Download - Claiming an Income Protection benefit
Claiming an Income Protection benefitThis document provides information about making a claim for Income Protection benefit.
Claiming Income Protection benefit
What is Income Protection?
Income protection (IP) insurance pays a monthly income,
while you are unable to work due to illness or injury. Australian
Catholic Superannuation and Retirement Fund’s (Australian
Catholic Superannuation) IP cover is unitised cover, with each
unit covering a ‘Salary’ up to $1,000.
What is the waiting period to claim? The waiting period is the number of consecutive days (either 30,
60 or 90 as applicable) for which you must be totally or partially
disabled before you are eligible to receive benefits.
The Waiting Period commences from the later of the following:
a. the date you were first examined by a Medical Practitioner
as Totally Disabled in relation to an injury or sickness that
gave rise to a claim; and
b. the date you ceased work due to that injury or sickness.
If you had consulted a Medical Practitioner within seven days of
ceasing work due to the injury or sickness, the Waiting Period will
commence from the date you ceased work.
What are the benefit periods?
The benefit period is the maximum amount of time ‘Total
Disability’, and ‘Partial Disability’ benefits may be paid for 2
years, 5 years and up to age 65. For your benefit period please
contact Australian Catholic Superannuation or log onto the
member portal. Login or register at www.catholicsuper.com.au
What is involved when making an IP claim?
The high-level steps of details outlining what is involved in
applying for the IP benefit.
Step 1
You can go online or advise Australian Catholic Superannuation that you wish to claim. You can make a claim through the Member Portal. In the Member Portal you simply click on ‘make a claim’. OR contact the Fund on 1300 658 776.
Step 2Complete lodgement form online OR alternately you can contact Australian Catholic Superannuation to raise a claim on your behalf.
Step 3
Depending on the information in the original forms, you may be required to see an independent doctor or specialist or provide further information. The Insurer may also request additional information from you, your doctors or employers.
Step 4Once all the requested information has been obtained by the insurer. The claim will be assessed. The assessment is undertaken by the Insurer.
Step 5
If the claim is approved, payments are made into your nominated bank account, with the super contribution portion paid into your Australian Catholic Superannuation account.
Step 6
If claim is declined, the information will be sent to the Fund’s Insurance Claims and Complaints Committee (The Trustee) for a decision to be reviewed.
Step 7
If The Trustee agrees with the insurer, a letter will be sent to you to explain why your claim was declined. If the Trustee disagrees with the insurer, they will send it back to the Insurer for further review.
What information do I need to provide to make the claim?
The information that is required to make a IP claim is:
• Declaration and Authority.
• An original certified copy of your ID.
• An Employer’s Statement. This statement will need to be
completed by your employer.
• Medical Attendants Statement.
• An EFT Form so we can be aware of your payment details.
• A Tax File Number Declaration.
The insurer will assess your claim and will request further
information to complete the assessment of the claim.
How to certify a document?
A certified document is a copy of the original proof of
identification document that has been signed and certified as a
true and correct copy of the original. Only authorised people can
certify a document.
A “Certifying your identification documents” flyer will be attached
to the initial claims pack
Will the insurer require further information once the claim is lodged?
More often than not, the insurer will request additional
information be provided. The insurer may request an
independent medical assessment by a medical practitioner of
their choosing, which is at their expense to assist with the review
process.
How long does the assessment take?
We are unable to provide an exact timeframe, as each case
is different however the insurer and Australian Catholic
Superannuation will strive to resolve the claim as quickly as
possible.
However, whilst your claim is being assessed, the insurer or
Australian Catholic Superannuation will contact you to provide
you with updates on your claim.
Roles and duties
What happens if my claim is approved, and benefits are paid?
If your claim is approved and the waiting period has expired,
payments are made monthly in arrears.
For example, after a waiting period of 90 days, the initial payment
of the claim will not be due to be paid until after the 120th day.
Roles Responsibilities
You (Member of fund)
• Lodge the claim online or complete the claim forms.
• Provide any information that has been requested.
Case Manager
• Provides you with the claim documents.
• Explains the process to you and help when required.
• Provides responses to any of your enquiries.
• Keeps you update on the progress of your claim.
Insurer
• Assesses the claim against the policy definition and provides the decision to the Trustee.
• Keeping you updated on the progress of your claim.
• If claim is approved, they pay the benefit to you.
Trustee• Will review the claim once the insurance
assessment has been completed. This is for declined IP claims only.
Claiming Income Protection benefit
What are benefit offsets?
Your IP benefit will be offset (reduced), so that the combined
amount of the benefit payable and Benefit Offsets is no more
than the lesser of the monthly equivalent of 85% of:
• the insured Member’s Salary; and
• the Maximum Benefit.
Your benefit will be offset (reduced) by the following:
All benefits or other payments (whether lump sum, periodic or
otherwise) which are paid, or are required to be paid, in relation
to your injury or illness, under any:
• workers’ compensation, motor accident compensation or
similar legislation or scheme;
• Common law settlements for loss of income, loss of earning
capacity or any other economic loss, whether paid as a
lump sum or not;
• Disability income type insurance policy from any other
insurance company;
• sick leave payments.
Any other loss of income, loss of earning capacity or any other
economic loss component of a lump sum payment paid or
required to be paid (except for lump sum received for TPD or a
lump sum superannuation payment).
Any income received from your employer while being paid a
benefit excluding annual leave, redundancy payments and long
service leave entitlements.
For the full information in relation your benefit offsets please refer
to the Insurance Factsheet.
What is the IP benefit?
The IP benefit is the lesser of:
• 85% of your Salary
• 85% of the benefit provided by the number of units you hold.
The benefit is split, so that 75/85ths of the benefit is paid to you
and 10/85ths is paid as a contribution to your Australian Catholic
Superannuation account.
How is the partial benefit calculated?
A partial disablement benefit is calculated using the below
formula.
When you are receiving a benefit, does the Insurer request information?
While you are receiving an IP benefit, the insurer may request
information on an ongoing basis. This can include financial
as well as medical information. If you are deemed fit by your
medical practitioner your IP may cease before your benefit
period expires.
When will IP benefits cease to be paid?
IP payments will cease when one of the following happens:
• You are no longer Totally Disabled or Partially Disabled (as
applicable)
• You reach the end of the benefit payment period (2 years
unless you have been approved/underwritten for a longer
payment period)
• You reach age 65
• You die
• If you are receiving a Partial Disability benefit, and the
amount you are earning, or capable of earning is equal to or
greater than your pre-disability ‘Salary’
• If you travel or reside overseas for more than six months
while claiming an IP benefit. Payments will only resume if
you return to Australia and establish your entitlement to a
benefit.
Claiming Income Protection benefit
A = is the Insured Member’s Pre-Disability Income
B = is the greater of the Insured Member’s income
during the month of Partial Disability or the
income the Insured Member is capable of
earning during the month of Partial Disability
C = is the Monthly Benefit
A – B x CA
What happens if my claim is not approved?
If the Insurer declines your claim, the information will be sent to
the Insurance, Claims and Complaints Committee (The Trustee)
for review to make sure it is fair and reasonable. If they agree
with the insurer’s decision, a letter will be sent to you explaining
why the claim was declined. If the Trustee disagrees with the
insurer’s decision, they will send the claim back to the insurer for
assessment.
What do I do if you disagree with the decision?
You may appeal the decision and provide further information to
support your appeal through our internal complaint’s procedure.
Once the new information is received your claim will be re-
assessed. The assessment will be undertaken by the Insurer.
Once a decision has been made, the information will once again
be sent to The Trustee. If you are unhappy with the outcome,
a complaint can be forwarded to the Australian Financial
Complaints Authority (AFCA).
AFCA is an independent external disputes resolution scheme to
assist members to resolve certain superannuation complaints.
Definitions
Employer member(s) means you are enrolled into Australian
Catholic Superannuation by an employer sponsor (i.e., an
employer who has completed an Employer application form),
who makes super contributions to the Fund on your behalf.
Partial Disability means solely as a result of Injury or illness you
are:
a. incapable or performing one or more duties of your usual
occupation necessary to produce income but has returned
to work in your usual occupation or is working in another
occupation and has a monthly salary less than your Pre-
Disability Salary; and
b. following the advice of a Medical Practitioner in relation to
your illness or Injury for which they are claiming.
Personal Members means you have joined Australian Catholic
Superannuation and you were not enrolled by an employer who
completed an application form to participate in the fund.
Total Disability means solely as a result of Injury or illness, you
are:
a. medically certified as being incapable of performing one or
more duties of your usual occupation necessary to produce
income:
a. not engaged in any occupation: and
b. under the care of a Medical Practitioner.
Salary
a. if you are in permanent employment: The annual
cash salary remuneration you were receiving from your
employer(s) for your personal exertion immediately prior to
becoming disabled. It includes non-cash benefits or fringe
benefits provided as a direct substitute for salary as well as
performance related commission and bonuses.
b. If you are a ‘casual’ or not employed: The annual
cash remuneration which you received from your
employer(s) for your personal exertion over the 12-month
period immediately prior to your disability (or since you
commenced employment if the period is less than 12
months). It includes non-cash benefits or fringe benefits
provided as a direct substitute for remuneration as well
performance related commission and bonuses received
by you during the 12-month period immediately prior to
your disability (or since you commenced employment if the
period is less than 12 months).
c. If you are self-employed: The total amount earned by your
business over the financial year (or proportion of a financial
year) as a direct result of your personal exertion or activities
through your usual occupation, less your share of business
expenses, but before income tax, (or the relevant proportion
for part of a financial year). Salary includes income from all
employment sources.
Waiting Period
Means the number of consecutive days (either 30, 60 or 90 as
applicable) for which you must be Totally Disabled or Partially
Disabled, as the case may be, before a disability benefit is
payable.
The Waiting Period commences from the later of the following:
a. the date you are first examined by a Medical Practitioner
as Totally Disabled in relation to your injury or sickness that
gave rise to the claim; and
b. the date you ceased work due to that injury or sickness.
If you consult a Medical Practitioner within seven days of ceasing
work due to the injury or sickness, the Waiting Period will
commence from the date you ceased work.
Insured Member
Means you have been accepted for insurance cover, or remains
covered, under this Policy and whose cover has neither been
terminated nor ceased.
For full definitions please refer to our insurance factsheet which
is available on our website www.catholicsuper.com.au.
Claiming Income Protection benefit
We’re here to help
If you require any assistance or information regarding the claims process, don’t hesitate to contact us on 1300 658 776 or email
Once you have lodged a claim you can contact AIA claims team on 03 9009 4850 if you require further assistance.
For the full terms and conditions, please refer to the Insurance Factsheet available on the Australian Catholic Superannuation website.
At the date of this publication Insurance is provided under group insurance policies taken out by the Trustee and issued by AIA Australia Ltd ABN 79 004 837 861 AFSL No. 230043 (Insurer). The document details the terms and conditions effective on and from 1 January 2021.
All cover is subject to the terms and conditions of the insurance policies. If there is any conflict between the information contained in this document and the insurance policies, the terms and conditions of the insurance policies will prevail.
You can request a free copy of the policy documents if you require details of the terms and conditions by contacting the Fund.
The information contained in this document does not take into account your specific needs or circumstances. Whilst all due care has been taken in the preparation of this document, the Trustee reserves the right to correct any errors or omissions.
Brisbane, Canberra, Perth, Port Macquarie, Sydney, Townsville
t 1300 658 776 PO Box 656 Burwood, NSW 1805
e [email protected] w www.catholicsuper.com.au
SCS Super Pty Limited, ABN 74 064 712 607, AFSL 230544, RSE
L0002264 Trustee of Australian Catholic Superannuation &
Retirement Fund, ABN 24 680 629 023, RSE R1055436
Any advice contained in this document is of a general nature only, and does not take into account your personal objectives, financial situation or needs. Prior to acting on any information in this document, you need to take into account your own financial circumstances, consider the Product Disclosure Statement and Target Market Determination for any product you are considering, and seek independent financial advice if you are unsure of what action to take.
This document was issued in March 2022.
This document has been prepared by SCS Super Pty Ltd, ABN 74 064 712 607, AFSL 230544, RSE L0002264 Trustee of Australian Catholic Superannuation & Retirement Fund, ABN 24 680 629 023, RSE R1055436. 33 Burwood Rd Burwood, NSW, 2134, Australia.
Claiming Income Protection benefit