Claiming an Income Protection benefit
What is an Income Protection (IP) claim?
If you are unable to work due to illness or injury, Income Protection (IP) cover can provide you with regular monthly benefit payments. IP can be paid if you’re totally disabled and unable to do any work, or if you’re partially disabled and can do some of your work in a limited capacity by either reduced hours or duties or both as a result of your illness or injury.
The maximum amount payable is either your Sum Insured or up to 85% of your Pre-Disability Income. Pre-Disability Income is the actual salary you were earning at the time you stopped working (this can be higher or lower than your sum insured). Once your Pre-Disability Income is confirmed as part of your claim, the benefit payable directly to you is up to 75% of your salary with a remaining balance of up to 10% paid into your super account as a contribution. If your Sum Insured is lower than your Pre-Disability Income, then the full Sum Insured is paid directly to you.
Where your claim is approved, monthly payments are paid in arrears one month after the end of the Waiting Period and continue for the duration of the Benefit Period as long as you remain medically supported as unfit for duties. Your claim can stop and restart as you recover and return to work, depending on your circumstances. Your Claims Assessor will let you know when this occurs and guide you through.
What is a Waiting Period?
The Waiting Period is the minimum number of consecutive days that must pass before any benefit may become payable. Our Waiting Periods can be either 30 or 60 days (default) and the period starts from the first date that you are medically certified as being unable to do any work. Please refer to your superannuation account to confirm your Waiting Period.
What is a Benefit Period?
The Benefit Period is the maximum length of time a benefit is payable for once the Waiting Period has finished and you remain medical certified as unable to return to full work, including your usual duties and hours.
Our Benefit Periods available can be either two years (default), five years, or payable to age 65 or to age 70. This means IP benefit payments automatically cease at either the end of your Benefit Period or upon turning age 65, whichever comes first. For example, if you’re 63 years of age at the time you lodge your claim, IP benefit payments will automatically cease when you turn age 65. If you have a Benefit Period to age 70 your benefit payments will cease upon turning age 70. Please refer to your Superannuation account to confirm your Benefit Period.
You can request to increase or decrease your Sum Insured, Waiting Period or Benefit Period at any time by completing our Adjusting your Insurance cover – apply or increase form. These requests are subject to approval by our Insurer, TAL, and cannot be made once you have lodged a claim.
What happens when you make a claim
Call our Helpline on 1300 963 720. We will help you with the first steps of the claim and inform you of the overall process. You will be asked a few questions relating to your claim to assist with determining the correct benefit you may be entitled to claim. When you call, the following information will be asked:
- details of your membership,
- details of your injury or illness,
- the date you first consulted your doctor about the condition preventing you from working and the date your doctor first certified you were unfit to work,
- details of the employer/s you were employed with prior to ceasing work, and
- the last day you were actively at work, together with your work status prior to ceasing work.
We will discuss the options available to you to lodge your claim. This can be either:
- A Tele-claim - A representative from our Insurer, TAL Life Limited, will call you at a mutually convenient time to discuss your claim and the assessment process. During this call, the TAL claims assessor will collect information from you as required to complete your Member Statement. The information will include your personal details, employment information, current and historical medical history, and the circumstances surrounding your claimed condition. A written record or call recording will be kept and can be sent to you on request. Once the Member Statement is completed, the remaining documents needed, such as an Employer Statement and the Attending Doctor’s Report, will be sent to you via email or post for completion.
- In Writing – Our Insurer will forward you all of the necessary claim forms for completion by you , your employer and your treating doctor.
In addition to the information collected during a tele-claim the following documents will be needed to commence the initial assessment of your claim against the insurance policy terms and conditions. The Insurer will review your medical condition together with your medical history and employment circumstances.
- Member Statement – to be completed by you (or your Power of Attorney), if you haven’t participated in a tele-claim
- Attending Doctor’s Statement (IP) – to be completed by your treating doctor. Copies of relevant medical reports and test results that support your illness or injury should be attached to the completed report. Any costs associated with completing this form will need to be covered by you.
- Employer Statement – to be completed by your employer at the time you stopped working.
- Tax file number declaration – to be used in determining the amount of tax (if any) that needs to be deducted from your benefit payment.
- Certified Proof of Identity – For security purposes certified proof of your identity such as your driver’s licence or passport is required. A certified copy is simply a photocopy of an original document that has been sighted, signed and stamped as being a ‘certified true copy’ by an authorised person. Photocopies of certified documents cannot be accepted. More information on how to certify documents can be found on our website.
Once the completed forms are returned directly to the Insurer, you will be assigned a dedicated case manager for the duration of your claim assessment.
To reach a decision on your claim or to continue your ongoing benefit payments, the Insurer may also request:
- you to provide further information,
- additional medical reports
- further information from your employer,
- any claim files held with other insurers or any other third party such as Worker’s Compensation.
During the initial assessment of your claim, any fees associated with requesting additional medical reports and examinations will be paid by the Insurer. Any fees associated with the completion of the Attending Doctor’s Statement and ongoing medical reports after a claim has been approved, is paid by the member.
Your claim will be assessed against the terms and conditions of the insurance policy at the date of your injury or illness (including any exclusions and/or pre-existing conditions you may have). The nature of your claim, the date of disablement and any additional information required to reach an outcome will influence the overall assessment processing time of your claim.
We will strive to reach an outcome as quickly as possible and will keep you regularly updated throughout the assessment process.
- If your claim is approved, the Insurer will inform you in writing, and confirm the date your benefit commences, your monthly benefit amounts and if any tax is deducted.
- If your claim is declined, we will let you know in writing of the reasons your medical condition does not satisfy the relevant definitions. Before formally declining your claim, we will write to you to allow an opportunity to provide any further evidence to support your claim.
Should this occur, and if you disagree with the decision, you can request a review. All review requests are treated as formal complaints and are independently assessed by the Insurer and Trustee.
If our Insurer approves your IP claim, monthly benefit payments will be paid in arrears and commence one month after the end of your Waiting Period. The Insurer will pay your monthly benefit electronically to your nominated bank account.
Once benefit payments have commenced, the Insurer may require your doctor to complete an Attending Doctor’s Statement, so they can assess if you qualify for ongoing IP payments.
FAQ about Income Protection claims
Being approved for monthly IP benefits depends on a number of factors. The driving factor is the definition of partial disability or total disability for IP in place at the time you ceased work and were medically diagnosed as being unfit for work. These definitions have changed over the years and can vary between products and superannuation funds.
Other factors such as your medical capacity, employment status, work duties and earnings, and the impact that your injury or illness has on you are all taken into consideration when assessing your claim.
Information will be gathered from your employer, doctors and specialists, or any other organisations that you may have lodged a claim with, to enable the Insurer to assess your claim correctly, fairly and within reason. The Insurer may also ask for additional tests or medical opinions from doctors of their choice.
Depending on which IP definition you meet will determine if you are eligible to receive a full IP benefit or a partial IP benefit. For more information on IP payments and our current definitions please refer to our Insurance guide available on our website. For past definitions and to discuss your circumstance please contact our Helpline.
The benefit payable will be determined by the IP sum insured as at the date you ceased work and your earned income, up to the maximum benefit.
Your earned income is determined differently depending upon whether you are a permanent employee, casual employee or self-employed at the time of your illness or injury.
The amount of Income Protection benefits payable to you will be reduced by the amount of any of the following benefits you are receiving as a result of the same illness or injury which has given rise to this claim:
- Court or out of court settlements which are directly or indirectly related to the illness or injury that forms the basis of your benefit being paid
- Employer funded sick leave payments
- Worker’s compensation scheme payments
- Motor accident compensations scheme payments
- Benefits paid under state or federal legislation, such as the Department of Veterans’ Affairs
- Income benefits from other disability income insurance policies or superannuation funds, and
- Statutory compensation, pension*, social security or similar schemes.
*Pension payments that may be considered as an offset would be Disability Support Pension payments if the reason for these payments is result of the injury or illness which is the cause of the claim with us.
Any IP benefits payable to you will not be reduced if you are receiving pension payments through your superannuation with the Fund, or you are aged 56 or older.
For more information refer to the Insurance guide.
IP benefits are paid as taxable income and, like salary and wages, attract Pay As You Go (PAYG) tax. The tax will be deducted from the benefit before it is paid to you and remitted to the Australian Taxation Office.
There are several steps involved in assessing a claim. We and the Insurer aim to finalise most claims within two months or sooner. The length of time depends on personal circumstances and availability of information required from you, your employer, your doctors and specialists to assess your claim. Where a decision cannot be reached within two months TAL will write to you to let you know the reasons for the delay.
We offer expert financial advice services through our licensed Financial Planners*. Our advisers can provide assistance on the likely impact of any benefit payment to your personal financial situation and help you make informed decisions about your benefit. To meet with a financial planner, please call us on 1300 963 720.
If at any time you are dissatisfied with any aspect of your claim, you can lodge a formal complaint. Our complaints handling information is available on our website.
We aim to resolve all complaints as soon as possible. However, if we have not resolved your complaint within 28 days, we will provide a progress update. A final response will be sent to you no later than 45 days for complaints about financial services including advice, and no later than 90 days for complaints about superannuation.
Call: 1300 695 433
GPO Box 4303
Melbourne VIC 3001
If you are not satisfied with our response to your complaint, or we have not responded to you within the above timeframes, you can refer your complaint to the Australian Financial Complaints Authority (AFCA). AFCA provides fair and independent financial services complaint resolution that is free to consumers. AFCA imposes strict time limits for lodging complaints. For more information about AFCA and their complaint process, visit afca.org.au.
Here’s how you can submit a complaint with AFCA:
Call: 1800 931 678 (free call)
Australian Financial Complaints Authority
GPO Box 3
Melbourne VIC 3001
Earned Income – Your earned income is determined differently depending upon whether you’re a permanent full-time or permanent part-time employee, non-permanent employee including casual, or self-employed at the Date of Disablement. For more information, please refer to the Insurance guide.
Sum insured – means the monthly amount of cover you are insured for under the policy.
Maximum Benefit – the amount you’ll be paid depends on the level of cover you have with us. Generally, your monthly benefit will be the lesser of:
- Your level of cover,
- Up to 85% of your earned income (including 10% Superannuation Contribution benefit), or
- $30,000 benefit per month
Date of Disablement – this is the date, as certified by a Medical Practitioner, on, or by which the illness or injury which is the principal cause of your claim for a Benefit under the Policy caused you:
a. where you were employed or self-employed, to cease to be able to work, or
b. where you were not employed or self-employed, to cease to be able to perform your Usual Occupation.
Where you continued to work beyond the date certified by your Medical Practitioner, the Date of Disablement is the date you ceased all work as a result of the illness or injury.
Usual Occupation – this means:
a. Where you are employed by an employer, the role you are performing for the employer. If, however, there has been a change to that role due to illness or injury within the 12 months before the Date of Disablement on which this definition is being applied, with the result that your role changed or your duties and/or hours you were performing for your employer before such illness or injury occurred.
b. Where you are self-employed, the role which you are engaged in for the purposes of your business, and
c. Where you do not fall under either point (a) or (b), the role that you were engaged in for the longest period in the 24 months before the Date of Disablement on which this definition is being applied or if you have never been employed, the role that you are reasonably suited to by education, training or experience which may include being engaged in Domestic Duties.
This guide is provided for general information only. It does not take into account your personal objectives, financial situation or needs and should therefore not be taken as personal advice. You should consider whether it is appropriate for you before acting on it and, if necessary, you should seek professional financial advice.
*Financial advice may be provided by Togethr Financial Planning Pty Ltd, ABN 84 124 491 078, AFSL 455010, (“TFP”), trading as MyLife MyAdvice. TFP is a related entity of Togethr Trustees Pty Ltd