1 MAURICE BLACKBURN LAWYERS SUPERANNUATION & DISABILITY INSURANCE INCOME PROTECTION
2 02 MAURICE BLACKBURN YOU RE WORTH FIGHTING FOR. If you are hurt, injured, or are facing an unfair situation, you and your family shouldn t have to suffer. That s why we never stand back when bad things happen to good people. At Maurice Blackburn we believe that the law should serve everyone. Who you are or where you re from, it doesn t matter. You re worth fighting for. Maurice Blackburn was born from one man s belief in making a difference to people s lives. Nearly 100 years on these values remain a powerful influence on everything we do. We exist to fight for your rights. For what you deserve. When life isn t fair we ll help you to fight for everything you re entitled to. Because at Maurice Blackburn, we fight for fair.
3 03 SUPERANNUATION & DISABILITY INSURANCE Income protection Income protection is insurance to cover your income if you can t work because of an injury or sickness. Most people are covered by some type of income protection insurance, although the terms and conditions vary from policy to policy. Many people with disabilities will be eligible for income protection payments. Have I got income protection insurance? Probably yes. Many employees are covered through their employers or superannuation fund. Others are covered if they are members of Incolink, Protect, IUS etc. Many self-employed people have private income protection. How do I find out if I am covered? Check your papers, for example your insurance policy, insurance renewal notice, annual superannuation statement. Then get advice see help at the end of the pamphlet. What am I covered for? Usually monthly payments for two years, five years, to age 65 or lifetime. The rate of payments is set out in the policy schedule. It s usually a flat monthly amount or up to 75% of your income. Sometimes it also includes superannuation payments. The waiting period for payments is usually seven days, 14 days, one month or three months. Are there any exclusions or offsets? Some policies exclude injuries or sicknesses you had before you took out the policy but not all it depends on the wording. If you had a disability before you were covered, you might still be able to claim. Payments are usually but not always offset against workers compensation, motor vehicle or Centrelink payments. Payments can also but not always be offset against compensation lump sums. If you re not sure whether exclusions or offsets apply to you, see help. Am I automatically covered if I suffer ill health? Most, but not all, work super funds offer basic income protection cover without filling in a health questionnaire. You will usually be covered even if you stop work because of a pre-existing disability. Some super funds only offer income protection cover if you are at work when you join. Private insurance policies usually require evidence of good health but some group
4 Your team certainly walked the extra mile and we are extremely appreciative. Superannuation client What does disability mean? It depends on the policy wording of disability. The most common definition is unfit for most/all of your usual job. insurance policies will cover you without filling in a health questionnaire. If you want extra cover, you will have to fill in a health questionnaire. Do I have to tell the insurance company about any health problems? If you didn t tell the insurance company about your health problems or previous medical appointments when you took out the policy, they may refuse your claim and try to cancel your policy. However, an insurance company can only do this if they are cancelling your policy within three years of you starting it and you should have told them about your health issues, or if you knew you should have told them and they re cancelling the policy more than three years after the start. If you told your insurance agent about your pre-existing problems, the insurer can t cancel your policy. The easiest definition is unfit for one of the duties of your usual job. The hardest definitions are unfit for your usual job or any other work given your education, training or experience. Other definitions include unfit to earn 25% or more of your usual income or unfit for your daily living activities. When can I make a claim? It s best to make a claim as soon as possible. Some policies say you must make a claim within 90 days, however, you can make a claim later. You can also claim past payments if you can prove you were disabled when you stopped work. Claims can usually be made many years after stopping work, although in some cases you might not be able to sue the insurer after six years.
5 05 SUPERANNUATION & DISABILITY INSURANCE What papers should I lodge with a claim? You will have to fill in and lodge a claim form, medical forms and other papers. It is really important to lodge the right medical reports. The reports should cover the definitions of disability and injury/ sickness in the policy. It might be possible to use other reports such as workers compensation or Centrelink reports. The opinions of your treating doctors are very important. Be careful that any reports don t damage your claim. It s also important to make good submissions as to why you are eligible for income protection and to cover any nondisclosure arguments. Get help before you lodge your claim. Should I sign authorities? Yes, so long as they are relevant to your claim. You will probably be asked to sign medical authorities as well as Health Insurance Commission, Centrelink, and workers compensation authorities. Don t sign any blank authorities. Only sign those with relevant organisations or doctors names on them that are relevant to your claim. Insurers are bound by privacy laws. Do I need to give the insurer my tax records? You will have to give the insurer your tax returns, and they can also ask for information from your accountant to work out your income now or in the past. However, they can only ask for information that is relevant to your claim and can t ask for all your tax records. Insurers often try to reduce or stop payments because of your current income or what you were earning before you took out the policy. However, you can appeal depending on what your actual income and expenses are or what you told the agent when you got the policy. Do I have to go to insurance doctors? Yes, so long as they are relevant to your claim. You might have to go to more than one appointment, but not too many it depends on what is reasonable and relevant to your claim. You can get copies of the reports. What happens if I go back to work? Under most insurance policies, you are entitled to partial disability benefits if you go back to work in less than a full capacity. Make sure you tell the insurance company about any return to work and what your income is so that they can work out what your partial disability benefits might be. The progress report forms you fill in will ask if you are working even if it s unpaid work. Keep copies and notes of what you tell the insurer. How long will a claim take? There is no time limit for a decision on a claim. Most take two three months, however it can be longer if there are complications.
6 6 MAURICE BLACKBURN Can I complain about the insurer? Yes, you can complain if your claim is rejected or if your payments are stopped or reduced or if you are being mucked around. You can lodge an internal complaint asking the insurer to change their decision with medical evidence and other submissions. The insurer has 45 days in which to make a decision on the complaint. Can I appeal to a court ombudsman? Yes, if you are not happy with the insurer s decision about your complaint, you can lodge a complaint with the Financial Ombudsman Service (FOS). FOS can change an insurer s decision, although there are limits on the Ombudsman s powers to deal with some complaints. FOS can make binding decisions on claims up to $6,700 per month or $280,000 in total. Complaints are usually dealt with by parties making written submissions and replies. You can be legally represented. Alternatively, you can take your case to court. There are no dollar limits on taking a case to court. It is usually quicker to take your case to court than to FOS but there are no filing fees at FOS. Should I appeal or complain? The insurance company s decision is not the end of the matter. Help Call Maurice Blackburn Lawyers for free advice about your income protection insurance rights. Call and you will be referred to a lawyer for free advice. More information about superannuation and insurance issues including testimonials from past clients is available on the website mauriceblackburn.com.au. Checklist for superannuation or insurance claims Have you stopped work? Are you on a Centrelink Disability Support Pension? Are you on a workers or motor vehicle accident compensation? Have you ever had: employment super? income protection insurance? employment disability insurance? private super? life insurance? mortgage protection insurance? trauma insurance? If you answered yes to any of the above (or if you re not sure), contact Maurice Blackburn to check for a possible claim. Most appeals or complaints either win or are settled. You should definitely get advice about whether you have a chance with an appeal to a court or a complaint to the Ombudsman and then decide what to do.
7 CONTACT US If you are considering legal action or want to fight for your rights, get in touch and we can assess what you need or arrange for a meeting with one of our lawyers. For most practice areas, your first consultation is free (business hours) mauriceblackburn.com.au Superannuation & Insurance Claims Work Related Injuries Road Accident Injuries Medical Negligence Asbestos Diseases Public Liability Faulty Products Comcare Will Disputes Employment & Industrial Law Class Actions Social Justice You are welcome to drop into one of our offices nationwide. Call us or visit the website for more details: Victorian Offices (03) Melbourne Dandenong Frankston Geelong Greensborough Mildura Reservoir Ringwood Sunshine Traralgon Wangaratta Queensland Offices (07) Brisbane Browns Plains Caboolture Cairns Gold Coast Ipswich Mackay Rockhampton Strathpine Sunshine Coast Toowoomba Townsville NSW Offices (02) Sydney Parramatta Western Australia Office (08) Perth ACT Office (02) Canberra We also have visiting offices in the other states and territories.
8 Maurice Blackburn is a leading Australian law firm certified to the international ISO 9001:2008 quality standard. Information correct at 1 April This brochure is a general guide to dealing with Superannuation claims and is not a substitute for professional advice in this area. Maurice Blackburn is proud to be carbon neutral (see our website for details). This brochure is printed on ecostar Silk. Made with 100% certified post consumer waste fibre, it is produced with a carbon neutral manufacturing process and has been made in a facility that operates under the ISO Environmental Management System. MB4184_NATSIP 06/14