WorkWelfareWills

(i) Introduction

• Many people with chronic illness will be able to claim disability benefits under insurance policies.

(ii) Types of Insurance Disability Policies

• Income protection
  • covers your income if you can’t work because of an injury or illness.
  • might include extra trauma or bed care benefits.
• Mortgage protection insurance
  • covers mortgage repayments.
• Consumer credit insurance
  • covers personal loan repayments.
• Trauma insurance
  • pays a lump sum upon a particular diagnosis, eg cancer, Multiple Sclerosis, heart attack or stroke.
• Term life insurance
  • pays a lump sum on death or maybe also Total and Permanent Disability (TPD).
  • might also pay a lump sum if you are diagnosed with a terminal illness (less than six or twelve months to live).
• Sickness and accident insurance
  • pays lump sums for TPD, loss of use of limbs, broken bones etc.
  • might be offered under employer or union group policies e.g. Protect, Incolink or IUS .

(iii) Income Protection Insurance

• Many self-employed people have private income protection insurance. Many employees are covered for income protection as part of their employment.
• You might be covered if you can’t do your usual job, one of the duties of your usual job or any other suitable work.
• You will be covered for fixed monthly payments or a percentage of your earnings after a qualifying period.
• The period of insurance payments will depend on the policy - it might be 2 years, 5 years, to age 65 or lifetime.
• If you go back to work, you might still be eligible for partial disability or rehabilitation payments.
• Some income protection policies also include trauma benefits for loss of use of limbs, Motor Neurone Disease, MS, heart attack etc.

(iv) Making Insurance Claims

a) When to claim

• Insurance disability claims should be made as soon as possible.
• However, claims can often be made years later.
• Claims can also be made by the estate of a person after they die.

b) How to claim

• There will be claim forms to fill out and medical reports and other papers to lodge.
• You might be asked to sign medical, Medicare and tax authorities and to go to a few medical and rehabilitation examinations.
• It’s important to give the right information/reports to help your claim – particularly medical reports and written submissions supporting the definition of disability in the policy.
• Claims can take approximately 3 to 12 months.

c) What if your claim is rejected?

• If your claim is rejected, if your insurance payments stop, are late or reduced, or if you are being mucked around, you can lodge a formal Complaint with the insurer.
• They have 21 or 45 days to make a new decision.
• If you are still not satisfied, you can appeal to the courts or to an industry complaints scheme [Financial Industry Complaints Service (FICS) or the Insurance Ombudsman Service (IOS)].
• FICS and the IOS are quicker and cheaper than most courts and complaints are decided by written submissions and replies without formal hearings.
• There are limits on the types of complaints they can deal with.
• It’s important to get update reports and make detailed written submissions to support an IOS or FICS complaint.
• Many appeals and complaints win or are settled.

(v). Important Note-Get help

• There are time limits for appeals to the courts and the industry complaints schemes.
• Get advice and help with a claim or appeal. (See 'Who can I go to for advice and more information' )

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