Some people are surprised to learn that their superannuation fund may include insurance cover that can provide financial support if an injury, illness or medical condition affects their ability to work.
The type of cover available and whether you can make a claim will depend on your superannuation policy and personal circumstances. This guide explains the types of insurance commonly held through super, who may be eligible to claim and what to expect during the claims process.
Key Takeaways
- Many superannuation funds provide insurance cover to eligible members
- Common forms of cover include Total and Permanent Disability (TPD), income protection and death cover
- Eligibility depends on the policy terms, your work history and your medical circumstances
- A superannuation insurance claim may be available following an injury, illness or psychological condition
- Medical evidence and supporting documents play an important role in the claims process
- Claims can sometimes be disputed by insurers or super funds
- In some situations, a person may be entitled to pursue a superannuation insurance claim and workers compensation benefits at the same time
What Insurance Cover Does Your Super Fund Include?
Many superannuation funds offer insurance benefits to eligible members as part of their superannuation account. The available cover depends on the fund, the insurance policy attached to the account and the member’s circumstances.
While not every member will hold the same cover, the most common forms of insurance available through superannuation are Total and Permanent Disability (TPD) cover, income protection cover and death cover.
Total and Permanent Disability (TPD) Cover
TPD cover may provide a lump sum benefit if an injury, illness or medical condition prevents a person from returning to work.
The requirements for a successful claim depend on the wording of the policy. Some policies assess whether a person can return to their usual occupation, while others consider their ability to work in occupations suited to their education or experience.
TPD claims can arise from physical injuries, serious illnesses and psychological conditions. The amount payable varies between policies and may be significantly higher than the member’s superannuation account balance.
Income Protection Cover
Income protection insurance provides regular payments when a person is temporarily unable to work because of injury or illness.
Most policies include waiting periods, benefit periods and other eligibility requirements. The amount payable is generally linked to the person’s pre-disability income, subject to the terms of the policy.
Income protection benefits are designed to assist with ongoing financial commitments while a person is recovering or unable to perform their usual work.
Death Cover
Death cover, sometimes called life insurance through superannuation, may provide a lump sum benefit when an insured member dies.
Depending on the policy and circumstances, the benefit may be paid to eligible dependents or to the member’s estate. Some policies may also include terminal illness benefits that can be accessed while the member is still alive if specific policy requirements are satisfied.
Who Is Eligible to Make a Superannuation Insurance Claim?
Eligibility is determined by the type of insurance held, the terms of the policy and the circumstances of the injury or illness.
Many people assume these claims are only available after workplace accidents. Ultimately, a superannuation insurance claim may arise from a wide range of circumstances, including motor vehicle accidents, medical conditions, serious illnesses, psychological injuries and injuries suffered outside of work. The key issue is usually whether the policy requirements have been met.
For example, a TPD insurer may assess your medical condition, employment history, qualifications and future work capacity. An income protection insurer may focus on your ability to continue performing your usual occupation during the period of incapacity.
Since policy wording can vary significantly between funds, obtaining advice from compensation lawyers before lodging a claim can help clarify your entitlements.
How to Make a Superannuation Insurance Claim
The claims process will vary depending on the superannuation fund and insurer involved. However, most superannuation insurance claims follow a similar pathway.
The first step is confirming what insurance cover exists within the superannuation account. This involves reviewing policy documents, obtaining information from the fund and identifying the eligibility requirements that apply.
Once the available cover has been confirmed, the insurer will generally require information about the condition giving rise to the claim, together with supporting evidence.
Many claims involve ongoing communication with both the superannuation fund and the insurer. Subject to the facts of the case, the insurer may also request further medical information, employment records or specialist reports before making a decision.
What Documents Do You Need?
The documents required will depend on the type of claim being made and the terms of the policy.
Common examples include:
- Claim forms issued by the insurer or superannuation fund
- Medical reports and treatment records
- Information from treating doctors and specialists
- Employment records
- Evidence of income and work history
- Identification documents
Some claims may require detailed information about a person’s education, training and employment background, particularly when future work capacity forms part of the assessment.
Providing carefully considered information can help avoid unnecessary delays during the assessment process.
How Long Does a Super Insurance Claim Take?
There is no standard timeframe for a superannuation insurance claim.
Some claims are resolved relatively quickly when liability is accepted and the required evidence is readily available. Others can take considerably longer, particularly if additional medical investigations are required or when the insurer seeks further information before making a decision.
The complexity of the medical condition, the amount of evidence required and the responsiveness of the parties involved can all influence how long the process takes.
What Happens If Your Super Fund Disputes Your Claim?
A claim is not automatically unsuccessful simply because it has been disputed. Insurers may request further evidence, raise questions about eligibility or rely on policy definitions when assessing a claim.
In some circumstances, a claim may be declined because the insurer takes a different view of the medical evidence or the person’s work capacity. If this occurs, it may be possible to challenge the decision.
The options available will depend on the circumstances of the claim, the reasons for the decision and the policy terms involved. Additional medical evidence or formal dispute resolution processes may assist in appropriate cases.
Many disputed claims ultimately turn on the strength of the available medical and factual material and how the policy wording applies to the individual’s circumstances.
Can You Claim Super Insurance and Workers Compensation at the Same Time?
In some situations, yes.
A person may be entitled to pursue a superannuation insurance claim and workers compensation benefits arising from the same injury or illness. This is because the two claims serve different purposes and are assessed under different legal and insurance frameworks.
For example, workers compensation may provide benefits such as weekly payments, medical expenses and lump sum compensation in certain circumstances. A TPD claim, on the other hand, is generally assessed under the terms of the insurance policy attached to the person’s superannuation account.
However, the interaction between different claims can be complex. Information provided in one claim may become relevant to another, and entitlement requirements may differ between schemes.
For this reason, it is important to consider all available entitlements before making decisions about any compensation or insurance claim.
Seeking Advice About a Superannuation Insurance Claim
Many people only become aware of their insurance entitlements after speaking with a lawyer or reviewing their superannuation fund claim in detail.
If an injury, illness or psychological condition has affected your ability to work, it may be worth investigating whether insurance cover exists through your superannuation fund. In some cases, significant benefits may be available even where a person has already stopped working or is receiving other forms of compensation.