Make a claim

Income Protection, TPD and Terminal Illness benefit claims

Your case manager will work closely with you, your employer, our insurer and rehabilitation providers (if applicable) to coordinate an approach to suit your situation.

Your case manager will guide you

Specifically, they’ll:

• Help you with the paperwork and answer your queries.
• Be a direct contact for you, all the way through your claim.
• Monitor progress and talk to the insurer on your behalf.
• Keep you up-to-date with how your claim’s going.
• Make sure your claim is being assessed efficiently.

How to claim

1. Call us before you complete any paperwork

   Call us right away. Even if you have a process underway for the injury or sickness—for example with your employer or if you’re on leave—just let us know. We’ll talk you through what’s involved and start the claims process with you.

   Call 1300 725 171

2. Complete and lodge your claim

   Work with your dedicated case manager to complete and submit your claim documents through the Insurance Portal in CSC Navigator. You will be able to view the progress of your claim and action any outstanding requirements. 

3. Wait while the insurer assesses your claim

   The insurer uses the information you’ve given us to assess your claim to decide whether, in its opinion, you’ve met the requirements under the policy to access your benefit. Usually, your case manager will be the go-between, between you and the insurer—but sometimes the insurer may contact you directly if they think it’ll help speed up the assessment.

   The insurer will decide if they’re going to accept or decline your claim. They’ll let us know how they reached their decision, then it’s over to us. 

   • If your claim is accepted, we’ll let you know

     If your Income Protection claim is accepted, we’ll write to let you know:

     • How we’ll pay your benefit.
     • Whether you’ll be able to access a rehab program.
     • What to expect while you’re receiving a benefit, for example, any ongoing assessment and monitoring that’s necessary.

     If your TPD or Terminal Illness claim is accepted, we’ll write to let you know:

     • That your benefit will be paid into your super account and when this will happen.
     • If your benefit payment will be a lump sum or if it will be set up as an income stream.
     • If we can release your super account balance under super law.

     We may be in touch if we need more information.

   • If your claim is declined, we’ll review the decision independently

     We’re legally obliged to (and of course we want to) act in your best interest, so we’ll always review the insurer’s claim decision. During this review, we’ll assess whether we agree with the insurer’s decision.

     If we don’t agree with the decision to decline, we’ll ask the insurer to reconsider your claim or to arrange more medical evidence. The claim will go back through the assessment process and your case manager will keep you up to speed with what’s going on.

     If we agree with the decision to decline, we’ll write to let you know why it was declined and why we agree.

     Your case manager will also let you know how to request a review and how to lodge a formal complaint.

     If you do this, and you’re not satisfied with how we manage your formal complaint (or you don’t get our response within 45 days of submitting your complaint), you may contact the Australian Financial Complaints Authority on 1800 931 678 or via [email protected] or at afca.org.au.

Death benefit claims

Losing someone close to you is one of the hardest things that you might have to go through. We want to make the process of making a claim as simple as possible.

How to claim

1. Call us before you complete any paperwork

   After we verify you, we’ll talk you through what’s involved.

   Call 1300 725 171

2. We'll provide you with a form to complete

   As a potential beneficiary, a case manager will give you a form to complete (all beneficiaries will complete this form.)

   If there’s:

   • A valid binding beneficiary nomination in place, we’ll make payments to that beneficiary.
   • No binding nomination, we’ll work out who the customer’s dependants are or who the executor is.

3. If the late customer had lifePLUS cover, the case manager will lodge a claim with the insurer

   If the insurance claim is approved, the benefit will be paid into the late customer’s PSSap account, if the account is closed, the benefit will be paid to the beneficiaries.

4. We'll notify beneficiaries

   Where there isn’t a valid binding nomination, all interested parties have 28 days to object to the decision (claim staking period). If potential beneficiaries or other interested parties object to our decision, we’ll request evidence from them to support the objection. The Reconsiderations Committee will review this evidence to decide if the objection changes the original decision.
   
   Note: The 28-day claim staking period may be waived in some circumstances. 
   
   To complain about a decision made by CSC or the Reconsiderations Committee, interested parties have 28 days to lodge their complaint with the Australian Financial Complaints Authority.

    

    

5. We'll pay beneficiaries

   We’ll distribute the super balance and any insurance benefit (if applicable and approved) to the beneficiaries. Beneficiaries should seek advice about whether there are any tax obligations they need to meet. See your financial adviser or visit the Australian Tax Office. 

When we can't pay benefits

Insurance always comes with some exceptions and restrictions.

There are some situations where we can't pay Income Protection or Death and TPD benefits because certain events are excluded from cover. 

We can't pay Income Protection benefits if disability is caused wholly or partly, or directly or indirectly by:

• any intentional self-inflicted injury or attempted suicide or self-destruction while sane or insane;
• uncomplicated pregnancy, childbirth or miscarriage;
• war or act of war, whether declared or not;
• active service in the armed forces or peacekeeping forces (whether armed or unarmed) of any country or territory or foreign or international organisation; or
• participation in a combat or fighting force of any country or territory or foreign or international organisation.

Under the Death and TPD policy, certain risks are excluded, these include: 

War 

A benefit will not be paid for Death, Terminal Illness or TPD that is caused wholly or partly, directly or indirectly by: 

• an act or activity of War unless death occurs on war service, 
• active service or participation in the armed forces, peace keeping forces or peace keeping operations (whether officially declared, or not declared, armed, unarmed, in a combat role or in a support or training capacity) of any country, territory or, foreign or international organisation in Australia or any foreign country. This includes organisations involved in international peace keeping efforts (such as the Australian Federal Police, or the United Nations), or 
• engagement in (including planning or preparing for) any terrorist activity in Australia or any foreign country. 

Self-inflicted acts or suicide 

• If Death is caused by suicide, Terminal Illness or TPD is caused due to a self-inflicted injury or attempted suicide and it is within 13 calendar months of the date a customer has applied for and been accepted for an increase in cover, the benefit payable under the Policy is the amount insured before the increase. 
• No benefit is payable for death or TPD caused by any self-inflicted injury or suicide, whether sane or insane while Limited Cover applies. 

Unlawful activity and incarceration 

A benefit will not be paid: 

• If Death, Terminal Illness or TPD is caused or contributed to by participation or involvement in an act or acts that constitute a Crime. Discretion may be applied, in the event of death, where the recipient of the benefit would otherwise be to a beneficiary who did not participate or was not involved in the Crime. There may be discretion applied if there is no conviction of the Crime. If you are found not guilty of a Crime this exclusion will not apply. 
• If a TPD condition first occurred or arose because of Incarceration, or was caused or contributed to directly or indirectly by an event first occurring or arising because of Incarceration. 
• For TPD during the period of Incarceration. 

For clarity, when you are no longer under Incarceration, you can continue or commence a claim for a condition, provided it is not excluded because it: 

• was caused or contributed to by participation or involvement in an act that may constitute a Crime, or 
• first arose or occurred because you were Incarcerated, or 
• was caused or contributed to directly or indirectly by an event occurring or arising while Incarcerated. 

Prior Terminal Illness or TPD claim 

A benefit will not be paid if you have been paid or is eligible or entitled to be paid a Terminal Illness or TPD benefit under a previous Policy or under any other insurance policy, for the same or related condition being claimed. 

Underwriting Decisions 

If you have completed a full insurance application and exclusions have been applied to your cover. A benefit will not be paid if the condition being claimed falls within the exclusion. 

How we protect your privacy

You trust us with very private information, particularly during the claims process. We’re committed to protecting your privacy in line with:

• CSC’s Privacy policy.
• Our privacy statement in the Insurance and your PSSap super booklet.
• AIA Australia’s (our insurer’s) privacy policy.