Claiming a benefit if you’re unable to work due to illness or injury
Claiming a benefit if you’re unable to work due to illness or injury
If you are unable to work due to illness or injury, IP cover can provide you with regular monthly benefit payments. IP can be paid if:
The maximum amount payable is either:
Once your pre-disability income is confirmed as part of your claim, the benefit payable 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.
If 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 being 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 will guide you through the process.
For full details on the insurance cover we offer, including important definitions of key terms relating to permanent incapacity claims, refer to our handy Insurance in your super guide for members.
If you’ve experienced an illness or injury that stops you from working, it can be a difficult and stressful time for you and your family. Our claims handbook has been designed to help you understand how the claims process works.
Your IP benefit may also include a contribution to your Catholic Super account. The contribution depends on the amount of IP cover you have and your monthly income. Where your amount of IP cover is:
Your monthly 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.
We may reduce your IP monthly benefit by the amount of any of the following benefits you are entitled to as a result of your inability to work:
But your benefit will not be reduced by:
Call our Service Centre and we’ll help you with the first steps of the claim and inform you of what’s involved with the overall process.
We’ll need to ask you a few questions to help determine the correct benefit you may be entitled to claim. For example we’ll ask you for:
In addition to the information collected, 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.
Once the completed forms are returned, we’ll lodge your claim with our insurer, and you’ll 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:
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 General Medical Statement and ongoing medical reports after a claim has been approved are paid by you.
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.
Our insurer will strive to reach an outcome as quickly as possible and we’ll keep you regularly updated throughout the assessment process.
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 super funds.
Other factors, such as your employment status, work duties and earnings – all immediately prior to the date of disability, your medical capacity, 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 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.
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’ll let you know in writing why your medical condition doesn’t satisfy the relevant definitions. Before formally declining your claim, we’ll write to you to give you 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 started, the insurer may require your doctor to complete a Progress Medical Statement, so they can assess if you qualify for ongoing IP payments.
There are several steps involved in assessing a claim, with the length of time depending on personal circumstances and the availability of information we require from you, your employer, your doctors and specialists to assess your claim.
Our insurer aims to finalise most claims within two months or sooner.
Where a decision can’t be reached within two months, the insurer will write to you to let you know the reasons for the delay.
Once your pre-disability income is confirmed as part of your claim, the benefit payable 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.
If your claim is approved, monthly payments are paid in arrears one month after the end of the waiting period and they continue for the duration of the benefit period, as long as you remain medically certified as being 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 will guide you through the process.
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, 60 or 90 days, and the period starts from the first date that you’re medically certified as being totally disabled. Check your account via Member Online to confirm the waiting period that applies to you.
The benefit period is the maximum length of time for which a benefit is payable, once the waiting period has finished and you remain medically certified as being unable to return to full work.
IP benefits are paid as taxable income and, like salary and wages, they attract Pay As You Go (PAYG) tax. The tax will be deducted from the benefit before it’s paid to you and remitted to the Australian Taxation Office.
Catholic Super offers expert financial advice services through our licensed Financial Planners.
Our advisers can provide assistance on the likely impact of any benefit payment with regards to your personal financial situation, and help you make informed decisions about your benefit.
Catholic Super offers expert financial advice services through our licensed Financial Planners.
Our advisers can provide assistance on the likely impact of any benefit payment with regards to your personal financial situation, and help you make informed decisions about your benefit.
Remember, we’re here if you need us for assistance with the claims process, or if you have any queries about the progress of a claim, or for any insurance related queries.
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