Claims, Mistakes and Official Sources
How to make a life, TPD or income protection claim in Australia
Step-by-step guide to claiming on life, TPD, trauma and income protection cover in super or retail, what evidence to gather, timeframes, and how to complain.
To make a claim, contact the super fund (for cover through super) or the insurer (for retail cover) as early as possible, ask for the claim forms, and send medical evidence, employment and income records, and proof of identity. The insurer assesses the claim against the policy definitions and must keep you informed. Under the Life Insurance Code of Practice, subscribing insurers commit to timeframes and regular updates. If you disagree with the decision, complain to the insurer or fund in writing first, then, if needed, to the Australian Financial Complaints Authority (AFCA), which is free.
This is the overview for the claims, mistakes and sources section.
Step 1: Find every policy that might pay
Before you claim, list every source of cover:
- Every super account, including old ones. ATO online services through myGov lists accounts; each fund's insurance section shows cover.
- Retail policies, including any held through an adviser or bought directly.
- Employer group cover outside super, such as salary continuance.
- Cover attached to loans or credit cards, sometimes called consumer credit insurance.
- Workers' compensation or transport accident schemes, if the illness or injury is work-related or from a road accident. These affect income protection; see offsets.
Claim on all of them. Holding cover in two funds can mean two payouts, if each definition is met.
Step 2: Notify early
Most policies ask you to notify the insurer within a set time. Late notice does not automatically defeat a claim, because the Insurance Contracts Act 1984 limits an insurer's ability to refuse a claim for late notice unless it was prejudiced. For income protection, notify during the waiting period so the claim is ready when benefits start.
Step 3: Gather evidence
| Claim type | Typical evidence |
|---|---|
| Death | Death certificate, the policy or fund details, beneficiary identity documents, sometimes a coroner's report |
| Terminal illness | Certificates from treating doctors, usually including a specialist, on life expectancy |
| TPD | Treating doctors' and specialists' reports on permanence and work capacity, employer statement, work history and education |
| Trauma | Specialist report and test results meeting the policy definition |
| Income protection | Medical certificates, employer statement, pre-disability income evidence (payslips, tax returns, business financials) |
Ask treating doctors to address the definition in the policy, not just your diagnosis. For TPD, that means your capacity for work suited to your education, training or experience. See TPD definitions.
Step 4: The assessment
The insurer may ask for more information, independent medical examinations, surveillance in some cases, and a review of your medical history. It checks whether the application was accurate; see the duty to take reasonable care.
Under the Life Insurance Code of Practice, subscribing insurers commit to:
- Telling you what they need and keeping you updated at regular intervals.
- Making decisions within set maximum timeframes for each claim type, unless there are unusual circumstances, and explaining any delay.
- Giving reasons in writing if they decline, and telling you how to complain.
- Treating vulnerable customers, including those with mental illness or in financial hardship, with care.
Insurers also have legal duties: claims handling and settling is a regulated financial service, so insurers must act efficiently, honestly and fairly. The duty of utmost good faith under the Insurance Contracts Act applies to both sides.
For cover in super, the trustee also has to consider the claim, and must be satisfied that you meet the condition of release before paying benefits out of the fund.
Step 5: If the claim is declined or delayed
- Ask for reasons and documents. You can request the information the insurer relied on, including medical reports.
- Complain in writing through the insurer's or fund's internal dispute resolution (IDR) process. Insurers generally must respond within 30 calendar days; super trustees within 45 days, with longer timeframes for some death benefit complaints.
- Go to AFCA if you are not satisfied or the deadline passes. See AFCA complaints.
- Consider a lawyer for large TPD or disputed claims. Many lawyers in this area work on a no-win, no-fee basis; ask for a written costs agreement and compare the fee with what AFCA would cost you (nothing).
Common reasons for declined claims
- The cover had lapsed, for example in an inactive super account. See the opt-in rules.
- The condition did not meet the definition, especially for TPD and trauma.
- The condition was excluded at acceptance.
- The insurer says the application contained a misrepresentation.
- Income evidence did not support the benefit claimed.
See life insurance mistakes to avoid.
Frequently asked questions
How long does a TPD claim take?
TPD claims often take months, because the insurer needs evidence of permanence and may wait for treatment outcomes. The Code sets maximum timeframes and requires regular updates. Ask the insurer what it is waiting for.
Can I claim on cover in a super account I no longer contribute to?
Yes, if the cover was still in force when you became ill or injured or died. Check the date the cover ended against the date of the event.
Can family members make a claim on my behalf?
Yes, with authority such as a power of attorney, or as beneficiaries or executors in the case of death.
Sources
- AFCA — complaints about insurers and super funds
- Financial Services Council — Life Insurance Code of Practice
- Moneysmart — making an insurance claim
- ASIC — claims handling regulation and reporting misconduct
- ATO — finding all your super accounts
