Sunsuper income protection insurance claims guide

Transcription

1 Sunsuper income protection insurance claims guide 1 December 2015 make your dreams more than dreams

2 Income protection insurance claims We can appreciate that being unable to work would be a difficult and uncertain time for you. We will strive to ensure that your claim is processed in a timely manner so you can receive a decision as quickly as possible. The Income protection insurance claims guide provides information about making an insurance claim. For information about insurance cover, including eligibility and the terms and conditions that apply, you should refer to the applicable Product Disclosure Statement (PDS). For a copy of the PDS, call us on General advice disclaimer The information in this guide is general information only and doesn t take into account your personal objectives, financial situation or needs. You should consider the appropriateness of any general information in this guide having regard to your own personal objectives, financial situation and needs. You should consider the Product Disclosure Statement before making a decision. Call or visit sunsuper.com.au for a copy. You should obtain financial advice tailored to your personal circumstances. Call us if you would like to speak with one of our qualified financial planners. Our qualified financial planners provide simple advice about super at no additional cost. More detailed advice, including that provided as part of the SunTracker program, may incur a fee. Sunsuper employees provide advice as representatives of Sunsuper Financial Services Pty Ltd (ABN AFSL No ) (SFS), wholly owned by the Sunsuper Superannuation Fund. Protecting your privacy Sunsuper respects the privacy of the information you give us. If you require a copy of our Privacy Policy visit sunsuper.com.au/privacy or call Sunsuper income protection insurance claims sunsuper.com.au

3 Income protection insurance claims 1. What is Income Protection (IP) Insurance Income Protection (IP) insurance provides you with a monthly income while you re unable to work due to temporary injury or sickness/illness. It is intended to ease the financial burden of your injury or sickness/illness by helping to cover the costs of day-to-day living as well as your treatment costs. To make an IP claim, you must meet the definition of Total Disability as outlined in the Definitions section of this Guide and have become totally and temporarily disabled while you were insured with Sunsuper. 2. How to make an IP claim If you believe you that you may be eligible to apply for an IP payment, we are here to help you along the way. To submit your claim you need to complete three major steps: Step 1 Before you call us, you will need to prepare some basic information about your claim This will allow us to start the claims process from the moment we first speak to you. The necessary information includes: Your Sunsuper membership number You can find this number in the top right hand corner of your Annual Statement as well as most other correspondence from Sunsuper Details about your injury/illness Step 2 Call Sunsuper on to start the claims process You ll be transferred to our Claims Team who will be able to help with the first steps of the claims process. The Claims Team will: provide you with details of your current account balance and insurance cover advise you of the documents and information you need to provide for the claim to be assessed, and send you the IP claim forms for completion. Date on which your injury first occurred or your sickness/illness first presented itself Details and date of your diagnosis Details about your work status The date you last worked The amount of hours worked per week leading up to your injury or sickness/illness Step 3 Complete and return the IP claim forms Please read all information we send to you carefully, and take the time you need to gather all information required to complete the claims process. You will need to answer several questions and provide us with additional information. Completing the claim form is the largest and most important step in this process: the details and evidence you provide will form the basis upon which the Insurer makes their decision in regards to your IP claim. We recognise that this may be a daunting task, and our Claims Team is here to help you every step of the way. We will provide you with the name and contact details of your own dedicated Claims Officer who will assist with your claim and help answer any questions you may have along the way. 1 Sunsuper income protection insurance claims sunsuper.com.au

4 Income protection insurance claims 3. What does an IP claims pack contain? There are a number of forms you will need to complete when making an IP claim (detailed below). Please do not hesitate to call the Claims Team if you have any questions. This will help us to ensure that your claim is progressed as quickly as possible. 1. Claim Application (Employee statement) What is this form for? This form is to be completed by you. It includes your contact information, employment details and basic details about your injury or sickness/illness. It will ask specific details about the work you performed leading up to your injury or sickness/illness, how your injury or sickness/ illness has affected your ability to work, whether you ve had a similar condition before and whether you intend to claim other benefits. Tips: You must provide us with several pieces of information, and these tips will help you to find them. The Trading name of last employer will be detailed on your payslip or your Payment Summary (group certificate) the Trading name of your last employer may not be the name you know your employer as, so please check this carefully. Fund of choice means the fund your employer was paying into at the time of your injury or sickness/illness. If you are unsure about the dates and hours you worked, we recommend that you contact the Human Resources department of your (previous) employer or refer back to your previous payslips. 2. Treating Doctor s Report What is this form for? This form is to be completed by the doctor who treated you at the time of your diagnosis. Their statement will describe the nature and extent of your disability and provide evidence for it (such as medical records, test results etc.). Tips: We recommend that you phone your doctor and let them know that you are in the process of making an IP claim. You may be required to make an appointment with your doctor to have them to complete this statement. Please note that you will be responsible for the costs of this appointment and any other costs involved in obtaining this statement. 3. An Employer statement What is this form for? This form is to be completed by your employer with whom you were employed at the time of your injury or sickness/illness. Your employer will be required to detail the scope of your position and outline the types of duties you performed in your role. Tips: We recommend that you contact the Human Resources department or your direct manager from your employer as this form must be completed by an authorised person who worked closely with you. 4. Centrelink Authority to Release Personal Information What is this form for? If you receive Centrelink benefits, you must complete this form to give authority to Sunsuper and its Insurer to obtain information about your benefits. 5. Authority to release personal Medicare and Pharmaceutical Benefits Scheme (PBS) claims information What are these form for? These forms provide authority for release of information from both Medicare and the Pharmaceutical Benefits Scheme (PBS) directly to the Insurer to assist them with the assessment of your claim. Please note: These forms are not required in every instance and will only be included where necessary. 6. Tax File Number declaration What is this form for? We are required to advise the Australian Taxation Office that we are making income payments to you in lieu of your salary. 7. Bank Account Nomination form What is this form for? This form asks how you would like to receive your money should your claim be successful. Tips: Providing this information to us at the outset will ensure that you can receive your claim monies without delay if your claim is approved. Remember, if you need assistance please call the Claims Team 2 Sunsuper income protection insurance claims sunsuper.com.au

5 Income protection insurance claims 4. What you will need to provide in your IP claim Completing your IP claim forms is an important step in your claim process. The details and evidence you provide will form the basis upon which the Insurer makes their decision. Providing us with all the information we require and completing your forms correctly will speed up your claims process. If information is missing or incomplete, we will need to contact you to ask for it, which will delay your claim. We understand that completing the claims application may be a daunting task, and our Claims Team is here to help you every step of the way. Please contact the Claims Team who will assist you with any questions you have about the information we require and completing your claim forms. Certified proof of your identity You must provide a certified copy of your ID as proof of your identity (for example, a driver s licence or passport). Why? Your super is your money, so for security purposes, we need to be sure that the super belongs to the person submitting the claim. Understandably, you won t want to send us your original documents, so we ask that you have a copy certified by an authorised person. Tips: See our Proof of Identity Requirements section for information on what forms of ID are suitable and how to have a copy certified. 3 Sunsuper income protection insurance claims sunsuper.com.au

6 Income Protection claims checklist Before you send your claim through, make sure you have fully and correctly completed the following requirements: Certified proof of your ID Claim Application (Employee statement) Treating Doctor s Report Employer statement Centrelink Authority to Release Personal Information (if required) Authority to release personal Medicare and Pharmaceutical Benefits Scheme (PBS) Claims information (if required) Tax File Number declaration Bank Account Nomination form 4

7 Income protection insurance claims 5. The IP claim assessment process Claim forms are received Insurer assesses the claim Claim is accepted by the Insurer Claim is declined by the Insurer Claim outcome and ongoing payment Sunsuper Trustee reviews Insurer s decline of claim Sunsuper Trustee disagrees with decline Sunsuper Trustee upholds decision to decline The Insurer may also: Claim forms are received Your dedicated Claims Officer will notify you once your claim has been received. Your Claims Officer will review your application and ask you for any further information we require. Once we have received all the information we require for this initial stage, we can begin the assessment of your claim. Your Claims Officer will endeavour to keep you updated on your claim s progress each fortnight. Insurer assesses the claim The Insurer will use the information you, your employer and your treating doctor provide when making its assessment. ask for additional reports from your doctor/s ask you to provide more information ask your employer for more information, and/or make an appointment for you to have a medical examination with an independent specialist/s. The Insurer will pay for any additional medical reports they request and any examinations they arrange for you to attend. Claim is accepted by the Insurer If your claim is accepted by the Insurer, we will contact you to advise that your claim has been approved, arrange for payment directly to your bank account, and send you a payment confirmation letter. 5 Sunsuper income protection insurance claims sunsuper.com.au

8 Income protection insurance claims Claim outcome and ongoing payment Claim is declined by Insurer If your claim is accepted and you remain unable to work, each month you will be asked to fill in a progress claim form and arrange for your treating doctor to complete a Medical Attendant s Statement form, so that the Insurer can consider further payments. We will send these forms to you after each payment, and you must return them at least 10 working days before your next payment is due. Unless further medical evidence is required, the prompt return of these forms will ensure you receive your next payment on time. Please note you are required to meet the cost for completion of these forms. Benefit payments will generally continue until: you no longer satisfy the relevant definition, e.g. Total Disability, Limited Total Disability or Partial Disability you reach the end of the benefit payment period or you turn 65 (whichever is earlier) you are employed under a Class 457, 422 or 418 working visa and the term of the Class 457, 422 or 418 visa expires, or you permanently depart Australia (whichever occurs earlier) you reside overseas and have received 12 months of payments, or your death. If your claim is declined by the Insurer, this generally means that the Insurer doesn t regard you as Totally Disabled or Partially Disabled according to the policy definition. Sunsuper Trustee reviews Insurer s decline of claim All claims declined by the Insurer are referred to the Sunsuper Trustee for assessment and consideration. If the Sunsuper Trustee disagrees with the decision of the Insurer and believes that your claim should be approved, your claim will be referred back to the Insurer for their reconsideration. The Claims Team will contact you to advise you of the next steps. If the Sunsuper Trustee agrees with the decision to decline the claim, your Claims Officer will contact you to advise you of this outcome. If you disagree with this decision you can lodge a written complaint with Sunsuper. Your complaint will be investigated, and if you are not satisfied with our response or we haven t responded within 90 days, you may ask the Superannuation Complaints Tribunal (SCT) whether you are eligible to submit a complaint to them. Time limits apply that affect when you can make a complaint to the SCT about an IP claim. Call the SCT on or visit their website for more information. 6 Sunsuper income protection insurance claims sunsuper.com.au

9 Income protection insurance claims 6. Frequently Asked Questions about IP claims Do I need a lawyer? Our claims process has been designed so that in most cases, you or your family should not require the assistance of a lawyer when making a claim. We don t give priority to claims lodged by lawyers all claims are dealt with in the same manner and follow the same process. If you are thinking about seeking legal help, we recommend that you first determine the costs involved in doing so and how they will impact your benefit payout. We recommend that you call us before seeking help from a lawyer. Do I have IP insurance? Not all Sunsuper members have IP insurance. To check your level of cover, login to Member Online, review your Annual Statement or call us on Is there a Waiting Period? In most cases, you will need to have been continuously unable to work due to injury or sickness for a period of time: 30, 60, 90 or 180 days depending on your type of cover. The Waiting Period will begin from the date you are Totally Disabled and unable to work as certified by a medical practitioner. Do I have to re-start a Waiting Period if I return to work? Generally, you may be able to return to work during the Waiting Period, but it is important to contact us to check this applies to you. If your waiting period is 30 days, you may be able to work for up to five days without having to start the Waiting Period again. If your Waiting Period is 60, 90 or 180 days, you may be able to return to work for up to 10 days during that time without having to re-start the Waiting Period. In these circumstances, if you do return to work, your original Waiting Period may be extended by the number of days you work. If you return to work for longer than the periods specified above, then the Waiting Period may start again. Are there any exclusions or restrictions? You will not be eligible to be paid an IP benefit if your injury or illness/sickness is caused, wholly or partly, directly or indirectly, from: deliberate self-inflicted injury or attempted suicide or self destruction while sane or insane uncomplicated pregnancy, childbirth or miscarriage your deployment to a hostile environment as part of active military service, or a criminal act committed by you. Limited cover will apply to your Standard IP cover for a period of 24 months and until you have been At Work for 30 consecutive days at the end of the 24 month period. What happens if I m partially disabled? A reduced monthly IP benefit may be payable if you become Partially Disabled. Please refer to the Definitions section of this Guide for further details. How much will I be paid? It is important to understand that any insurance benefit amount is determined at the date you became disabled; the insurance benefit amounts shown on your Annual statements or in Member Online may therefore differ to the amount at your disablement date. The monthly benefit you will be paid will be the lower of: the level of cover selected by you less any offsets, and 75% of your monthly rate of Pre-Disability Income less any offsets, plus a superannuation contribution where this forms part of your insured IP cover. When are benefit payments made? Once your claim has been accepted by the Insurer, your first monthly payment will be paid in arrears one month after the end of the waiting period. Subsequent payments are made monthly. 7 Sunsuper income protection insurance claims sunsuper.com.au

10 Income protection insurance claims Will I pay tax on the benefit? Your monthly benefit will be paid to you, less any PAYG tax payable. You will receive a PAYG Payment Summary for IP benefits paid to you during the financial year as soon as possible after the 30th of June for inclusion in your annual tax return. Will there be offsets to my benefit payment? Your IP benefit payment may be reduced by the following payments: Workers Compensation or Transport Accident Compensation or similar legislation in relation to your injury or illness any other payments, statutory or otherwise, paid to you for loss of income in relation your injury or sickness any other payments made under any disability income type insurance policy, and/or any other lump sum payment which relates to loss of income due to injury or illness (other than a TPD or terminal illness benefit under this Policy). Your IP benefit payment may also be reduced by any sick leave from your employer, however you are generally not required to use all your sick leave before receiving an Income Protection benefit. What happens if I have a recurring injury or sickness/illness? Following a claim, if you make a further claim arising from the same or related cause as the first claim, the further claim will be: a) treated as a separate claim if it occurred after you returned to work for at least 6 continuous months, or b) deemed to be a continuation of the original claim if made within 6 months from the end of payments from the earlier claim. A further Waiting Period will not apply in this case, however the relevant benefit period will be adjusted to take into account prior benefits paid under this policy for the original claim. 8 Sunsuper income protection insurance claims sunsuper.com.au

11 Rehabilitation in Super Work is Good Medicine Returning to work can restore more than your income: it helps to restore your identity and self-esteem. At Sunsuper, we work with our insurers to offer you access to one of the largest and most experienced rehabilitation teams. This means that if you have suffered an injury, disability or health condition, we can arrange workrelated rehabilitation to assist in your return to meaningful work. Together with our insurers, we work in partnership with you, your treating health professionals and employer to help you return to suitable work as part of your recovery plan. If you are unemployed, we can help you improve your readiness for work and/or locate suitable employment. Rehabilitation services may include: initial meetings with a rehabilitation provider to identify your return to work needs workplace visits to identify solutions for your return to work plan equipment to ensure you maintain your job career guidance to explore alternative work options if you can t work in your usual role improving your skills and capabilities so that your return to work is sustainable. Rehabilitation is not appropriate for everyone. If you would like further information about your rehabilitation options please speak with your Claims Officer at Sunsuper by calling Together we may be able to assist you in getting back to work and back to a fuller life! 9

12 Proof of identity requirements 10

13 Proof of identity requirements Australia s $2 trillion super pot represents a large and growing temptation for criminals, with identity theft the biggest risk when it comes to safeguarding your money; and no-one is immune. That s why super funds will ask you to provide certain information and documents about your identity when you request money from your account. We need to be sure that the super belongs to the person making the claim. Getting your identity documents together to access your money may seem like an unnecessary hassle, but we can assure you it s essential, your protection is our top priority. When do you need to prove your identity? All super funds, including Sunsuper, will ask you to provide certified identification before paying any money out. If you cannot provide us with one of the primary identification documents outlined on this page, then we may accept two of the documents listed in the table on the following page, one document from each column. It s important to note we cannot accept documents that have expired. We also reserve the right to request additional information to verify your identity before paying your benefit claim. What is an acceptable identification document? Any one of the following documents will be accepted as primary identification: a driver s licence or permit issued under a law of a State or Territory, or equivalent authority of a foreign country, that contains your photo, name, residential address and date of birth (please copy and certify both front and back sections if relevant) a passport issued by the Commonwealth a card issued under a law of a State or Territory for the purpose of proving the person s age which contains your photo, name and date of birth (please copy and certify both front and back sections if relevant), or a passport or a similar document issued for the purpose of international travel or a national identity card issued for the purpose of identification that: A. contains your photo, name and signature B. is issued by a foreign government, the United Nations or an agency of the United Nations C. if written in a language that is not understood by the person carrying out the verification, is accompanied by an English translation prepared by an accredited translator. If you don t have any primary identification, see the table over for acceptable forms of secondary identification. 11 Sunsuper income protection insurance claims sunsuper.com.au

14 Proof of identity requirements One document from this column plus One document from this column A birth certificate or birth extract issued by a State or Territory A citizenship certificate issued by the Commonwealth A citizenship certificate issued by a foreign government A birth certificate issued by a foreign government, the United Nations or an agency of the United Nations A pension card issued by the Department of Human Services that entitles you to financial benefits A healthcare card issued by the Department of Human Services that entitles you to financial benefits A notice that: a) was issued to you by the Commonwealth, a State or a Territory within the preceding 12 months, b) contains your name and your residential address, and c) records the provision of financial benefits to you under a law of the Commonwealth, State or Territory (as the case may be). A notice that: a) was issued to you by the Australian Taxation Office within the preceding 12 months, b) contains your name and your residential address, and c) records a debt payable to or by you to the Commonwealth under Commonwealth law relating to taxation. A notice that: a) was issued to you by a local government body or utilities provider within the preceding three months, b) contains your name and your residential address, and c) records the provision of services by that local government body or utilities provider to your address or to that person. In relation to a person under the age of 18, a notice that: a) was issued to you by a school principal within the preceding three months, b) contains your name and your residential address, and c) records the period of time you attended the school. Note: If any of the approved documents have been issued by a foreign government and are written in a language that is not understood by the person carrying out the verification, the documents must be accompanied by an English translation prepared by an accredited translator. What if you ve recently changed your name? If you have changed your name and have not yet advised us, you will need to provide what is called a linking document. A linking document is used to prove a relationship exists between two (or more) names. Examples of acceptable linking documents are: certificate from the Births, Deaths and Marriages Registration Office or relevant government source from the issuing country (i.e. marriage certificate or change of name) deed poll or decree nisi. What do we mean by certified? We understand you ll want to provide us with copies of your identification documents rather than the originals. However, you must have these copies certified as a true copy of the original. This means that you need to have a person who is authorised to certify documents (see the section on the following page) sight the original document and the copy of the documents (e.g. a photocopy) to make sure both documents 12 Sunsuper income protection insurance claims sunsuper.com.au

15 Proof of identity requirements are identical, and then certify all copied pages as true copies by writing or stamping certified true copy on them. They must also sign and print their name on the document and record their qualification (e.g. Justice of the Peace) and the date. Who can certify your identification documents in Australia? Only certain people are authorised to certify documents in Australia. Approved people include those who are currently authorised to witness a statutory declaration under the Statutory Declarations Regulations 1993 (Commonwealth), Schedule 2, Part 1 and Part 2. People authorised to certify your documents include a: Health professional, such as a Chiropractor, Dentist, Medical practitioner, Nurse, Optometrist, Pharmacist, Physiotherapist, Psychologist Legal professional, such as a Legal practitioner, Patent attorney, Trade marks attorney Teacher (full-time) at a school or tertiary education institution Accountant (member of ICA, ASA, IPA or CPA, ATMA, NTAA) Veterinary surgeon Bank officer, building society officer, credit union officer, finance company officer employed for five years or more Justice of the Peace, commissioner of declarations, or commissioner of affidavits police officer, sheriff or sheriff s officer notary public Those who hold a Court position, such as a Bailiff, Judge, Magistrate, Registrar, or Deputy Registrar, Clerk, Master of a court, CEO of a Commonwealth court Government representatives (elected): Federal, State or Territory or Local Public servants: Federal, State or Territory or Local employed for five years or more. Minister of religion, or marriage celebrant. If you are unable to locate any of the above certifiers, others may be accepted. We recommend you contact us on to confirm who else we will accept as a certifier. What does a certified identity document look like? This is what a certified proof of identity document should look like: Copy of the document that identifies you, (i.e. your passport or driver s license front and back) Write or stamp certified true copy of original document Have the authorised person sign the document Authorised person s stamp and registration number (if applicable) Name, qualification, phone number and address of authorised person, and Date of authorisation Sunsuper income protection insurance claims sunsuper.com.au

16 Proof of identity requirements What if you live overseas? If your claim is submitted from outside Australia, we still require certified identification documents before we can pay out your benefit. The list of acceptable documents is still the same; however, we can only accept certified identification documents that are signed by an: Australian consular officer Australian diplomatic officer police officer of an overseas force Judge of a Court or magistrate in an overseas jurisdiction international Justice of the Peace (JP) registrar or deputy registrar of a Court commissioner of oaths. The person who is authorised to certify documents must sight the original and the copy to make sure both documents are identical, and then certify all copied pages as true copies by writing or stamping certified true copy followed by their signature, printed name, qualification (e.g. police officer) and date. We also require evidence of the certifier s status. Examples of what is acceptable include: notary public Qualification Police officer Judge or magistrate Justice of the Peace Certification Required Details of their police badge number Certificate of their appointment to their position Justice of the Peace stamp or number 14 Sunsuper income protection insurance claims sunsuper.com.au

17 Definitions 15

18 Definitions IMPORTANT: The definitions shown in this section are some of the definitions that apply to insurance cover in Sunsuper for life, for whom the insurer is AIA Australia Limited ABN (AIA). They may also apply to some Sunsuper for life Business and Sunsuper for life Corporate Plans, depending on the insurer and/or the insurance offered in the Plan. For the definitions that apply to a particular product or plan, refer to the applicable Product Disclosure Statement (PDS). For a copy of the PDS, call us on Accident is defined as a physical injury that is caused solely and directly by violent, visible, external and unexpected means that is not traceable, even indirectly, to any pre-existing mental or physical condition. Activities means: (i) Rising/sitting: the ability to rise and sit using a chair with arms without the help of another person. (ii) Hearing: the ability to clearly hear (with a hearing aid or other aid if normally used) conversational speech in a quiet room in your first language. (iii) Communicating through speech: the ability to speak with sufficient clarity to be able to hold a conversation in a quiet room in your first language. (iv) Seeing: the ability to see such that, when tested with visual aids, vision is measured at better than 6/60 in the better eye using a Snellen chart. (v) Walking: the ability to walk more than 200 metres on a level surface without stopping due to breathlessness, angina or severe pain somewhere in the body. (vi) Lifting and carrying: the ability to lift (from bench height) and carry a 2kg weight a distance of 10 metres and place the item back down at bench height. (vii) Communicating through written words: the ability to write legibly with a pen or pencil or use a keyboard with either hand. For the purpose of assessing a TPD claim, where you are unable to perform one or more of the Activities upon commencement of cover, that Activity shall not be taken into consideration for TPD assessment. Aids and adaptions mean equipment or fixtures to assist you without the assistance of another person to carry out Activities. Approved Leave means parental leave, annual leave, bereavement leave, long service leave or any other leave approved by your employer for reasons other than related to injury or sickness. At Work (for death, TPD and IP cover) means you are: a) actively performing or capable of performing all of your normal duties, without limitation or restriction due to injury or sickness, and where working you are working normal hours on the day cover is to commence, and b) in the Insurer s opinion, not restricted by sickness or injury from being capable of actively performing your full and normal duties on a full-time basis (for at least 30 hours per week) even though actual employment may be on a full-time, part-time, casual or contract basis, and c) not in receipt of, or entitled to claim, any income support benefits from any source including workers compensation benefits, statutory transport accident benefits and disability income benefits. You will be considered to be At Work on the applicable date, as the context requires, if you are on Approved Leave for reasons other than injury or sickness, and not taking into account the leave, are able to meet the At Work definition. In addition for death and TPD cover only, At Work also means if you are not gainfully employed but are engaged in full-time Domestic Duties you will meet the At Work requirement if you are able to actively perform your normal full-time Domestic Duties without restriction due to injury or sickness. Benefit Period means the maximum period of time for which benefits will be paid for any one period of Total Disability, Limited Total Disability or one period of Total and Partial Disability. Binding death benefit nomination is a legal instrument that binds the Trustee of Sunsuper to pay the death benefit to the dependants, or legal personal representative nominated in the binding death benefit nomination form. Provided the nomination is valid and less than three years old, then the Sunsuper Trustee has no discretion in relation to whom the benefit is paid. Cognitive Function means intellectual capacity, loss of which requires you to be under the continuous care and supervision of another adult person for at least 3 consecutive months and, at the end of that 3-month period, you are likely to require permanent ongoing continuous care and supervision by another adult person. Date of Disablement (for IP claims) is where you are: (a) working and then cease work as a result of a sickness or injury, the last day you worked provided this was as a result of a sickness or injury and which has been certified by a medical practitioner, or (b) on Approved Leave or unemployed and suffer a sickness or injury which prevents you from returning to work as a result of that sickness or injury, the Date of Disablement will be determined based on the certification provided by the medical practitioner as the date on which you became disabled. 16 Sunsuper income protection insurance claims sunsuper.com.au

19 Definitions Domestic Duties means where you have chosen to remain at home and perform unpaid home duties as your primary occupation. The choice to remain at home should not be due to unemployment or as a result of a sickness or injury. Employed (for TPD claims) means: (i) you are engaged under a contract of employment with an Australian employer (which includes on secondment or transfer to an international subsidiary or an associated or affiliated company of an Australian employer), or (ii) you are a Self-Employed person and earning an income under an ABN registered entity, or (iii) you have been unemployed for less than 12 months, or (iv) you have been on Unpaid Leave for less than 2 years with an Australian employer, or (v) you are working for an overseas employer at least 15 hours per week, or (vi) you are engaged in unpaid Domestic Duties in your own home. Income (for IP claims) means your pre-tax income derived from your occupation, less any expenses incurred in deriving that income. Unless otherwise agreed with the Insurer, Income does not include director s fees, overtime payments, commissions, bonuses, penalty or shift allowances, mandated superannuation contributions, investment income, income received from deferred compensation plans, disability income policies, retirement plans or any income derived from non-vocational activities. For Self-Employed Persons, Income means the income generated by the business or practice due to your personal exertion or activities, less your share of necessarily incurred business expenses and investment income. For Corporate Income Protection cover the definition of income may differ from this definition. Please refer to your Employer Plan guide which can be found on your Employer website. Proof of Income is also required at the time of a benefit claim. For claims, Income is determined at the first day of absence from your employment due to the injury or sickness resulting in Total Disability. The amount of benefit will depend on the cover most recently accepted by the Insurer. Limited cover means you are only covered for claims arising from a sickness which first Manifests itself or an injury which occurred on or after the date your cover commenced, most recently commenced or increased (where applicable) under the policy and was not related to the condition that occurred before the date your cover commenced, most recently commenced or increased (where applicable) under the policy. Manifests means that symptoms exist which would cause an ordinary prudent person to seek diagnosis, care or treatment, or that medical advice or treatment has been recommended by or received from a Medical Practitioner. Limited Total Disability (for IP claims) means as a result of sickness or injury, you: (a) have been incapacitated to such an extent as to render yourself unable to engage in your usual occupation or any occupation for which you are reasonably suited by education, training and experience, and (b) remain under the regular care, attendance and following the advice of a registered medical practitioner in relation to that sickness or injury, and (c) are not engaged in any occupation (whether paid or unpaid). The above definition applies for up to 24 months while you are on Unpaid Leave provided you were working on average less than 15 hours per week in the 3 months immediately prior to going on Unpaid Leave. Occupational Categories The following Occupational Categories apply within Tailored cover. Professional and White will also apply to White Collar cover. Professional White collar professionals performing no manual duties (e.g. doctor, lawyer, accountant). Usually those with a tertiary qualification or registered with a professional body (and they must be using these qualifications in their occupation). White Clerical, administration and managerial occupations involving office duties only. Includes those who do less than 10% light manual duties (e.g. administrator, bookkeeper, computer operator). Light Blue Certain light-manual skilled workers (e.g. photocopy/tv repairers), purchasing officers, travelling sales representatives, claims/loss assessor, business owners in non-hazardous industries involved in light manual work (e.g. coffee shop owner) and supervisors of workers in Medium Blue occupations. Medium Blue Qualified tradespeople involved in non-hazardous industries doing light manual work (e.g. qualified tradespeople such as cabinetmaker, carpenter, plumber, mechanic). Heavy Blue Heavy manual workers, unskilled or performing higher risk occupations, tradespeople involved in heavier manual work (e.g. brick layer (qualified), interstate bus driver, warehouse worker, carpet layer, house removalist). Hazardous There are other occupations classified as hazardous including airline crew and pilots, fire fighters, 17 Sunsuper income protection insurance claims sunsuper.com.au

20 Definitions professional sportspeople, police, underground workers, miners, and those working at heights above 10 metres. For hazardous occupations, the Insurer reserves the right to assess applications for cover on a different premium basis to the five categories listed above. Partial Disability or Partially Disabled (for IP claims) means that, following a period of Total Disability (for 7 out of the first 10 working days of the Waiting Period) and while you continue to be either Totally or Partially Disabled during the Waiting Period you: (a) have returned to work in your usual or an alternative occupation, and (b) are under the care of and complying with the reasonable advice given by a registered medical practitioner, and (c) as a result of the disability, you have suffered and continue to suffer loss of income as a direct result of the injury or sickness. The income benefit paid during Partial Disability will be calculated in line with the proportionate loss of income from the end of the Waiting Period. Pre-Disability Income (for IP claims) means the higher of the gross monthly income you earned at the Date of Disablement or an average of the gross monthly income earned by you over the 3 months immediately prior to the Date of Disablement. If you are a casual or contract employee, or unemployed, the Pre-Disability Income means the average of the gross monthly income earned over the 12 months (or if employed less than 12 months, over your period of employment) immediately prior to the Date of Disablement. If you are Self-Employed, Pre-Disability Income means the greater of the average of the gross monthly income earned over the12 months and the latest financial year immediately prior to the Date of Disablement. Preferred beneficiary nomination is where the deceased member has advised us who they would like to receive their benefits when they die. It will act as a guide for the Sunsuper Trustee in deciding how to pay the death benefit. In most cases, the Sunsuper Trustee will pay the benefit as nominated, but not always. The Sunsuper Trustee has a responsibility to make sure the benefits are distributed in an appropriate manner. At the time of death, the nomination of a preferred beneficiary(s) may no longer be up-to-date, or there may be other dependants who have a claim to the benefits. For example, if an adult child has been nominated with no financial dependency to receive the benefit, and there was a spouse and minor child, it is likely the Sunsuper Trustee would pay the benefit to the spouse and minor child. Self-Employed Person means a person who is predominantly working in their own business on a regular basis and earning an income under an ABN registered entity. Terminal Illness means you are suffering from an illness, or have incurred an injury, that is likely to result in your death within a period of 12 months from the date of certification of the Terminal Illness by two registered Medical Practitioners (one being a specialist physician in the particular medical field), both acceptable to the insurer. The benefit the insurance policy pays out is called a Terminal Illness Benefit. Terminal Medical Condition is a condition of release under the Superannuation Industry (Supervision) Regulations 1994 (Cth). For more information, please refer to the Sunsuper for life guide. Total Disability or Totally Disabled (for IP claims) means that, as a direct result of injury or sickness, you are: (a) continuously and completely unable to perform at least one of the major duties of your usual occupation based on the work performed at the time of injury or sickness, and (b) under the regular care of and complying with the reasonable advice given by a registered medical practitioner in respect of that injury or sickness, and (c) not in any occupation for which a person would normally expect to receive remuneration or profit. A major duty is an income-producing duty of your regular occupation, which involves at least 20% of your overall occupational tasks. The above definition applies for up to 24 months while you are on Unpaid Leave provided you were working an average of 15 hours or more per week in the 3 months immediately prior to going on Unpaid Leave. Total Permanent Disability (TPD) means: Part A You have suffered the total and irrecoverable loss of: (i) the use of two limbs; or (ii) the use of the sight of both eyes; or (iii) the use of one limb and the sight of one eye; or (iv) Cognitive Function. (where limb is defined as the whole hand or the whole foot); and the Insurer, after considering all relevant evidence which is reasonably available, then determines you will be unable ever again to be gainfully employed in any occupation for which you are reasonably suited by education, training or experience; 18 Sunsuper income protection insurance claims sunsuper.com.au

21 Definitions or Part B Where, at the date of disablement, you were Employed: (i) you are unable to perform your occupation duties based on the work performed at the time of disablement by reason of an injury or sickness for a period of three consecutive months as a result of the injury or sickness; and (ii) you under the care of, and following the advice of, a medical practitioner; and (iii) the Insurer, after considering all relevant evidence which is or reasonably available, then determines you will be unable ever again to be gainfully employed in any occupation for which you are reasonably suited by education, training or experience. Part C Where, at the date of disablement, you were not Employed: (i) you have not, as a result of an injury or sickness, been able to perform at least two Activities for a period of three consecutive months after the occurrence of the injury or sickness; and (ii) you are under the care of, and following the advice of, a medical practitioner; and (iii) the Insurer, after considering all relevant evidence which is reasonably available, then determines that it is likely, due to the injury or sickness, that you are totally and permanently unable to perform (with Aids and adaptions) at least two Activities; and (iv) the Insurer, after considering all relevant evidence which is reasonably available, then determines you will be unable ever again to be gainfully employed in any occupation for which you are reasonably suited by education, training or experience. Note: a different TPD definition may apply to some members and if this applies to you, you will have been informed separately. Unpaid Leave means leave (not being cessation of employment) without pay from your employer. This leave must be: (a) approved by your employer or authorised by: (i) the Commonwealth, a State or a Territory, or (ii) a certified agreement or award made by a tribunal or body having the authority to do so under the law of the Commonwealth, a State or a Territory. (b) in relation to which you have a statutory or contractual right to resume employment at the end of the leave, and (c) in relation to which you are not being paid by the employer. Unpaid Leave excludes leave: (a) that is due to your injury or sickness, or (b) during which you receive or are entitled to receive: (i) income benefits, or (ii) disability income benefits, or (iii) social security sickness benefits, or (c) due to strike or lockout. Waiting Period TPD claims The waiting period for a TPD claim is the amount of time you may need to prove you have been absent from work for as a result of your disability. If your date of disablement occurred prior to 1/07/2011, you will need to provide the following Performs your occupational duties based on the work performed at the time of your disablement, or Where you were unemployed at the time of your disablement you are unable to perform either unpaid domestic duties or activities of daily living for a period of six (6) consecutive months as a result of your injury or illness. There is no waiting period if you ve suffered the total and irrevocable loss of use of: two limbs (where limb is defined as the whole hand or whole foot), or the sight of both eyes, or one limb and the sight of one eye. If your date of disablement occurred on or after 01/07/2011, you will need to provide the following proof before your claim can be assessed: proof that you are unable to perform your occupational duties based on the work performed at the time of your disablement, or proof that you are totally and permanently unable to perform (with aids and adaptations) at least two activities (refer to the PDS for the definition of activities ) for three (3) consecutive months as a result of your injury or illness. There is no waiting period if you ve suffered the total and irrevocable loss of use of: two limbs (where limb is defined as the whole hand or whole foot), or the sight of both eyes, or one limb and the sight of one eye, or cognitive function. 19 Sunsuper income protection insurance claims sunsuper.com.au

22 make your dreams more than dreams Contacting us is easy: ( when overseas) GPO Box 2924 Brisbane QLD 4001 sunsuper.com.au twitter.com/sunsuper facebook.com/sunsuper linkedin.com/company/sunsuper Sunsuper is a member of The Association of Superannuation Funds of Australia Limited (ASFA). The Sunsuper income protection insurance claims guide is prepared and issued by Sunsuper Pty Ltd, the issuer and Trustee of the Sunsuper Superannuation Fund (referred to as the Fund or Sunsuper ): Sunsuper Pty Ltd Sunsuper Superannuation Fund ABN ABN AFSL No SPIN SSR 0100 AU MySuper Authorisation Unique Super Identifier (USI) Copyright 2015 Sunsuper Pty Ltd 1860 (10/15)