUS insurance claim, the primary evidence items that are requested from employers, as a part of the employer statement includes: Pay/Leave information, monthly pay slips, any return to work (where attempted) documentation, occupation history and training. This is the employer’s opportunity to provide relevant information about your employee. This also means that you will always be aware of a PSSap lifePLUS IP claim which has been lodged by an employee.

Assisting terminally ill PSSap members

Assisting terminally ill PSSap members

IRC quick guide for PSSap members

A quick guide to invalidity retirement for PSSap members

IRC-APP Applications for issue of invalidity retirement certificate

Application for issue of invalidity retirement certificate You can use this form to apply for an invalidity retirement certificate for employees who are CSS, PSS or PSSap customers. The employee’s case manager and a payroll officer will need to complete and sign the form.

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