Your Responsibilities when entering an Insurance Claim

It is your responsibility as the:

  • life insured,
  • your appointed power of attorney
  • or the executor of your estate

to prove that the claimable event has occurred.

For all types of personal insurance claims, basic details of the claimable event are recorded.

As your nominated adviser, we can complete this process for you and register the claim with the insurance company. Following notification of the claim, the insurer will release what information they require from you. The type of information required by the insurer to assess the claim will depend on the nature of the claim.

In the case of a Life Insurance claim, the claim form is shorter and more straightforward. The proof required is a certified copy of the death certificate.

In the event of a claim for an illness or injury, the claim form is lengthier as the insurer will collect information regarding the illness or injury event. The responsibility is on you to prove that the illness or injury event occurred. This requirement must be proven by a relevant medical professional.

Using the diagnosis of cancer as an example of a claimable illness, a section of the required claim form is completed by the relevant medical specialist, usually an oncologist, in the case of a cancer diagnosis. The medical specialist will confirm the diagnosis and will usually include relevant medical reports, such as a histopathology report that will detail the grade and stage of cancer.

It is important to note that the insurer will not accept a self-diagnosis or medical information provided by a professional employed in a field that is unrelated to the claimable event.

Additional evidence is required in Income Protection and Total Permanent Disablement (TPD) claims, beyond proof of the claimable illness or injury event. As both Income Protection and TPD Insurance relate to your ability to generate income by performing your occupational duties, further evidence is required by the insurer. The medical evidence must prove that the insured person was unable to perform the duties of their occupation due to the illness or injury.

Using the example of a back injury to illustrate the responsibility of proof required, you may be able to provide evidence of episodes of back pain from relevant medical professionals, however, if the insured person was able to continue to work through the episodes of back pain, there is no evidence that the injury caused the insured person to be unable to work.

Hence, an Income Protection claim could fail in this regard as there is no evidence to prove that the back pain caused you to be unable to perform the duties required by their occupation.

Income Protection insurance provides protection for your loss of income due to illness or injury that has affected your ability to work to generate income. As Income Protection insurance insures loss of income, a claim on this type of insurance requires financial proof.

The majority of Income Protection contracts are indemnity-based policies. Indemnity Income Protection insurance contracts seek to return you to the financial position you were in prior to the loss of income causing illness or injury. To provide this financial proof, you will need to prove your income to the insurance company.

Tax records are usually the method that the insurance company will use to validate the claim of lost income, therefore the more up-to-date and complete your income and tax records are, the easier it will be for you to access this information and submit this to the insurer as part of your claim.

To recap, the evidence required in a personal insurance claim:

  • All personal insurance contracts

Confirmation from relevant authorities or medical professional(s) of the claimable event, illness or injury.

  • Income Protection & TPD insurance

Proof that the illness or injury event has caused you to be unable to perform the duties of your job.

  • Income Protection insurance

Financial proof that the illness or injury has caused you to lose income.

All of this can seem daunting especially if you are ill, injured, or are experiencing the grief of losing a loved one. Assistance from us can be of value to you at this time. We can liaise between you, the insurance company, your medical provider, and your accountant if required, to coordinate the evidence required to assess the claim. If you think you may need to claim on your insurance policy or have any queries in regards to the process involved in activating a claim, please contact us.