Sunsuper income protection insurance claims guide

Sunsuper
income
protection
insurance
claims guide
1 July 2016
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more than dreams
INCOME PROTECTION INSURANCE CLAIMS
We can appreciate that being unable to work would be a difficult
and uncertain time for you. We will strive to ensure that your claim is
processed in a timely manner so you can receive a decision as quickly
as possible.
The Income protection insurance claims guide provides information about making an insurance claim. For information about insurance cover, including eligibility
and the terms and conditions that apply, you should refer to the applicable Product Disclosure Statement (PDS). For a copy of the PDS, call us on 13 11 84.
General advice disclaimer The information in this guide is general information only and doesn’t take into account your personal objectives, financial situation
or needs. You should consider the appropriateness of any general information in this guide having regard to your own personal objectives, financial situation and
needs. You should consider the Product Disclosure Statement before making a decision. Call 13 11 84 or visit sunsuper.com.au for a copy. You should obtain
financial advice tailored to your personal circumstances. Call us if you would like to speak with one of our qualified financial planners.
Our phone based qualified financial planners provide simple advice about your Sunsuper account at no additional cost. More comprehensive advice may incur
a fee. Sunsuper employees provide advice as representatives of Sunsuper Financial Services Pty Ltd (ABN 50 087 154 818 AFSL No. 227867) (SFS), wholly
owned by the Sunsuper Superannuation Fund.
We are committed to respecting the privacy of personal information you give us. If you would like a copy of Sunsuper’s Privacy Policy visit sunsuper.com.au/privacy or
call 13 11 84. Sunsuper income protection insurance claims
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INCOME PROTECTION INSURANCE CLAIMS
1. What is Income Protection (IP)
Insurance
Income Protection (IP) insurance provides you with a monthly
income while you’re unable to work due to temporary injury or
sickness/illness. It is intended to ease the financial burden of
your injury or sickness/illness by helping to cover the costs of
day-to-day living as well as your treatment costs.
To make an IP claim, you must meet the definition of ‘Total
Disability’ as outlined in your Insurance Guide (Sunsuper for life
and Sunsuper for life Business) or your Corporate Plan guide
(Sunsuper for life Corporate) and have become totally and
temporarily disabled while you were insured with Sunsuper.
2. How to make an IP claim
If you believe you that you may be eligible to apply for an IP
payment, we are here to help you along the way. To submit
your claim you need to complete three major steps:
Step 1
Step 2
Before you call us, you will
need to prepare some basic
information about your claim
Call Sunsuper on 13 11 84
to start the claims process
This will allow us to start the claims process from
the moment we first speak to you.
The necessary information includes:
• Your Sunsuper membership number
• You can find this number in the top right hand
corner of your Annual Statement as well as
most other correspondence from Sunsuper
You’ll be transferred to our Claims Team who
will be able to help with the first steps of the
claims process.
The Claims Team will:
• provide you with details of your current account
balance and insurance cover
• advise you of the documents and information you
need to provide for the claim to be assessed, and
• send you the IP claim forms for completion.
• Details about your injury/illness
• Date on which your injury first occurred or
your sickness/illness first presented itself
• Details and date of your diagnosis
• Details about your work status
• The date you last worked
• The amount of hours worked per week
leading up to your injury or sickness/illness
Step 3
Complete and return the
IP claim forms
Please read all information we send to you carefully,
and take the time you need to gather all information
required to complete the claims process. You will need
to answer several questions and provide us with
additional information. Completing the claim form is
the largest and most important step in this process:
the details and evidence you provide will form the
basis upon which the Insurer makes their decision in
regards to your IP claim.
We recognise that this may be a daunting task, and
our Claims Team is here to help you every step of the
way. We will provide you with the name and contact
details of your own dedicated Claims Representative
who will assist with your claim and help answer any
questions you may have along the way.
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INCOME PROTECTION INSURANCE CLAIMS
3. What does an IP ‘claims pack’ contain?
There are a number of forms you will need to complete when
making an IP claim (detailed below). Please do not hesitate to
call the Claims Team if you have any questions. This will help us
to ensure that your claim is progressed as quickly as possible.
1. Claim Application
What is this form for? This form is to be completed by you. It
includes your contact information, employment details and basic
details about your injury or sickness/illness.
It will ask specific details about the work you performed leading
3. An Employer statement
What is this form for? This form is to be completed by your
employer with whom you were employed at the time of your
injury or sickness/illness. Your employer will be required to
detail the scope of your position and outline the types of duties
you performed in your role.
Tips: We recommend that you contact the Human Resources
department or your direct manager from your employer as this
form must be completed by an authorised person who worked
closely with you.
up to your injury or sickness/illness, how your injury or sickness/
illness has affected your ability to work, whether you’ve had
a similar condition before and whether you intend to claim
other benefits.
Tips: You must provide us with several pieces of information,
and these tips will help you to find them.
4. Centrelink Authority to Release
Personal Information
What is this form for? If you receive Centrelink benefits, you
must complete this form to give authority to Sunsuper and its
Insurer to obtain information about your benefits.
• The ‘Trading name of last employer’ will be detailed on your
payslip or your Payment Summary (group certificate)—the
Trading name of your last employer may not be the name you
know your employer as, so please check this carefully.
• ‘Fund of choice’ means the fund your employer was paying
into at the time of your injury or sickness/illness.
If you are unsure about the dates and hours you worked,
we recommend that you contact the Human Resources
department of your (previous) employer or refer back to your
previous payslips.
5. Authority to release personal
Medicare and Pharmaceutical
Benefits Scheme (PBS) claims
information
What are these form for? These forms provide authority
for release of information from both Medicare and the
Pharmaceutical Benefits Scheme (PBS) directly to the Insurer to
assist them with the assessment of your claim.
Please note: These forms are not required in every instance
2. Treating Doctor’s Report
and will only be included where necessary.
What is this form for? This form is to be completed by the
6. Tax File Number declaration
doctor who treated you at the time of your diagnosis. Their
statement will describe the nature and extent of your disability
What is this form for? We are required to advise the Australian
and provide evidence for it (such as medical records, test
Taxation Office that we are making income payments to you in
results etc.).
lieu of your salary.
Tips: We recommend that you phone your doctor and let them
know that you are in the process of making an IP claim. You may
be required to make an appointment with your doctor to have
them to complete this statement. Please note that you will be
responsible for the costs of this appointment and any other
costs involved in obtaining this statement.
7. Bank Account Nomination form
What is this form for? This form asks how you would like to
receive your money should your claim be successful.
Tips: Providing this information to us at the outset will ensure
that you can receive your payment without delay if your claim
is approved.
Remember, if you need assistance
please call the Claims Team
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INCOME PROTECTION INSURANCE CLAIMS
4. What you will need to provide
in your IP claim
Completing your IP claim forms is an important step in your
claim process. The details and evidence you provide will form
the basis upon which the Insurer makes their decision. Providing
us with all the information we require and completing your
forms correctly will speed up your claims process. If information
is missing or incomplete, we will need to contact you to ask for
it, which will delay your claim. We understand that completing
the claims application may be a daunting task, and our Claims
Team is here to help you every step of the way. Please contact
the Claims Team who will assist you with any questions you
have about the information we require and completing your
claim forms.
Certified proof of your identity
You must provide a certified copy of your ID as proof of your
identity (for example, a driver’s licence or passport).
Why? Your super is your money, so for security purposes,
we need to be sure that the super belongs to the person
submitting the claim. Understandably, you won’t want to send
us your original documents, so we ask that you have a copy
certified by an authorised person.
Tips: See our Proof of Identity Requirements section for
information on what forms of ID are suitable and how to have
a copy certified.
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Income Protection claims
checklist
Before you send your claim through, make
sure you have fully and correctly completed
the following requirements:
□ Certified proof of your ID
□ Claim Application
□ Treating Doctor’s Report
□ Employer statement
□ Centrelink Authority to Release
Personal Information (if required)
□ Authority to release personal Medicare
and Pharmaceutical Benefits Scheme
(PBS) Claims information (if required)
□ Tax File Number declaration
□ Bank Account Nomination form
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INCOME PROTECTION INSURANCE CLAIMS
5. The IP claim assessment process
Claim forms are received
Insurer assesses
the claim
Claim is accepted
by the Insurer
Claim is declined
by the Insurer
Claim outcome and
ongoing payment
Sunsuper Trustee reviews
Insurer’s decline of claim
Sunsuper Trustee
disagrees with decline
Sunsuper Trustee upholds
decision to decline
The Insurer may also:
Claim forms are received
• ask for additional reports from your doctor/s
• ask you to provide more information
• ask your employer for more information, and/or
Your dedicated Claims Representative will notify you once your
claim has been received. Your Claims Representative will review
your application and ask you for any further information we
• make an appointment for you to have a medical examination
with an independent specialist/s.
require. Once we have received all the information we require
The Insurer will pay for any additional medical reports they
for this initial stage, we can begin the assessment of your claim.
request and any examinations they arrange for you to attend.
Your Claims Representative will endeavour to keep you updated
on your claim’s progress each fortnight.
Insurer assesses the claim
Claim is accepted
by the Insurer
If your claim is accepted by the Insurer, we will contact you
to advise that your claim has been approved, arrange for
The Insurer will use the information you, your employer and your
payment directly to your bank account, and send you a payment
treating doctor provide when making its assessment.
confirmation letter.
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INCOME PROTECTION INSURANCE CLAIMS
Claim outcome and
ongoing payment
Claim is declined by Insurer
If your claim is accepted and you remain unable to work,
If your claim is declined by the Insurer, this generally means
each month you will be asked to fill in a progress claim form
that the Insurer doesn’t regard you as ‘Totally Disabled’ or
and arrange for your treating doctor to complete a Medical
‘Partially Disabled’ according to the policy definition.
Attendant’s Statement form, so that the Insurer can consider
further payments. We will send these forms to you after each
payment, and you must return them at least 10 working days
before your next payment is due. Unless further medical
evidence is required, the prompt return of these forms will
Sunsuper Trustee reviews
Insurer’s decline of claim
ensure you receive your next payment on time. Please note you
are required to meet the cost for completion of these forms.
Benefit payments will generally continue until:
• you no longer satisfy the relevant definition, e.g. ‘Total
Disability’, ‘Limited Total Disability’ or ‘Partial Disability’
• you reach the end of the benefit payment period or you
turn 65 (whichever is earlier)
• you are employed under a Class 457, 422 or 418 working
All claims declined by the Insurer are referred to the Sunsuper
Trustee for assessment and consideration. If the Sunsuper
Trustee disagrees with the decision of the Insurer and believes
that your claim should be approved, your claim will be referred
back to the Insurer for their reconsideration. The Claims
Team will contact you to advise you of the next steps. If the
Sunsuper Trustee agrees with the decision to decline the
claim, your Claims Representative will contact you to advise
you of this outcome. If you disagree with this decision you
visa and the term of the Class 457, 422 or 418 visa
can lodge a written complaint with Sunsuper. Your complaint
expires, or you permanently depart Australia (whichever
will be investigated, and if you are not satisfied with our
occurs earlier)
response or we haven’t responded within 90 days, you may
• you reside overseas and have received 12 months
of payments, or
• your death.
ask the Superannuation Complaints Tribunal (SCT) whether you
are eligible to submit a complaint to them. Time limits apply that
affect when you can make a complaint to the SCT about an IP
claim. Call the SCT on 1300 884 114 or visit their website www.
sct.gov.au for more information.
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INCOME PROTECTION INSURANCE CLAIMS
6. Frequently Asked Questions about IP claims
Do I need a lawyer?
Are there any exclusions or restrictions?
Our claims process has been designed so that in most cases,
You will not be eligible to be paid an IP benefit if your injury
you or your family should not require the assistance of a lawyer
or illness/sickness is caused, wholly or partly, directly or
when making a claim. We don’t give priority to claims lodged
indirectly, from:
by lawyers – all claims are dealt with in the same manner and
follow the same process. If you are thinking about seeking legal
help, we recommend that you first determine the costs involved
in doing so and how they will impact your benefit payout. We
recommend that you call us before seeking help from a lawyer.
Do I have IP insurance?
Not all Sunsuper members have IP insurance. To check your
• deliberate self-inflicted injury or attempted suicide or self
destruction while sane or insane
• uncomplicated pregnancy, childbirth or miscarriage
• your deployment to a hostile environment as part of active
military service, or
• a criminal act committed by you.
level of cover, login to Member Online, review your Annual
Limited cover will apply to your Standard IP cover for a period of
Statement or call us on 13 11 84.
24 months and until you have been At Work for 30 consecutive
days at the end of the 24 month period.
Is there a Waiting Period?
In most cases, you will need to have been continuously unable
What happens if I’m partially disabled?
to work due to injury or sickness for a period of time: 30, 60,
A reduced monthly IP benefit may be payable if you become
90 or 180 days depending on your type of cover. The Waiting
‘Partially Disabled’. For definitions, refer to your Insurance
Period will begin from the date you are Totally Disabled and
guide (Sunsuper for life and Sunsuper for life Business) or
unable to work as certified by a medical practitioner.
your Corporate Plan guide (Sunsuper for life Corporate).
Do I have to re-start a Waiting Period
if I return to work?
How much will I be paid?
Generally, you may be able to return to work during the Waiting
Period, but it is important to contact us to check this applies
to you. If your waiting period is 30 days, you may be able to
work for up to five days without having to start the Waiting
Period again. If your Waiting Period is 60, 90 or 180 days, you
may be able to return to work for up to 10 days during that
time without having to re-start the Waiting Period. In these
circumstances, if you do return to work, your original Waiting
It is important to understand that any insurance benefit
amount is determined at the date you became disabled; the
insurance benefit amounts shown on your Annual statements
or in Member Online may therefore differ to the amount at your
disablement date.
The monthly benefit you will be paid will be the lower of:
• the level of cover selected by you less any offsets, and
• 75% of your monthly rate of Pre-Disability Income less any
Period may be extended by the number of days you work. If you
offsets, plus a superannuation contribution where this forms
return to work for longer than the periods specified above, then
part of your insured IP cover.
the Waiting Period may start again.
When are benefit payments made?
Once your claim has been accepted by the Insurer, your first
monthly payment will be paid in arrears one month after
the end of the waiting period. Subsequent payments are
made monthly.
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INCOME PROTECTION INSURANCE CLAIMS
Will I pay tax on the benefit?
Your monthly benefit will be paid to you, less any PAYG tax
payable. You will receive a PAYG Payment Summary for IP
benefits paid to you during the financial year as soon as
possible after the 30th of June for inclusion in your annual
tax return.
Will there be offsets to my
benefit payment?
Your IP benefit payment may be reduced by the
following payments:
• Workers’ Compensation or Transport Accident Compensation
or similar legislation in relation to your injury or illness
• any other payments, statutory or otherwise, paid to you for
loss of income in relation your injury or sickness
• any other payments made under any disability income type
insurance policy, and/or
• any other lump sum payment which relates to loss of income
due to injury or illness (other than a TPD or terminal illness
benefit under the relevant Policy).
Your IP benefit payment may also be reduced by any sick
leave from your employer, however you are generally not
required to use all your sick leave before receiving an Income
Protection benefit.
What happens if I have a recurring
injury or sickness/illness?
Following a claim, if you make a further claim arising from
the same or related cause as the first claim, the further claim
will be:
a)treated as a separate claim if it occurred after you returned
to work for at least 6 continuous months, or
b)deemed to be a continuation of the original claim if made
within 6 months from the end of payments from the earlier
claim. A further Waiting Period will not apply in this case,
however the relevant benefit period will be adjusted to take
into account prior benefits paid under the relevant policy for
the original claim.
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Occupational Rehabilitation in Super –
‘Work is Good Medicine’
Returning to work can restore more than your
income: it helps to restore your identity and
self-esteem.
At Sunsuper, we work with our insurers to
offer you access to one of the largest and most
experienced rehabilitation teams. This means
that if you have suffered an injury, disability
or health condition, we can arrange workrelated rehabilitation to assist in your return to
meaningful work.
Together with our insurers, we work in
partnership with you, your treating health
professionals and employer to help you return
to suitable work as part of your recovery
plan. If you are unemployed, we can help you
improve your readiness for work and/or locate
suitable employment.
Occupational rehabilitation services may include:
• initial meetings with a rehabilitation provider
to identify your return to work needs
• workplace visits to identify solutions for
your return to work plan
• equipment to ensure you maintain your job
• career guidance to explore alternative work
options if you can’t work in your usual role
• improving your skills and capabilities so that
your return to work is sustainable.
Rehabilitation is not appropriate for everyone.
If you would like further information about
your rehabilitation options please speak with
your Claims Representative at Sunsuper by
calling 13 11 84.
Together we may be able to assist you in
getting back to work and back to a fuller life!
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Proof of identity
requirements
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PROOF OF IDENTITY REQUIREMENTS
when it comes to safeguarding your money; and no-one is
What is an acceptable identification
document?
immune. That’s why super funds will ask you to provide certain
Any one of the following documents will be accepted as
information and documents about your identity when you
primary identification:
Australia’s $2 trillion super pot represents a large and growing
temptation for criminals, with identity theft the biggest risk
request money from your account. We need to be sure that the
super belongs to the person making the claim. Getting your
identity documents together to access your money may seem
like an unnecessary hassle, but we can assure you it’s essential,
your protection is our top priority.
When do you need to prove your
identity?
All super funds, including Sunsuper, will ask you to provide
certified identification before paying any money out.
If you cannot provide us with one of the primary identification
documents outlined on this page, then we may accept two of
the documents listed in the table on the following page, one
document from each column. It’s important to note we cannot
accept documents that have expired. We also reserve the right
to request additional information to verify your identity before
paying your benefit claim.
• a driver’s licence or permit issued under a law of a State or
Territory, or equivalent authority of a foreign country, that
contains your photo, name, residential address and date of
birth (please copy and certify both front and back sections
if relevant)
• a passport issued by the Commonwealth
• a card issued under a law of a State or Territory for the
purpose of proving the person’s age which contains your
photo, name and date of birth (please copy and certify both
front and back sections if relevant), or
• a passport or a similar document issued for the purpose of
international travel or a national identity card issued for the
purpose of identification that:
A. contains your photo, name and signature
B. is issued by a foreign government, the United Nations
or an agency of the United Nations
C. if written in a language that is not understood
by the person carrying out the verification, is
accompanied by an English translation prepared by an
accredited translator.
If you don’t have any primary identification, see the table over
for acceptable forms of secondary identification.
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PROOF OF IDENTITY REQUIREMENTS
One document from this column
• A birth certificate or birth extract issued by a State
or Territory
• A citizenship certificate issued by the Commonwealth
• A citizenship certificate issued by a foreign government
• A birth certificate issued by a foreign government, the
United Nations or an agency of the United Nations
plus
One document from this column
A notice that:
a)was issued to you by the Commonwealth, a State or
a Territory within the preceding 12 months,
b) contains your name and your residential address, and
c)records the provision of financial benefits to you under
a law of the Commonwealth, State or Territory (as the
case may be).
• A pension card issued by the Department of Human
Services that entitles you to financial benefits
• A healthcare card issued by the Department of Human
Services that entitles you to financial benefits
A notice that:
a)was issued to you by the Australian Taxation Office
within the preceding 12 months,
b) contains your name and your residential address, and
c)records a debt payable to or by you to the
Commonwealth under Commonwealth law relating
to taxation.
A notice that:
a)was issued to you by a local government body or utilities
provider within the preceding three months,
b) contains your name and your residential address, and
c)records the provision of services by that local
government body or utilities provider to your address or
to that person.
In relation to a person under the age of 18, a notice that:
a)was issued to you by a school principal within the
preceding three months,
b) contains your name and your residential address, and
c) records the period of time you attended the school.
Note: If any of the approved documents have been issued by
a foreign government and are written in a language that is not
understood by the person carrying out the verification, the
documents must be accompanied by an English translation
prepared by an accredited translator.
Examples of acceptable linking documents are:
• certificate from the Births, Deaths and Marriages
Registration Office or relevant government source from the
issuing country (i.e. marriage certificate or change of name)
• deed poll or decree nisi.
What if you’ve recently changed
your name?
What do we mean by certified?
If you have changed your name and have not yet advised us,
We understand you’ll want to provide us with copies of your
you will need to provide what is called a ‘linking document’. A
linking document is used to prove a relationship exists between
two (or more) names.
identification documents rather than the originals. However,
you must have these copies ‘certified’ as a true copy of the
original. This means that you need to have a person who
is authorised to certify documents (see the section on the
following page) sight the original document and the copy of
the documents (e.g. a photocopy) to make sure both documents
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PROOF OF IDENTITY REQUIREMENTS
are identical, and then ‘certify’ all copied pages as true copies
by writing or stamping ‘certified true copy’ on them. They must
also sign and print their name on the document and record their
qualification (e.g. Justice of the Peace) and the date.
•
Accountant (member of ICA, ASA, IPA or CPA, ATMA, NTAA)
•
Veterinary surgeon
•
Bank officer, building society officer, credit union officer,
finance company officer – employed for five years or more
Who can certify your identification
documents in Australia?
• Justice of the Peace, commissioner of declarations, or
Only certain people are authorised to certify documents in
• police officer, sheriff or sheriff’s officer
Australia. Approved people include those who are currently
authorised to witness a statutory declaration under the
Statutory Declarations Regulations 1993 (Commonwealth),
commissioner of affidavits
• notary public
• Those who hold a Court position, such as a Bailiff, Judge,
Schedule 2, Part 1 and Part 2.
Magistrate, Registrar, or Deputy Registrar, Clerk, Master of
a court, CEO of a Commonwealth court
People authorised to certify your documents include a:
• Health professional, such as a Chiropractor, Dentist,
• Government representatives (elected): Federal, State or
Territory or Local
Medical practitioner, Nurse, Optometrist, Pharmacist,
Physiotherapist, Psychologist
• Public servants: Federal, State or Territory or Local –
employed for five years or more.
• Legal professional, such as a Legal practitioner, Patent
attorney, Trade marks attorney
• Teacher (full-time) at a school or tertiary
education institution
• Minister of religion, or marriage celebrant.
If you are unable to locate any of the above certifiers, others
may be accepted. We recommend you contact us on 13 11 84
to confirm who else we will accept as a certifier.
What does a certified identity document look like?
This is what a certified proof of identity document
should look like:
Copy of the document that identifies you, (i.e. your passport or
driver’s license – front and back)
Write or stamp “certified true copy” of original document
Have the authorised person sign the document
Authorised person’s stamp and registration number
(if applicable)
Name, qualification, phone number and address of
authorised person, and
Date of authorisation
00000000 0 0000
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PROOF OF IDENTITY REQUIREMENTS
What if you live overseas?
• Judge of a Court or magistrate in an overseas jurisdiction
If your claim is submitted from outside Australia, we still require
• international Justice of the Peace (JP)
certified identification documents before we can pay out
• registrar or deputy registrar of a Court
your benefit.
The list of acceptable documents is still the same; however,
we can only accept certified identification documents that are
signed by an:
• Australian consular officer
• commissioner of oaths.
The person who is authorised to certify documents must sight
the original and the copy to make sure both documents are
identical, and then ‘certify’ all copied pages as true copies
by writing or stamping ‘certified true copy’ followed by their
• Australian diplomatic officer
signature, printed name, qualification (e.g. police officer)
• police officer of an overseas force
Examples of what is acceptable include:
and date. We also require evidence of the certifier’s status.
• notary public
Qualification
Certification Required
Police officer
Details of their police badge number
Judge or magistrate
Certificate of their appointment to their position
Justice of the Peace
Justice of the Peace stamp or number
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make your dreams
more than dreams
Contacting us is easy:
13 11 84 (+61 7 3121 0700 when overseas)
GPO Box 2924 Brisbane QLD 4001
sunsuper.com.au
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ABN 88 010 720 840 ABN 98 503 137 921
AFSL No. 228975 SPIN SSR 0100 AU
MySuper Authorisation 98 503 137 921 996
Unique Super Identifier (USI) 98 503 137 921 001
Sunsuper is a member of The Association of Superannuation Funds
of Australia Limited (ASFA).
Copyright ©2016 Sunsuper Pty Ltd 1860 (07/16)
The Sunsuper insurance claims guide is prepared and issued
by Sunsuper Pty Ltd, the issuer and Trustee of the Sunsuper
Superannuation Fund (referred to as ‘the Fund’ or ‘Sunsuper’):