Sunsuper insurance claims guide

Transcription

1 Sunsuper insurance claims guide Want to know more about: Making a claim How a claim is assessed 1 December 2015 make your dreams more than dreams

2 Getting Started What has happened to you or your loved one? You have an injury or sickness/illness which has permanently stopped you from working Please see Section 1: Total & permanent disability insurance claims 1 You ve lost a loved one Please see Section 2: Death insurance claims 11 You have an injury or sickness/illness which has stopped you from working temporarily Please see Section 3: Income protection insurance claims 23 You ve been diagnosed with a terminal illness Please see Section 4: Terminal illness claims 35

3 At Sunsuper, we understand that making a claim can be a stressful and difficult process. We appreciate that the circumstances of every claim are as different as the individuals making them. To help you and your family through this difficult time, Sunsuper has a team of dedicated and experienced staff who are able to assist you. Our Claims Team are trained specialists who will handle your claims journey with compassion and professionalism. We have developed this guide to help step you through the claims process. The following sections contain all the information you will need to help you make a claim. From basic details about the claim type and your eligibility through to in-depth guides on the information required for each claim, this comprehensive guide aims to simplify the process and explain all requirements in simple steps that are easy for you to follow. Sunsuper is committed to helping you access your entitlements. Our claims process has been designed During , Sunsuper paid so that in most cases, you or your family out just over $307 Million in should not require the assistance of a insurance claims. lawyer when making a claim. If you need help, our dedicated Claims Team is here to help guide you through the process. If you choose to seek professional help, we recommend that you first determine the costs involved in doing so and how they will impact your benefit payout. We give no priority to claims lodged by professionals all claims are dealt with in the same manner and follow the same process. Depending on the claim type, it can take up to six months or more for you to receive a final decision on your application. Once we have received your application, it is reviewed internally before being passed on to the Insurer who is ultimately responsible for assessing the claim. The assessment process involves many steps from working out whether you are eligible to claim, through to evaluating claim documentation including medical reports and other supporting evidence. While the process can be lengthy, we will strive to expedite it for you and keep you informed of your claim s status. If you have any further questions, please contact your dedicated Claims Officer or call our Contact Centre on

4 SUNSUPER INSURANCE CLAIMS GUIDE Contents 1 2 Total & permanent disability insurance claims What is Total & Permanent Disability (TPD) Insurance? How to make a TPD claim What does a TPD claims pack contain? 3 1. Claim Application (Employee statement) 3 2. Total and Permanent Disablement claim (Medical Attendant s statement) 3 3. Employer statement (Total and Permanent Disablement claim) 3 4. Benefit payment instruction 4 5. Centrelink Authority to Release Personal Information 4 6. Authority to release personal Medicare and Pharmaceutical Benefits Scheme (PBS) claims information What you will need to provide in your TPD claim 4 Certified proof of your identity 4 TPD claims Checklist The TPD insurance claim assessment process Frequently asked questions about TPD claims 8 Do I need a lawyer? 8 When can I make a TPD claim? 8 What if I am not sure I have insurance? 8 Why does it take so long? 8 Is there a Waiting Period? 8 Are there any injury or sickness/illness exceptions? 8 What happens if I have a self-inflicted injury? 8 How much will it cost? 8 What happens if I am receiving Income Protection payments? 8 What if I am self employed? 8 What if I am unemployed? 8 Death insurance claims What is a Death claim? How to make a Death claim What does a Death benefit claims pack contain? Appointment of representative Death benefit application form Employer statement What you will need to provide in the death claim 14 Certified proof of your identity 14 Death claims checklist Death insurance claim assessment process Frequently asked questions about Death claims 19 Do I need a lawyer? 19 What is a binding death nomination? 19 Who is eligible to receive the benefit? 19 Legal Personal Representatives 19 What is a dependant? 19 What is an interdependent relationship? 19 What is a financial dependant? 19 What happens if the deceased member committed suicide? 20 Are there any other exceptions? 20 Why does it take so long? 20 How much will I be paid? 20 What is the impact of where the benefit is paid? 20 What is a Family Provision application? 20 Will tax be payable on the benefit? 20 Will funeral expenses be reimbursed? 20 Will I be eligible for an anti-detriment payment? 20 Income protection insurance claims What is Income Protection (IP) Insurance How to make an IP claim What does an IP claims pack contain? Claim Application (Employee statement) Treating Doctor s Report An Employer statement Centrelink Authority to Release Personal Information Authority to release personal Medicare and Pharmaceutical Benefits Scheme (PBS) claims information Tax File Number declaration Bank Account Nomination form What you will need to provide in your IP claim 26 Certified proof of your identity 26 Income Protection claims checklist The IP claim assessment process Frequently Asked Questions about IP claims 30 Do I need a lawyer? 30 Do I have IP insurance? 30 Is there a Waiting Period? 30 Do I have to re-start a Waiting Period if I return to work? 30 Are there any exclusions or restrictions? 30 Sunsuper insurance claims guide

5 What happens if I m partially disabled? Frequently Asked Questions about TI claims 39 How much will I be paid? 30 Do I need a lawyer? 39 When are benefit payments made? 30 How much would I be entitled to? 39 Will I pay tax on the benefit? 31 Will there be offsets to my benefit payment? 31 What happens if I have a recurring injury or sickness/illness? 31 What happens if I am receiving an Income Protection payment? 39 How much will I be paid? 39 Are there any tax implications? 39 4 Rehabilitation in Super Work is Good Medicine 33 Terminal illness claims What is a Terminal Illness (TI) claim? 36 How is terminal illness defined? How to make a TI claim What does a TI claims pack contain? Application for early release of benefit form Employer statement Authority to access information Medical Practitioners certificate Binding death nomination form How do I prepare for the application process not being completed before my death? 39 Proof of identity requirements 41 When do you need to prove your identity? 42 What is an acceptable identification document? 42 What if you ve recently changed your name? 43 What do we mean by certified? 43 Who can certify your identification documents in Australia? 44 What if you live overseas? 45 Definitions What you will need to provide in your TI claim 38 Certified proof of your identity The TI claim assessment process 38 Coordination and assessment of your application 38 Payment of your claim 38 The 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.com.au

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7 1 Total & permanent disability insurance claims We can appreciate that being unable to work is 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. 1

8 1 TOTAL & PERMANENT DISABILITY INSURANCE CLAIMS 1.1 What is Total & Permanent Disability (TPD) Insurance? Total and Permanent Disability (TPD) insurance is a type of insurance cover which pays you a lump sum in the event that you become totally and permanently disabled. The term totally and permanently disabled means that you will be unable to ever work again in your own or any other occupation for which you are suited by training, education or experience. If your TPD claim is approved, you are usually able to withdraw your superannuation account balance and any insured benefit, allowing you and your dependants to pay debts or bills, provide an ongoing income or fund your special medical needs. The amount of your lump sum payout therefore depends on your superannuation balance and how much insurance cover you have at the time of injury or sickness/illness. Having insurance cover doesn t automatically mean that you will receive a TPD payment. The assessment process takes into account the TPD definition in place at the time you ceased work, your current job or occupation, any education, training and work experience you have, and the impact that your injury or sickness/illness will have on your ability to work again. The Insurer will contact your employer and your doctors to obtain information, and they may also send you for additional tests and/ or examinations to a doctor of their choice. TPD definitions vary between superannuation funds. Sometimes you may be eligible for a benefit from one fund but not from the other fund. If you don t have insurance with us, you may still be able to claim your super balance under a Permanent Incapacity Benefit. Permanent Incapacity is defined in the Superannuation Industry (Supervision) Regulations 1994 (Cth). Members suffering from Terminal Medical Conditions may also be able to access their super balance. Please contact the Claims Team for further information. 1.2 How to make a TPD claim If you believe that you may be eligible to apply for a TPD claim, we are here to help you along the way. To submit your claim, you need to complete the three major steps listed below. 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 or sickness/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 TPD claim forms for completion. The 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 you worked per week leading up to your injury or sickness/illness Step 3 Complete and return the TPD claim forms 2 Sunsuper insurance claims guide

9 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 TPD claim. We recognise that this may be a daunting task. Our Claims Team is here to help you every step of the way, assisting with your claim and helping to answer any questions you may have. 1.3 What does a TPD claims pack contain? There are a number of forms you will need to complete when making a TPD 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 processed 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 were performing 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 superannuation 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 payslips. 2. Total and Permanent Disablement claim (Medical Attendant s statement) 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 injury or sickness/illness and provide evidence for it (such as medical records, test results etc.). Please note: So that we can make the process of lodging your claim as easy as possible, in some instances our Insurer will contact your treating doctor directly for completion of this form. If this is the case, this form will not be sent to you as it will be sent directly to your doctor. Tips: We recommend that you contact your doctor and let them know that you are in the process of making a TPD claim. You may be required to make an appointment with your doctor to have them complete this statement. Please note that you will be responsible for the costs of this appointment. 3. Employer statement (Total and Permanent Disablement claim) What is this form for? This form is to be completed by your (previous) employer with whom you were employed at the time of your injury or sickness/illness. They will need to provide information about the types of duties you performed in your role. Tips: We recommend that you contact the HR department or your direct manager from your (previous) employer, as this form must be completed by an authorised person. Why so many questions? In order to properly assess your claim, the Insurer requires detailed information from you, your employer and your doctor. While we recognise that your claim requires a number of questions to be answered, collecting as much information at the start will help validate your claim and speed up the process. We understand that this may be a daunting task, and our Claims Team is here to help you every step of the way. If you require assistance, please contact the Claims Team sunsuper.com.au 3

10 1 TOTAL & PERMANENT DISABILITY INSURANCE CLAIMS 4. Benefit payment instruction What is this form for? This form asks how you would like to receive your money should your claim be approved. Tips: Providing this information to us at the start will ensure that you can receive your claim monies without delay if your claim is approved. If you are unsure of how you would like your claim monies paid, we can arrange for you to speak with one of our qualified financial planners who will be able to assist you to make the best decision for your individual circumstances. 5. Centrelink Authority to Release Personal Information What is this form for? If you receive Centrelink benefits, you will be required to complete this form to give authority to Sunsuper and its Insurer to obtain information about your benefits. This form allows the Insurer to access any information or medical reports held by Centrelink which may help with the assessment of your claim. Please note: This form is not required in every instance and will only be included where necessary. 6. 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. 1.4 What you will need to provide in your TPD claim Completing your TPD claim application is the largest and most 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. Please note: These forms are not required in every instance and will only be included where necessary. Remember, if you need assistance please call the Claims Team 4 Sunsuper insurance claims guide

11 TPD claims Checklist Before you send your claim through, make sure you have fully and correctly completed the following requirements: Certified proof of ID Claim Application (Employee statement) Total and Permanent Disablement claim (Medical Attendant s statement) Employer statement (Total and Permanent Disablement claim) Benefit payment instruction Centrelink Authority to Release Personal Information (if required) Authority to release personal Medicare and Pharmaceutical Benefits Scheme (PBS) claims information (if required) 5

12 1 TOTAL & PERMANENT DISABILITY INSURANCE CLAIMS 1.5 The TPD insurance claim assessment process Claim forms are received Insurer assesses claim Claim is declined by Insurer Claim is accepted by Insurer Claim is deferred by Insurer Sunsuper Trustee reviews Insurer s decline of claim Sunsuper Trustee reviews Insurers acceptance of claim and makes payment Sunsuper Trustee disagrees with decline Sunsuper Trustee upholds decision to decline claim Please note: the process for Permanent Incapacity claims (where there is no insurance) is similar to the above but does not involve the insurer. Claim forms are received Insurer assesses claim Once we have received your claim forms, the Claims Team 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. Throughout the life of the claim, the Claims Team will keep you updated on its progress. The Insurer will use the information you, your employer and your treating doctor provide when making its assessment. The Insurer may also: 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 examinations they arrange for you to attend. Once all required information has been collected, the Insurer will assess your claim and decide whether it will accept, defer or decline your claim. 6 Sunsuper insurance claims guide

13 Claim is accepted by Insurer Claim is declined by Insurer If your insurance claim is accepted by the Insurer, the insurance monies will be paid to Sunsuper and initially invested in the Cash option. Funds will be held in this relatively stable investment option until the Sunsuper Trustee finalises payment to you. Sunsuper Trustee reviews Insurer s acceptance of claim and makes payment The Sunsuper Trustee will assess your claim and the Claims Team will contact you to advise that your claim has been approved. If you have already provided us with payment instructions via the Benefit payment instruction form (see page 4), we will pay your benefit accordingly. If your payment instructions have not been received, the Claims Team will contact you to discuss your payment options. You have the choice of taking the payment in cash, leaving it in your Sunsuper account or rolling it over to another approved superannuation fund. If you choose to take your benefit in cash (paid into your bank account or via cheque), you ll receive notification and details of the payment. PAYG tax will be withheld from your benefit where applicable. If you choose to leave your benefit in Sunsuper, any insurance proceeds will be moved into your chosen investment option(s) (or the Lifecycle Investment Strategy where you haven t made a choice). Please note that if your claim is successful, you will no longer be eligible to receive other default cover, such as a death benefit or another TPD benefit from Sunsuper unless you re-apply for cover, provide evidence of your health and the Insurer accepts your application. If your insurance claim is declined by the Insurer, it will be 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. Sunsuper Trustee reviews Insurer s decline of claim If the Sunsuper Trustee agrees with the decision to decline your claim, the Claims Team 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, you are then able to ask the Superannuation Complaints Tribunal (SCT) whether you are eligible to submit a complaint to them. The SCT is an independent body set up by the Commonwealth Government to assist members (or their beneficiaries) in resolving certain superannuation complaints. Before seeking the SCT s help, you must first lodge a complaint directly with Sunsuper. Time limits affect when you can make a complaint to the SCT about a TPD claim. Call the SCT on or visit their website for more information. Claim is deferred by Insurer The Insurer may defer your claim for a period of time to determine the full extent of your disability and to ascertain whether it s permanent. Your claim will be reviewed at the end of this period, and either a decision will be made or your claim may be deferred again sunsuper.com.au 7

14 1 TOTAL & PERMANENT DISABILITY INSURANCE CLAIMS 1.6 Frequently asked questions about TPD 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. When can I make a TPD claim? If you are claiming for TPD, this means that you have been and are still suffering from an ongoing and serious injury or sickness/illness that is permanently preventing you from working or from performing daily activities. To apply for a TPD claim, you must satisfy the definition of Total and Permanent Disability and meet the Waiting Period requirements. See our Definitions section of this Guide for more information. What if I am not sure I have insurance? Login to Member Online and check your details at sunsuper.com.au/memberonline review your most recent statement or call us on Why does it take so long? There are many steps involved in assessing a claim. The process is lengthy and can take a number of months. We and the Insurer need to assess all relevant facts, including information from you, your employer, your doctor and medical specialists to ensure that the correct decision is made. Is there a Waiting Period? The current Waiting Period for a TPD claim is generally three months. This means that you must have been absent from work as a result of your injury or sickness/illness for a period of three months or more before you can lodge a TPD claim. There are some instances where the Waiting Period may not apply. Please check with the Sunsuper Claims Team if this applies to you. Are there any injury or sickness/illness exceptions? You will not be eligible to make a TPD claim where your injury or sickness/illness is caused, wholly or partly, directly or indirectly from you being deployed to a hostile environment as part of active military service. What happens if I have a selfinflicted injury? In some instances, you will not be eligible to make a TPD claim if your injury or sickness/illness is caused by an intentional selfinflicted act. Please check with the Sunsuper Claims Team if this applies to you. How much will it cost? To enable our Insurer to assess your claim, you ll need to provide medical evidence to support your application. The cost of any information required to initiate the claim process is to be met by you. This includes having a doctor complete a Medical Attendant s statement (if applicable). If the Insurer requests additional information or reports from your doctor, or requests an independent medical examination, the cost of these will be paid by the Insurer. What happens if I am receiving Income Protection payments? If you are receiving Income Protection payments, these will continue as long as you satisfy the terms of the Income Protection claim policy. What if I am self employed? The process of making a claim remains the same irrespective of whether you work for an organisation or work for yourself. What if I am unemployed? The assessment of your TPD claim may be based on a different definition than if you were working. See the Definitions section of this Guide for more information. 8 Sunsuper insurance claims guide

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17 2 Death insurance claims We understand that dealing with the loss of a loved one is a difficult time. We are here to help you and your family with the process of applying for a death payment, and we will do our best to help ensure that your claim is dealt with as quickly as possible. 11

18 2 DEATH INSURANCE CLAIMS 2.1 What is a Death claim? A death claim is a claim for a deceased Sunsuper member s account balance. When the member had active death insurance at their time of death, the death insurance cover is also included in the death claim. 2.2 How to make a Death claim If you believe that you may be eligible to claim as a beneficiary of the member, we are here to help throughout the claims process. The three major steps that you need to complete in order to submit your claim are listed below. 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: The member s Sunsuper membership number. You can find this number in the top right hand corner of the member s Annual Statement as well as most other correspondence from Sunsuper. 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: confirm details of the member, advise you of the documents and information you need to provide for the claim to be assessed, and send you the claim forms for completion. The member s date of birth. We will begin the death benefit claim process as soon as we hear of a member s death, however formal notification is required for any claim to proceed. We require a certified copy of one of the following documents: death certificate coroner s report autopsy report inquest finding a medical certificate of death, completed by a registered medical practitioner. Once we receive formal notification of the death, the member s existing account balance will be switched into Sunsuper s Cash Option, normally within five working days. Funds will be held here until the Sunsuper Trustee finalises payment to the beneficiaries. This is a relatively stable investment option subject to small growth and fluctuation. Any insurance benefits will also be paid into this option. Step 3 Complete and return the 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. We recognise that this may be an emotional and 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. 12 Sunsuper insurance claims guide

19 2.3 What does a Death benefit claims pack contain? The claims Pack includes a number of forms that you need to complete when making a claim for death benefits. Please do not hesitate to call the Claims Team if you have any questions about these forms as we want to ensure that your claim is progressed as quickly as possible. 1. Appointment of representative What is this form for: this form is to be completed if you wish Sunsuper to communicate with, or release information to, a person or organisation acting on your behalf. Tips: Our claims process has been designed so that you or your family should not require the assistance of a lawyer when making a claim. If you require assistance, our dedicated Claims Team is here to help guide you through the process. If you choose to seek professional help, we recommend that you first determine the costs involved in doing so and how they will impact your benefit payout. We give no priority to claims lodged by professionals all claims are dealt with in the same manner and follow the same process. 2. Death benefit application form Probate is a Court order that allows the Executor named in a Will to manage the deceased individual s estate and assets. Letters of Administration: where the deceased has not left a Will, a person may apply to the Supreme Court (in the State or Territory in which the deceased resided) for a grant of Letters of Administration. Generally, the deceased person s next-of-kin will be granted Letters of Administration. Similar to a grant of Probate, Letters of Administration allow the person appointed to administer the deceased s estate. A person who is granted Letters of Administration is called an Administrator. 3. Employer statement What is this form for? This form is to be completed by the deceased member s (previous) employer with whom they were employed at the time of their death or immediately prior. This form will only be requested if there is active insurance at the time of the deceased member s death. Tips: We recommend that you contact the Human Resources department from the deceased s previous employer as this form must be completed by an authorised person. What is this form for: this form requests details about the deceased Sunsuper member, including details about their last employer and other superannuation accounts as well as information about you, the claimant and your relationship to the deceased. In order to ensure Sunsuper pays the correct beneficiary, we are required to ask about the deceased member s family situation, including details about their spouse, children, parents, living arrangements and financial affairs. Tips: As this form references a lot of legal terms, we have explained many of these below to make it quicker and easier for you fill in this form. A Will is a legal document that details how an individual s property and belongings are to be divided upon their death. Under a Will, an Executor who is responsible for looking after an individual s estate is appointed. Upon the individual s death, the executor will work out the individual s assets, pay any debts and then distribute the remaining assets in accordance with the details of the Will sunsuper.com.au 13

20 2 DEATH INSURANCE CLAIMS 2.4 What you will need to provide in the death claim Completing the claim forms is the largest and most important step in the claim process. The details and evidence you provide will form the basis upon which the Sunsuper Trustee and the Insurer (if relevant) 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 claim application may be a daunting and emotional 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 (for example, a driver s licence or passport) as proof of your identity. Why? For security purposes we need to be sure of the identity of the individual who is 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. 14 Sunsuper insurance claims guide

21 Death claims checklist Before you send your claim through, make sure you have fully and correctly completed the following requirements: A certified copy of your ID Death benefit application form Employer statement Full Certificate of Death Certificate of the deceased s Birth or an extract of Birth Entry Last Will and Testament of the deceased (if one was left) Grant of Probate or Letters of Administration (if already obtained) Marriage Certificate of the deceased (if applicable) 15

22 2 DEATH INSURANCE CLAIMS 2.5 Death insurance claim assessment process Claim forms are received Claim is accepted by the insurer Insurer assesses claim Sunsuper Trustee assesses claim Claim is declined by Insurer Sunsuper trustee disagrees with insurer decision Claim outcome is advised claim staking is required Claim outcome is advised no claim staking is required Objection is received No objection is received Sunsuper trustee agrees with insurer decision Claim payment Please note: the process for Death claims for a deceased member s account balance where there is no insurance, or where an insurance claim has been rejected, is similar to the above but does not involve the insurer. 16 Sunsuper insurance claims guide

23 Claim forms are received Claim outcome is advised claim staking is required Once we have received your claim form, 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. Throughout the claims process, your Claims Officer will keep you updated on its progress. After a decision has been made, the Sunsuper Trustee will contact all potential beneficiaries to advise where the benefit will be paid and in what proportions. This is referred to as the claim staking process. Any interested parties who are unhappy with the determination will have 28 days to object. Insurer assesses claim Objection is received Once you have provided the information requested, and we have confirmed that the member was insured at the date of death, we will submit an insurance claim to the Insurer. If the insurer declines the claim, it is then referred to the Sunsuper Trustee for review. Claim is accepted by the insurer Once a claim is accepted by the insurer, it goes to the Sunsuper Trustee to determine where the death benefit will be paid. Sunsuper Trustee assesses claim Once all the information is obtained from possible beneficiaries, the claim is submitted to the Sunsuper Trustee to determine where the benefit will be paid. The Claims Committee meets once a month to make these decisions. Uncomplicated claims for example where there is a lifetime partner and no other dependants may be determined more frequently. If we receive an objection, we will contact all potential beneficiaries to advise them that an objection has been received and allow a period of time for any further submissions. The claim will then be resubmitted to the next claims committee meeting where the Sunsuper Trustee will either confirm or change the initial decision. If the decision is confirmed, a confirmation letter will be sent to the beneficiaries, which then allows another 28 days for any potential beneficiaries still unhappy with the decision to lodge a complaint with the Superannuation Complaints Tribunal (SCT). If the decision is changed, applicants will once again have 28 days to notify the Sunsuper Trustee of any objections. If any party provides an objection to the revised decision, the process of advising all interested parties and inviting further submissions will be repeated before the claim is presented to the Sunsuper Trustee again. Claim outcome is advised no claim staking is required Claim staking is not required where a valid binding death benefit nomination exists. It may also not be required where the benefit amount is very small or in cases where there is only one possible dependant sunsuper.com.au 17

24 2 DEATH INSURANCE CLAIMS Claim is declined by Insurer If the claim is declined by the Insurer, it will be referred to the Sunsuper Trustee for assessment. If the Sunsuper Trustee disagrees with the decision of the Insurer and believes that the claim should be approved, the claim will be referred back to the Insurer for their reconsideration. Your Claims Officer 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, you are then able to ask the Superannuation Complaints Tribunal (SCT) whether you are eligible to submit a complaint to them. The SCT is an independent body set up by the Commonwealth Government to assist members (or their beneficiaries) in resolving certain superannuation complaints. Before seeking the SCT s help, you must have first lodged a complaint directly with Sunsuper. Time limits affect when you can make a complaint to the SCT about a death claim. Call the SCT on or visit their website for more information. Claim payment Payment will generally be made to the beneficiaries within a few days of the Sunsuper Trustee decision (if no claim staking is required), or upon the 28 day objection period expiring, provided there are no objections. For payment to be made, we must have received certified proof of identity documents for the beneficiaries, TFN (where applicable) and been notified how and where the payment is to be made. The Sunsuper Trustee will generally pay the benefit directly to the beneficiaries determined, except in the case of minor children, when we may pay to a parent or legal guardian on behalf of a child, or pay to the Public Trustee. 18 Sunsuper insurance claims guide

25 2.6 Frequently asked questions about death 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. What is a binding death nomination? A binding death nomination is a legal instrument that binds the Sunsuper Trustee to pay the death benefit to the deceased member s dependants, or legal personal representative nominated by the deceased. Provided the nomination is valid and less than three years old, then the Sunsuper Trustee must pay the death benefit in accordance with the nomination. If the binding death benefit nomination is found to be invalid, then the Sunsuper Trustee will use its discretion to determine how the benefit is paid, much the same way as a preferred beneficiary nomination. If there is a Court order that the Sunsuper Trustee is subject to, the Sunsuper Trustee will be bound to follow that Court order. An invalid or lapsed nomination may still be used by the Sunsuper Trustee as a guide when paying the death benefit, however it does not ensure it will be paid in the same way as a valid binding death benefit nomination. Who is eligible to receive the benefit? When deciding where the benefit will be paid, the Sunsuper Trustee will check to see if the deceased member had recorded their wishes concerning who their super benefits will be paid to by completing a binding death benefit nomination. If there is a valid binding death benefit nomination, the Sunsuper Trustee is bound to pay the death benefit in accordance with that nomination. If there is no binding death benefit nomination, or the nomination is invalid, the Sunsuper Trustee will decide who the death benefit will be paid to. Regardless of whether there is a valid binding death benefit nomination in place,the legislation dictates that a death benefit can normally only be paid to a dependant, the deceased member s LPR, or a combination of deceased member s dependants and the LPR. As a general rule, if there is no valid binding nomination, a spouse (including a de-facto) and minor children will be given priority over other claimants (including adult children), especially claimants who were not financially dependent on the member. It is important to note, a de-facto relationship will generally exist where a couple live together on a genuine domestic basis. Also, in most cases, parents and friends aren t considered dependants unless an interdependent relationship exists or the person was dependant on the deceased for maintenance or support at the time of death. Legal Personal Representatives Where a deceased has a valid Will, a legal personal representative (LPR) is the executor of their estate. If no Will exists then the Supreme Court can appoint someone to be the LPR to administer the estate. This process is called a Grant of Letters of Administration. What is a dependant? A dependant can be any spouse (including a de-facto), any child, any person who was in an interdependent relationship or any other person who the Sunsuper Trustee considers was dependent on the deceased member for maintenance or support (financial dependant), at the date of death. What is an interdependent relationship? Someone can be in an interdependent relationship if they have a close personal relationship, they live together, one or each of them provides the other with financial support, and/or one or each of them provides the other with domestic support and personal care. Dependency can also arise where two people have a close personal relationship, but don t live together or provide each other with financial support or personal care because of a physical, intellectual or psychiatric disability. A person wishing to be considered on the grounds of an interdependent relationship will be asked to provide information to substantiate the existence of the relationship. Examples of this include, but are not limited to: evidence of a mutual commitment to a shared life evidence of jointly owned property or shared living costs public perception of a close personal relationship evidence of an intention that the relationship be permanent. What is a financial dependant? A financial dependency may exist where you relied on the deceased member for some or all of your financial needs (for example, where you had an ongoing reliance on the deceased member to assist with things such as rent or mortgage sunsuper.com.au 19

26 2 DEATH INSURANCE CLAIMS payments, and without their assistance your standard of living could not be maintained). A person wishing to be considered on the grounds of financial dependency will be asked to provide information to substantiate the existence of dependency. This would require evidence of either regular or irregular financial support from the deceased member. What happens if the deceased member committed suicide? In some instances, an insured death benefit will not be paid where the death is caused by suicide or any intentional selfinflicted act within 12 months of the deceased member s insurance cover start date. Please check with the Claims Team to see if this applies in your circumstance. Are there any other exceptions? An insured death benefit will not be paid where the death is caused, wholly or partly, directly or indirectly from the deceased member being deployed to a hostile environment as part of active military service. Why does it take so long? There are many steps involved in assessing a claim. The process is lengthy and can take a number of months. Sunsuper needs to assess all relevant facts to ensure that it is paying the monies to the right person/people. How much will I be paid? It is important that claimants understand that any insurance benefit payable is determined at the date of the deceased member s death. The insurance benefit amounts shown on the deceased member s Annual statements or online are as at a specific time and may be different than the amount at the date of their death. Total benefit paid will include the member s account balance and any insurance benefit payable. What is the impact of where the benefit is paid? If the benefit is paid to the LPR, the death benefit is paid directly to the deceased member s estate and will be paid in accordance with the terms of the deceased member s Will, and will be subject to family provision claims and claims by any creditors of the deceased member s estate. What is a Family Provision application? A Family Provision application is a challenge to a Will, which occurs where a family member of the deceased feels that they have not been adequately provided for under the Will. Will tax be payable on the benefit? Generally tax is not payable if the benefit is paid to a dependant, unless the beneficiary is an adult child who is 18 or more years of age and not financially dependent. Tax is also not payable when paid to the LPR where the beneficiaries of the estate are dependants of the deceased member under taxation laws. Payment to most other beneficiaries will be taxable. Tax on superannuation is complicated and we recommend you speak to one of our qualified financial advisers to understand how this will impact any benefits paid. Just call us on to arrange an over the phone or in person appointment today. Will funeral expenses be reimbursed? Under the Sunsuper Trust Deed and superannuation law, there is no specific provision that permits payment or reimbursement of funeral expenses from a superannuation death benefit. Any person who has paid funeral expenses is not, by reason only of that payment, a dependant for superannuation purposes. Will I be eligible for an anti-detriment payment? Some dependants may be eligible for an anti-detriment payment. This is essentially a payment that restores the deceased member s super balance to what it would have been if contributions tax had not been paid on the taxable contributions. If you are eligible for this payment, you will automatically be paid a separate payment shortly after the death benefit is paid. In some cases, PAYG tax on these payments may be applicable. It is important to understand the impact of where the benefit is paid. If the benefit is paid to a dependant, the death benefit is paid directly to the person(s) and does not form part of the deceased member s estate. It is consequently excluded from family provision claims against the deceased member s estate under relevant State or Territory legislation and from claims by any creditors of the deceased member s estate. 20 Sunsuper insurance claims guide