QSuper Guide. Permanent Disability Benefit Guide
|
|
- Jordan Thornton
- 7 years ago
- Views:
Transcription
1 QSuper Guide Permanent Disability Benefit Guide Issued: 3 August 2015
2 2 Permanent Disability Benefit Guide Contents Your permanent disability insurance 3 How is my benefit calculated? 4 How is my benefit paid? 5 Review and appeal process 6 Permanent Disability Benefit Application form Member Centres 70 Eagle Street Brisbane and 63 George Street Brisbane Telephone ( if overseas) Monday Friday 8.30am to 5.00pm Queensland time Postal address GPO Box 200 Brisbane Qld 4001 Fax (07) Website qsuper.qld.gov.au ABN: SFN: /08/2015 IB28 And so you know, this information is provided by QInvest Limited (ABN AFSL and Australian Credit Licence Number ) which is ultimately owned by the QSuper Board (ABN ) as trustee for the QSuper Fund (ABN ). All products are issued by the QSuper Board as trustee for the QSuper Fund. When we say QSuper, we re talking about the QSuper Board, the QSuper Fund, QSuper Limited or QInvest Limited, unless the context we re using it in suggests otherwise. We ve put this information together as general information only so keep in mind that it doesn t take into account your personal objectives, financial situation or needs, it shouldn t be relied on as legal or taxation advice and doesn t take the place of this type of advice. What we say about law or proposals is based on our interpretation of the law or proposals at the time we printed this document. You should consider whether the product is appropriate for you by reading a copy of the product disclosure statement before making a decision you can do this by downloading a copy from our website at qsuper.qld.gov.au or call us on QSuper Board of Trustees 2015
3 Permanent Disability Benefit Guide 3 Your permanent disability insurance This guide explains what you need to do to make a claim for a permanent disability benefit if you ve suffered an illness or injury that s left you unable to work. How do I apply? Like most insurance claims, there s paperwork you need to complete. Either you or your employer can apply for you to be assessed for a permanent disability benefit. Or we can start the process for you (if we re already paying you an income protection benefit and your medical details indicate you might not be able to return to your normal work). What we need from you or your employer is a detailed medical report from a medical practitioner. We need to let you know that you (or your employer) need to cover any costs for your doctor to provide this report. We ll pay for any subsequent medical information we need to assess your claim. To make a claim, please complete the Permanent Disability Benefit Application form that s included with this guide. You ll need to have a medical practitioner or specialist complete the doctor s statement at the back of this guide. We ve tried to make claiming as simple as possible, but please get in touch if you need any help completing the form. The completed documents you need to send us are: member s statement (completed by you) employer s statement (completed by your employer if you work for a non-queensland Government employer) doctor s statement (completed by a medical practitioner or specialist) copies of any other medical reports or certificates you might have about your injury or illness a certified copy of your proof of age (such as your birth certificate, passport or driver licence). Just so you know, a certified copy is a photocopy of an original document signed by a qualified certifier as a true copy of the original (you can find a list of these in our Proving your Identity factsheet on our website). How do you assess my claim? We understand you want your claim assessed as quickly as possible. We ll work with you to ensure this happens. Once we receive all the necessary paperwork from you, we ll allocate a claims manager and they ll contact you. As they manage your entire claim, they can talk you through the claims process. And they can answer any questions you might have about your claim. If you don t work for the Queensland Government, your insurance is provided by TAL Life Limited. If this is the case, we ll send your completed paperwork to them. Like us, they ll allocate a claims manager who ll get in touch with you and they ll manage your whole claim. We might get in touch with you to ask for additional information before we can make a decision about your claim. This could include: requesting further medical reports about your medical history or illness/injury (we cover any costs to get these reports) arranging for you to be seen by an independent medical specialist requesting additional financial information to help us work out your benefit. What if my claim isn t approved? If we don t approve your claim, we ll send you a statement of reasons explaining our decision. We let you know later in this guide what you can do if you re not happy with our decision. What if I m receiving an income protection benefit? An income protection benefit is payable if you re temporarily unable to work in your current job due to an illness or injury. If you become permanently disabled your income protection benefit stops. You can read more about this in our Income Protection Benefit Guide on our website, or call us and we ll send you a copy. What if I have a terminal medical condition? If you re diagnosed with a terminal medical condition that is likely to result in your death within 24 months, you may be able to access your super and your insurance benefit (if applicable). Just be aware though, if you aren t employed by the Queensland Government, accessing your super balance early due to a terminal medical condition could mean you are no longer eligible to claim your insurance benefit, which may be payable if you are diagnosed with a condition that is likely to result in your death within 12 months. The important terms section in the Accumulation Account Insurance Guide provides the definition(s) of having a terminal medical condition. You also should read our Terminal Medical Condition factsheet for more information, and to find out how accessing your super early may affect your eligibility to claim your insurance benefit. These documents are all available to download on our website at qsuper.qld.gov.au or call us and we ll send you a copy. What happens if I pass away? If you pass away, any insurance payout becomes part of your super benefit. Many people are surprised to know that your super doesn t form part of your estate. Instead it s distributed by the QSuper Board, generally to a dependant or legal personal representative. The Death Benefit Guide has more information about who can receive your super and any tax rules that apply. You can choose the person/s who ll receive your super when you pass away (as long as they re eligible) by completing and sending us a Making a Binding Death Benefit mination form available on our website, or call us and we ll send you a copy. If you have a Defined Benefit, or Police account, there might also be a benefit that s payable to your dependent children if you pass away. If you ve received a lump sum insurance benefit and you pass away from the same condition within 12 months of receiving it, there might also be a benefit payable to your dependent children.
4 4 Permanent Disability Benefit Guide How is my benefit calculated? Accumulation account If your super s in an Accumulation account with us, your death and TPD cover is provided in units, with each unit being worth a certain amount of cover. The value and cost of each unit varies with age. Between ages 65-69, you re only eligible for death cover. If you re a police officer 1, your death and TPD cover ends once you re 60. So your cover is calculated as the number of units multiplied by its value. For example, David is 36, works for Queensland Health and makes a standard contribution to his super, meaning he automatically gets four units of cover. The value of each unit is $125,000 so the amount of cover he has is $500,000. The benefit we pay if your claim is approved includes the insured amount as well as the balance of your Accumulation account when you make a claim. Of course, the payment of any additional cover you might have is subject to the pre-existing condition exclusion period. Defined Benefit account If your super s in a Defined Benefit account, and you re under 55, there are two parts to your payment: your current accrued benefits including any extra money you have in an Accumulation account your insurance benefit (this is your prospective benefit, which means the amount your Defined Benefit account would have grown if you d stayed a member up to age 55.) If you re working part-time, we ll adjust the prospective benefit we mentioned above to reflect this. If you re 55 or over, we ll pay your current accrued benefits only. You should know that you might be entitled to extra benefits if you have additional death and disability cover. The age limit for additional disability cover is 65. Additional death-only cover stops once you re 70. Proportional benefits If you aren t employed by the Queensland Government or a related entity and we ve received employer contributions for you and you have standard insurance, there might be a proportional benefit available within the five year pre-existing exclusion period. If you were at work on 16 December 2013, the pre-existing exclusion period reduced to a maximum of five years for your existing level of standard insurance cover and additional insurance cover. As we show in the table below, proportional benefits might be payable if your disability is related to a pre-existing medical condition, and it occurs between the second and fifth year of continuous insurance cover. Period of insured membership Up to 2 years 0% Between 2 years and 4 years 11 months 5 years or more 100% Percentage of standard insurance benefit 10% x amount insured + 2.5% x amount insured for each full month of continuous cover after 2 years You can check how much insurance cover you have by: logging in to Member Online (you ll first need to register for Member Online if you haven t already) reading your latest annual statement checking your QSuper welcome letter calling us on Pre-existing medical conditions A pre-existing medical condition is essentially a medical condition that you had before your cover started. If you commenced work on or after 16 December 2013 for the Queensland Government or a related entity employer, there s no pre-existing condition exclusion period for your standard cover (so we ll pay your benefit even if you had the condition before your cover started). However, if you were at work prior to 16 December 2013 a pre-existing exclusion period may apply. For all additional units of cover, there s a pre-existing exclusion period which depends on your date of disability. If you re not working for the Queensland Government or a related entity employer, there s a five year pre-existing exclusion period. However, you might be able to claim proportional benefits during the five year pre-existing exclusion period, which we explain now. 1 Different insurance arrangements apply to police officers.
5 Permanent Disability Benefit Guide 5 How is my benefit paid? What are my lump sum payment options? 1. Leave your benefit in an Accumulation account You can leave your money with us in an Accumulation account (and add other money to your account such as voluntary contributions or rollovers from other super funds). That way you ll continue to enjoy all the great benefits of being a QSuper member including low fees, solid returns and personalised service. This account offers a whole range of investment options, so we ve got something to suit your risk appetite and the level of involvement you re looking for. Of course, a number of factors (including your investment choices) will affect your account balance. You can make withdrawals from your super when you need to, just remember you need to withdraw a minimum of $2,000. You can read more about this in the Accumulation Account Guide on our website, or call us and we ll send you a copy. 2. Open an Income account Our award-winning 1 Income account gives you a flexible and tax-effective way to receive regular income payments from your super in retirement. You just need an opening balance of $30,000 to start an Income account. You can choose how much money you want to receive, although annual minimum limits apply. You can also withdraw lump sums if you need extra cash for any reason. So you know, you can t invest extra money into the account after the initial deposit, but you can open more than one Income account and receive separate incomes from each. Read more about our Income account in the Income Account Guide on our website, or give us a call. 3. Cash in your benefit You can take your benefit as cash but you might have to pay tax on some of your benefit. You can find out more by reading the Tax Explanation factsheet on our website. 4. Roll over to another complying super fund You can roll over part or all of your super into another complying super fund but first compare our low fees, solid returns and personalised service to what s offered by other funds. How is this benefit calculated? The PPD benefit is equal to your current accrued benefit. It s made up of: an unrestricted non-preserved amount (this is the cashable amount) and/or a preserved amount (the amount that s locked away until you permanently retire from the workforce and reach your preservation age). You can access your cashable amount at any time. You can check your annual statement to see what this amount is. We pay you this benefit as a lump sum payment. So you know, this is payable regardless of any pre-existing medical conditions. The rest of your benefit is preserved until you permanently retire from the workforce and reach your preservation age. You need to keep your benefit in an account with us or another complying super fund (make sure you first compare our low fees, solid returns and personalised service to what s offered by other funds). You can read more about this benefit in the Defined Benefit Account Guide on our website, or call us and we ll send you a copy. Your privacy We take the privacy of your information seriously. If you d like to know more about our individual privacy policies, download QSuper s Your Privacy factsheet on our website at qsuper.qld.gov.au, or download TAL s privacy policy at tal.com.au/privacy-policy Permanent and Partial Disability (Defined Benefit account holders only) If your illness or injury has left you permanently unfit or unable to do your usual job (but not totally and permanently disabled), you might be eligible to receive a permanent and partial disability (PPD) benefit. 1 Chant West Super Fund Awards 2015.
6 6 Permanent Disability Benefit Guide Review and appeal process What if I m not happy with the decision? We understand not everyone will be satisfied with decisions QSuper and TAL make on claims. You re welcome to lodge an appeal for review by QSuper and/or TAL. Send your appeal in writing to: Legal Review Unit, QSuper Group Life Insurance, GPO Box 200, Brisbane Qld You need to cover any costs to obtain medical reports you need or want to support your appeal. If you re still not satisfied with the decision after our review, you can lodge a complaint with the Superannuation Complaints Tribunal (SCT). This needs to be done within two years of the date we made the original decision. What is the Superannuation Complaints Tribunal (SCT)? The SCT is an independent tribunal set up by the Australian Government to review complaints relating to decisions made by super funds. It s designed to be an economical, fair, and quick review process. Just remember you need to use our internal appeal process before going to the SCT. If you re not happy with the decision or we haven t contacted you within 90 days of lodging your appeal, call the SCT on They ll let you know if they can deal with your complaint and if they can, the information you ll need to give them. You can visit the SCT website at sct.gov.au for further information. Need more information? To find new ways to get more out of your super, have a play around with the tools and calculators on our website at qsuper.qld.gov.au. You can experiment with as many different inputs and scenarios as you like. And we re always here to help on the phone too. Just call us on to get in touch.
7 QSuper Form Please complete in block letters, in blue or black ink. 1 Permanent Disability Benefit Application Member ment Who needs to complete this form? You need to complete this part of the claim form to apply for a permanent disability benefit. We need detailed information about your job and your illness/injury to be able to assess your claim. Make sure you provide your current medical practitioner s contact details in case we need to get in touch with them for more information. And get in touch if you need any help completing the form. 1 Personal details 2 Details of your illness or injury Client number You can find your client number on your annual statement or by logging in to Member Online. Title Surname Given names Please enclose copies of any medical information you have, such as WorkCover records or Veterans Affairs assessments that might be useful when we consider your claim. of your illness or injury (please provide a detailed description) What caused your illness or injury? Previous name 1 (if we know you by another name) Date of birth (dd/mm/yyyy) Home phone number Are you receiving, or willing to receive, appropriate medical care as recommended by your treating medical practitioners? If no, please provide reasons Mobile phone number address Work phone number When did you first start to experience signs or symptoms? Date (dd/mm/yyyy) Residential address When was your illness first diagnosed or when were you injured? Date (dd/mm/yyyy) Postal address Employment status As above When did you first visit a doctor about your illness or injury? Date (dd/mm/yyyy) If you ve suffered from a similar illness or injury previously, please tell us about it below. Please describe the illness or injury, when you were diagnosed, the doctor you saw and any treatment you had. Self-employed Full-time Part-time Casual Other (including unemployed) If other or unemployed, please provide details below: Doctor s name Doctor s address 1 If you ve changed your name you ll need to give us certified copies of either a marriage certificate or other legal change of name document.
8 2 Permanent Disability Benefit Application Member ment Doctor s phone number Please tell us about the treatment you ve had for this illness or injury Please tell us your capacity to do the following activities: Can you dress yourself? (e.g. putting on and taking off clothes) Please describe the help you need and any limitations. Describe the treatment Date started (dd/mm/yyyy) How often Can you bathe yourself? (e.g. washing and showering) Please describe the help you need and any limitations. Are you currently participating in treatment? How effective has the treatment been? Toileting (e.g. can you use the toilet, including getting on and off?) Please describe the help you need and any limitations. Have you been able to work in any job, whether full-time or part-time, paid or unpaid, since your illness/injury? If so, please give details. Are you mobile? (e.g. walking, getting in and out of a chair or bed) Please describe the help you need and any limitations. Do you plan to return to work? If no, please provide details Can you feed yourself? (e.g. getting food from a plate to your mouth) Please describe the help you need and any limitations. Can you do housework? (e.g. cooking and cleaning) Please describe the help you need and any limitations. If yes, when do you think you ll return to work? (dd/mm/yyyy) Do you need rehab assistance? (please specify below) Are you able to drive? If no, please provide details Have you talked to your doctor about a return to work program? (please describe below) Do you take care of children or other dependants? What was the outcome of this discussion?
9 Permanent Disability Benefit Application Member ment 3 3 Medical practitioner details Please provide details of your current treating medical practitioner(s) and/or specialist(s). Practitioner 1 Practitioner 4 Phone number Phone number Postal address Postal address Specialty Specialty Date first contacted (dd/mm/yyyy) Date last contacted (dd/mm/yyyy) Date first contacted (dd/mm/yyyy) Date last contacted (dd/mm/yyyy) Practitioner 2 Practitioner 5 Phone number Phone number Postal address Postal address Specialty Specialty Date first contacted (dd/mm/yyyy) Date last contacted (dd/mm/yyyy) Date first contacted (dd/mm/yyyy) Date last contacted (dd/mm/yyyy) Practitioner 3 If you ve consulted other doctors, specialists or health professionals about your illness or injury, please provide their details separately and attach it to your application form. Phone number Postal address Specialty Date first contacted (dd/mm/yyyy) Date last contacted (dd/mm/yyyy)
10 4 Permanent Disability Benefit Application Member ment 4 Recreational activities 6 Job details and employment history Please describe your hobbies/interests/social activities Please describe your job in detail, including all your duties and responsibilities. (Please attach your position description and a copy of your resume.) Does your condition affect your ability to do these activities? If yes, please describe how you re affected. If your role involves manual handing duties (lifting, carrying, pushing, pulling) please provide details of these specific duties below. 5 Other entitlement details Have you claimed a permanent disability benefit in the past? Date paid (or date of application) Amount of benefit (and who paid the benefit) $ Have you claimed (or do you plan to claim) other insurance for this illness/injury? If yes, please provide details. What was your base salary before your illness/injury? $ Hourly Fortnightly Monthly What duties are/were you able to do? What duties are/were you prevented from doing? Start date (dd/mm/yyyy) End date (dd/mm/yyyy) Have you claimed (or do you plan to claim) Department of Human Services entitlements for this illness or injury? Start date (dd/mm/yyyy) End date (dd/mm/yyyy) What educational qualifications, degrees, certificates (including First Aid and OHS) do you hold? Please include the year achieved when providing details below. Secondary school (e.g. year 10, year 12) Have you claimed (or do you plan to claim) a benefit from WorkCover for this illness or injury? Start date (dd/mm/yyyy) End date (dd/mm/yyyy) Tertiary (university or technical college) Post-graduate Claims manager TAFE Phone number Claim no. Other If you re claiming any other insurance or entitlements, please provide your: Case manager s name Describe your specific work skills (for example, management/ supervision, retail, computer skills)? Case manager s phone number Claim reference number Insurance company
11 Permanent Disability Benefit Application Member ment 5 Please provide details of previous jobs (approximate dates are fine) Position Employer When did you first stop working because of your illness or injury? Date (dd/mm/yyyy) Start date (dd/mm/yyyy) End date (dd/mm/yyyy) If you ve terminated your employment, was it due to this illness or injury? Please describe all of your duties and responsibilities If yes, please tell us the exact date this happened and the name of your employer. Date (dd/mm/yyyy) Position Employer of employer Start date (dd/mm/yyyy) End date (dd/mm/yyyy) Please describe all of your duties and responsibilities Please complete if you re self-employed What were your income and expenses for the last 12 months (pre-disability)? Gross income from occupation $ Expenses $ Position Start date (dd/mm/yyyy) Employer End date (dd/mm/yyyy) What were your income and expenses for the last 24 months (pre-disability)? Gross income from occupation $ Expenses $ Please describe all of your duties and responsibilities Are you still employed? Do you/have you managed or supervised staff? If yes, how many? Your employer District/school/region (only if you work for the Queensland Government and it applies to you) Position/title Payroll number Manager s name Manager s phone number
12 6 Permanent Disability Benefit Application Member ment 7 Authority to access and release 8 medical details Declaration and authorisation I consent to QSuper (and its agents and advisers) to contact medical practitioners I ve seen and to contact other organisations who might have medical or other information that s relevant to my claim. I understand these organisations could include: WorkCover, Department of Human Services, Q-COMP, Department of Veterans Affairs, insurance companies and my employer. I authorise those medical practitioners and other organisations to release such details (which may include sensitive or health information) to QSuper, its agents and advisers as may be requested. I consent to QSuper releasing medical and other information (which may include sensitive or health information) to my employer, WorkCover, medical and allied health advisers, and agents who could be asked to provide reports and/or opinions about my claim. I understand and agree that if I don t sign this authority, or if I don t give information requested by QSuper or its representatives, QSuper mightn t be able to assess my claim. I consent to the release of my personal and medical information from, and to the following parties for the purpose of investigating and assessing my claim: 1. Workers compensation 2. CTP insurer 3. Federal and Government including the Department of Human Services and the Department of Veterans Affairs 4. My employer (only with my written consent) 5. My accountant 6. My doctors, specialist/s and their agents 7. QSuper 8. QSuper s appointed insurer TAL Life Ltd (ABN ) 9. QSuper s appointed assessor which could be located overseas in rth America or the European Union. Signature Date (dd/mm/yyyy) I confirm the information included in this application is true and correct, and I haven t withheld any information that s relevant to this claim. I agree to provide all medical information that s requested and to undertake any medical or occupational assessments that QSuper considers appropriate. Signature Date (dd/mm/yyyy) Checklist Make sure you use this checklist to check you ve fully completed the Permanent Disability Benefit Application form and you have all the supporting documents ready to send us. I ve provided all the relevant information in section 1. I ve provided details on my condition in section 2 and attached copies of any medical evidence I already have on my condition (and any other relevant information). I ve provided details of my recent medical practitioners in section 3. If I m claiming any other entitlements, I ve provided details in section 5. I ve completed my job details and employment history. I ve completed and signed the medical authority. I ve signed the QSuper declaration in section 8. A copy of this content and your authorisation is considered the same as an original. Member Centres 70 Eagle Street Brisbane and 63 George Street Brisbane Telephone ( if overseas) Monday Friday 8.30am to 5.00pm Queensland time Postal address GPO Box 200 Brisbane Qld 4001 Fax (07) Website qsuper.qld.gov.au ABN: SFN: /08/2015 IB28 Just quickly, we need to let you know that this form is issued by the QSuper Board (ABN ). All QSuper products are issued by the QSuper Board as trustee for the QSuper Fund (ABN ). We take the privacy of your personal information very seriously. We re collecting this information to administer your superannuation account and are authorised to do this under the Superannuation ( Public Sector) Act We may pass your information on to your employer, authorised service providers (e.g. external insurers), other superannuation funds and government departments or agencies. We may also disclose this information to third parties if we need to, if you ve given consent to the disclosure, or if we re required to by law. If you want to know more about our privacy policy, you can download QSuper s Your Privacy factsheet from our website or call us on and ask for a copy. We ve put this information together as general information only so keep in mind that it doesn t take into account your personal objectives, financial situation, or needs, shouldn t be relied on as legal or taxation advice, and doesn t take the place of this type of advice. Before you make any decision to acquire a product, or to keep hold of one you already have you should consider the PDS, which you can download at qsuper.qld.gov.au, or call us on for a copy. QSuper Board of Trustees 2015
13 QSuper Form Please complete in block letters, in blue or black ink. 1 Permanent Disability Benefit Application Employer s ment (n-queensland Government employers) Who needs to complete this form? This part of the claim form needs to be completed by your non-queensland Government employer (HR or payroll office staff). 1 Employee s details 3 Salary details Title Given names Surname Date of birth (dd/mm/yyyy) Payroll number Position/title What was your employee s basic monthly salary (gross) before they stopped working? $ What was your employee s package monthly salary (gross) before they stopped working? $ per month per month Please provide details of the salary package below. Work phone number Date employee joined this company (dd/mm/yyyy) When did you start contributing to QSuper for this employee? (dd/mm/yyyy) 2 Employer details of employer Work phone number Mobile phone number address Address of head office Employee s work address Same as above
14 2 Permanent Disability Benefit Application Employer s ment 4 Employment status 5 Return to work What is the employee s employment status? Self-employed Permanent part-time Permanent full-time Casual Other including unemployed (please tell us below) Please tell us the employee s present employment status (and include a date if it applies) Still employed Resigned Terminated (dd/mm/yyyy) (dd/mm/yyyy) (dd/mm/yyyy) Are there any workplace accommodations that could be made to assist the employee to return to work, such as modified hours, light duties, modified duties, or an alternate role? Please provide details of what could be supported below. Modified duties Modified hours Light duties Alternate role Are there any specific requirements to start a graduated return to work? If yes, please specify. Redundancy Disability leave Retirement Other (specify below) (dd/mm/yyyy) (dd/mm/yyyy) (dd/mm/yyyy) (dd/mm/yyyy) Is there a return-to-work coordinator to help the employee with an appropriate return-to-work plan? If so, please provide contact details. Work phone number Mobile phone number How many hours did the employee work on average before their injury or illness? hours per week address What date did the employee stop all duties? (dd/mm/yyyy) So you know this date isn t necessarily the same as the date their employment was terminated. Did the employee work in a reduced capacity or in a different role before they stopped working? If yes, please provide details below. What was the reason the employee stopped work?
15 Permanent Disability Benefit Application Employer s ment 3 6 Physical work environment details Does the employee s job require them to work in any of the following conditions? Please tick the relevant option. Outside If yes, percentage of time % If the employee s job involves manual handling, please describe the types of items they might lift/push/pull/carry, the physical demand associated with these tasks and how often they perform these tasks? Lift (floor to waist) In extreme cold and/or heat Lift (knee to shoulder) If yes, percentage of time % In a damp or humid environment If yes, percentage of time % Lift (waist to overhead) Push/pull In a noisy environment Carry If yes, percentage of time % In a dusty or unventilated environment How long is the employee required to do the following before they can change their position or the activity? If yes, percentage of time % Around toxic fumes If yes, percentage of time % During the employee s normal routine, what percentage of time does the job require the employee to lift or carry the following weights? 23kg or over Never 1-25% 26-50% 51-75% % 9 to 22kg Never 1-25% 26-50% 51-75% % Under 9kg Never 1-25% 26-50% 51-75% % During the employee s normal routine, what percentage of time does their job involve the following activities? Walking Never 1-25% 26-50% 51-75% % Walking on uneven ground Never 1-25% 26-50% 51-75% % Sitting at one time 0-30 mins Standing at one time 0-30 mins Driving at one time 0-30 mins During the average day, what s the average number of hours the employee spends in the following positions or activities? Sitting 0-2 hours Standng Driving 0-2 hours 0-2 hours mins mins mins 2-4 hours 2-4 hours 2-4 hours mins mins mins 4-6 hours 4-6 hours 4-6 hours Over 90 mins Over 90 mins Over 90 mins 6-8 hours 6-8 hours 6-8 hours What percentage of the employee s time is spent on the following activities? Talking Writing % % Driving Never 1-25% 26-50% 51-75% % Reaching above shoulders Never 1-25% 26-50% 51-75% % Reaching below shoulder height Never 1-25% 26-50% 51-75% % Bending or crouching Never 1-25% 26-50% 51-75% % Kneeling or crawling Never 1-25% 26-50% 51-75% % Supervising other people Please describe below any other aspects or demands of the employee s work duties that aren t described in the above categories. Are you aware of any other claims being made by or for the employee? If yes, please provide details. %
16 4 Permanent Disability Benefit Application Employer s ment 7 Supporting documents Please attach the following documents with your completed form (and please tick the box to confirm the attachments). Job description Rehabilitation reports and plans Proof of earnings (last two payslips) Leave reports (annual leave, sick leave) for the past 12 months Termination documents Any other information to assist in the assessment of the employee s claim. 8 Declaration I declare the information included in this form is true and correct, and I haven t withheld any relevant information. Signature Date (dd/mm/yyyy) Member Centres 70 Eagle Street Brisbane and 63 George Street Brisbane Telephone ( if overseas) Monday Friday 8.30am to 5.00pm Queensland time Postal address GPO Box 200 Brisbane Qld 4001 Fax (07) Website qsuper.qld.gov.au ABN: SFN: /08/2015 IB28 Just quickly, we need to let you know that this form is issued by the QSuper Board (ABN ). All QSuper products are issued by the QSuper Board as trustee for the QSuper Fund (ABN ). We take the privacy of your personal information very seriously. We re collecting this information to administer your superannuation account and are authorised to do this under the Superannuation ( Public Sector) Act We may pass your information on to your employer, authorised service providers (e.g. external insurers), other superannuation funds and government departments or agencies. We may also disclose this information to third parties if we need to, if you ve given consent to the disclosure, or if we re required to by law. If you want to know more about our privacy policy, you can download QSuper s Your Privacy factsheet from our website or call us on and ask for a copy. We ve put this information together as general information only so keep in mind that it doesn t take into account your personal objectives, financial situation, or needs, shouldn t be relied on as legal or taxation advice, and doesn t take the place of this type of advice. Before you make any decision to acquire a product, or to keep hold of one you already have you should consider the PDS, which you can download at qsuper.qld.gov.au, or call us on for a copy. QSuper Board of Trustees 2015
17 QSuper Form Please complete in block letters, in blue or black ink. 1 Permanent Disability Benefit Application Doctor s ment Who needs to complete this form? Your medical practitioner needs to complete this form. We need detailed information from them about your illness/injury before we can pay you a permanent disability benefit. Remember that you re responsible for covering any costs your doctor charges to complete this form. 1 Claimant s details 2 Treatment history (medical practitioner completing this form) Title Given names Surname Speciality Work phone number Date of birth (dd/mm/yyyy) Height (cm) Weight (kg) Practice address Postal address Are you the claimant s usual general practitioner? If yes, what date did you first begin treating the claimant? (dd/mm/yyyy) If no, who referred the claimant to you? When did the claimant s symptoms relating to this condition first occur? (dd/mm/yyyy) Please outline the claimant s initial symptoms relating to this condition. What was the diagnosis?
18 2 Permanent Disability Benefit Application Doctor s ment Has the claimant ever experienced these, or similar symptoms, previously? Please indicate the primary diagnosis affecting your patient s functional capacity. If yes, from when? (dd/mm/yyyy) If yes, please explain. Please detail your objective findings in regard to the diagnosis that was made. Please outline any other diagnoses that are affecting your patient s functional capacity (if applicable). What active treatment (including medication and dosage) has the claimant received from yourself and other practitioners since this condition was diagnosed? Please outline the objective findings to support the additional diagnoses noted above. What tests or investigations have been done to date and what were the results of these tests? Did the claimant see any other doctors prior to their first consultation with you? How often are you seeing the claimant at this time? If yes, please provide the contact details of the doctor first seen and the date of this consultation. Practice Have the claimant s symptoms changed in frequency or severity? If yes, please describe how. Postal address Has the claimant been referred to a consultant or specialist? Work phone number If yes, date referred: Date (dd/mm/yyyy) First appointment Date of consultation (dd/mm/yyyy) If yes, please provide contact details for the consultant or specialist. When was the diagnosis made? (dd/mm/yyyy) Speciality Work phone number Practice Postal address
19 Permanent Disability Benefit Application Doctor s ment 3 3 Claimant s capacity to work What is your understanding of the claimant s job and their duties? 4 Declaration Speciality Is the claimant working at present?, part-time, full-time If yes, when did the claimant return to work? Signature Date (dd/mm/yyyy) Is the claimant currently performing their usual work duties? If no, what duties is the claimant performing? How many hours is the claimant currently working each week? hours per week Please outline the medically-supported restrictions and/or limitations that would need to be considered for the claimant to return to work. In regard to the restrictions and limitations you ve noted above, if there was a way these could be accommodated in the claimant s workplace (or in a different role/job), are there any medical barriers to them pursuing such work opportunities now or in the future? If yes, please outline the specific medical barriers and if these are considered temporary or permanent, providing relevant details.
20 4 Permanent Disability Benefit Application Doctor s ment Member Centres 70 Eagle Street Brisbane and 63 George Street Brisbane Telephone ( if overseas) Monday Friday 8.30am to 5.00pm Queensland time Postal address GPO Box 200 Brisbane Qld 4001 Fax (07) Website qsuper.qld.gov.au ABN: SFN: /08/2015 IB28 Just quickly, we need to let you know that this form is issued by the QSuper Board (ABN ). All QSuper products are issued by the QSuper Board as trustee for the QSuper Fund (ABN ). We take the privacy of your personal information very seriously. We re collecting this information to administer your superannuation account and are authorised to do this under the Superannuation ( Public Sector) Act We may pass your information on to your employer, authorised service providers (e.g. external insurers), other superannuation funds and government departments or agencies. We may also disclose this information to third parties if we need to, if you ve given consent to the disclosure, or if we re required to by law. If you want to know more about our privacy policy, you can download QSuper s Your Privacy factsheet from our website or call us on and ask for a copy. We ve put this information together as general information only so keep in mind that it doesn t take into account your personal objectives, financial situation, or needs, shouldn t be relied on as legal or taxation advice, and doesn t take the place of this type of advice. Before you make any decision to acquire a product, or to keep hold of one you already have you should consider the PDS, which you can download at qsuper.qld.gov.au, or call us on for a copy. QSuper Board of Trustees IB28
Permanent Disability Benefit Guide. Issued: December 2013
Permanent Disability Benefit Guide Issued: December 2013 Contents Your insurance... 3 Permanent disability benefit... 4 How is my benefit calculated?... 6 How is my benefit paid?... 7 Review and appeal
More information2013 Benefit Statement Notes
2013 Benefit Statement Notes At 30 June 2013 Important information The Board of Trustees of the State Public Sector Superannuation Scheme (ABN 32 125 059 006) (QSuper Board) is required to provide you
More informationSuperannuation Surcharge Guide. Issued: December 2013
Superannuation Surcharge Guide Issued: December 2013 Contents Introduction... 3 Surcharge process... 4 What are my options?... 5 Need more information?... 7 Contact Centres 70 Eagle Street Brisbane 63
More informationDefined Benefit Account Guide. Including the Deferred Retirement Benefit Issued 7 September 2015
Defined Benefit Account Guide Including the Deferred Retirement Benefit Issued 7 September 2015 2 Defined Benefit Account Guide Who s this guide for? Read this guide if you have a Defined Benefit account
More informationInsurance Transfer Form Russell SuperSolution Master Trust Private Division
Insurance Transfer Form Russell SuperSolution Master Trust Private Division If you hold insurance cover in another superannuation fund or directly with another life insurer, you can apply to transfer your
More informationLife Events/Salary Increase cover
Fact sheet and form Life Events/Salary Increase cover What this fact sheet covers This fact sheet provides information about Life Events insurance cover and Salary Increase cover available through our
More informationFixed insurance cover
Fact sheet and form Fixed insurance cover When it comes to insurance cover, one size doesn t necessarily fit all. That s why you have the ability to convert your Death and Total & Permanent Disablement
More informationInsurance in your superannuation 3. Death and Total and Permanent Disablement (TPD) cover 3. Income protection cover 8. The Insurer s definitions 12
1 July 2014 JUMP TO Insurance in your superannuation 3 Death and Total and Permanent Disablement (TPD) 3 Income protection 8 The Insurer s definitions 12 Nominating your beneficiary 16 The information
More informationIndividual insurance transfer
AON MASTER TRUST Individual insurance transfer Use this form if you are a current member or joining the Aon Master Trust as a new member and you wish to transfer your current insurance cover with another
More informationLump sum benefit payment request for your superannuation or account based pension
Lump sum benefit payment request for your superannuation or account based pension How to claim a benefit To claim a benefit you will need to complete the attached Benefit Payment Request and send it direct
More informationMacquarie Life Total Permanent Disability (TPD): Claimant s Statement
Macquarie Life Total Permanent Disability (TPD): Claimant s ment Filling in this statement Please complete all sections, use black ink and mark boxes like this with an X. 1 May we disclose information
More informationWithdrawal Flexi Pension
Fact sheet and form Withdrawal Flexi Pension You can make a full or partial lump sum withdrawal from your Flexi Pension account at any time. What this fact sheet covers This fact sheet explains the rules
More informationThe Insurer s definitions 12. Nominating your beneficiary 16
Russell iq Super 1 July 2014 JUMP TO Insurance in your superannuation 3 The Insurer s definitions 12 Nominating your beneficiary 16 The information in this document provides additional information to the
More informationEarly release of super on compassionate grounds How to make a claim
Early release of super on compassionate grounds How to make a claim Please note if you have ceased work due to sickness or injury, call us on 13 11 84 before proceeding. Am I eligible to make a claim?
More informationAccumulation Account Guide. Issued 3 August 2015
Issued 3 August 2015 2 WINNER 2015 Our superannuation product identification number (SPIN) is QSU0101AU (Accumulation) Our superannuation fund number (SFN) is 2610 419 41 Our MySuper authorisation number
More informationImportant changes to insurance
Important changes to insurance Effective 1 July 2013 rest.com.au 1800 063 627 Contents Why have these changes been made? 2 New cover levels 2 New insurance costs 5 Access to higher cover under the new
More informationSuper/pension account Payment request
Super/pension account Payment request Complete this form in BLOCK LETTERS and: post it to Asgard, PO Box 7490, Cloisters Square, Perth WA 6850 or fax it to (08) 9481 4834 Note: if this form is faxed, you
More informationPersonal Plan. Product Disclosure Statement. www.australiansuper.com/join
Personal Plan Product Disclosure Statement www.australiansuper.com/join 1. About AustralianSuper 2. How super works 3. Benefits of investing with AustralianSuper 4. Risks of super 5. How we invest your
More informationCessation of employment
SR1 04/12 Cessation of employment Benefit application form Before you start Before you complete this benefit application form, please read the CSS Product Disclosure Statement. This form and the Explanatory
More informationBlue Care Income Protection Claim Form
Blue Care Income Protection Claim Form INCOME PROTECTION CLAIMS In order to alleviate any delay in the processing time of your claim, please ensure the following: The claim form is returned with all fields
More informationIncome protection claims
PSSap14 04/12 Income protection claims Who should read this? Members with income protection cover who have not worked for an extended period of time due to injury or sickness and wish to claim for income
More informationMyLife MyInsurance Application to Increase Income Protection Cover due to Salary Increase Part A
MyLife MyInsurance Application to Increase Income Protection Cover due to Salary Increase Part A If you have Income Protection cover you may be eligible to increase your cover to ensure it keeps up with
More informationI ve been injured at work. What do I do? Information for workers
The Application for Compensation form is an approved form under the Workers Compensation and Rehabilitation Act 2003. The general information contained on this and the following two pages are not part
More informationgrow your super Seven ways to Some handy hints to help you grow your super investments December 2014 Now incorporating Find out how you can:
Find out how you can: Make regular personal contributions a small amount can make all the difference. Salary sacrifice your contributions and reduce your tax at the same time. Seven ways to grow your super
More informationWA Super Insurance Guide
MY SUPER APPROVED WA Super Insurance Guide The information in this document forms part of the WA Super Product Disclosure Statement, November 2013 You should read the PDS in conjunction with this Member
More informationREQUEST FOR WITHDRAWAL
REQUEST FOR WITHDRAWAL If you need help For assistance call NGS Super Customer Service Team on 1300 133 177. Step 1. Complete your personal details Please print in black or blue pen, in uppercase, one
More informationRedundancy. Benefit application form. Before you start SRR1 01/14. What we need from you. What you can expect from us
SRR1 01/14 Redundancy Benefit application form Before you start Before you complete this benefit application form, please read the CSS Product Disclosure Statement. This form and the Explanatory notes
More informationContents 1 Protect yourself and
Insurance handbook for Personal Super Auth. No. 75 493 363 262 473 1 November 2015 The information in this document forms part of the Product Disclosure Statement for Cbus Personal Super of 1 November
More informationBeazley Energy Super Income Protection. form. claim
Beazley Energy Super Income Protection form claim Beazley Energy Super Income Protection Claim form Page 2 claim contents form Privacy statement Page 3 Important notice Page 4 Section A Claimants section
More informationTelstra Super Personal Plus Application Please complete this application form to open a Telstra Super Personal Plus account.
Telstra Super Personal Plus Application Please complete this application form to open a Telstra Super Personal Plus account. RED SECTIONS FOR YOUR INFORMATION GREY SECTIONS TO FILL OUT INVESTMENT CHOICE
More informationTransferring your insurance cover into Bendigo and Adelaide Bank Staff Super
Staff Superannuation Plan a sub-plan of IOOF Employer Super 1 January 2014 Transferring your insurance cover into Bendigo and Adelaide Bank Staff Super If you hold insurance cover in another superannuation
More informationSuper Member Income Protection Insurance Matching Form
Super Member Income Protection Insurance Matching Form Complete this form if you want LUCRF Super to match the amount of your existing Income Protection insurance cover held with another fund. IMPORTANT:
More informationFact Sheet > Super SA > Triple S > Your Questions Answered MAKING AN INCOME PROTECTION CLAIM
Fact Sheet > Super SA > Triple S > Your Questions Answered MAKING AN INCOME PROTECTION CLAIM > 1 IN THIS FACT SHEET > What is Income Protection (IP)? > Circumstances under which IP will not be paid > Step
More informationTelstra Super Personal Plus
01/ 17 NOVEMBER 2015 PRODUCT DISCLOSURE STATEMENT Telstra Super Personal Plus Making the most of your future Contents 01 About Telstra Super and Telstra Super Personal Plus 02 02 How super works 02 03
More informationTransferring your insurance cover into JR Super
The JR Superannuation Fund is a division of IOOF Employer Super. IOOF Employer Super is one of many products and services offered by the IOOF group. Transferring your insurance cover into JR Super If you
More informationINCOME CLAIM FORM FOR NON-WORK RELATED INJURY OR SICKNESS (Medical/Surgical or Specialist costs are not covered)
INCOME CLAIM FORM FOR NON-WORK RELATED INJURY OR SICKNESS (Medical/Surgical or Specialist costs are not covered) This INCOME CLAIM FORM FOR NON-WORK RELATED INJURY OR ILLNESS is to be returned to All Trades
More informationInsurance. Who should read this? What you re covered for. What you should know up front. Why should I have Death, TPD and IP cover?
PSSap11 04/12 Insurance Who should read this? Members who want information about death, total permanent disability (TPD) income protection (IP) insurance. What you should know up front It is important
More informationWageGuard Group Income Protection Claim Form
WageGuard Group Income Protection Claim Form Frequently Asked Questions How long will it take to complete my section of the form? We ve tested it -- it takes about 20 minutes. We want to settle your claim
More informationApplication for Compensation
Application for Compensation This Application for Compensation form for injured workers is an approved form under the Workers Compensation and Rehabilitation Act 2003 (the Act). The general information
More informationSuperannuation and Deferred Annuity Redemption / transfer form
Superannuation and Deferred Annuity Redemption / transfer form This form is to be used when redeeming your superannuation benefit from the Zurich Deferred Annuity or from the Zurich Master Superannuation
More informationComplete this form to withdraw part or all of your benefit as a lump sum, roll over to another GESB account and/or to another complying super fund.
Benefit access Gesb Super and West State Super SUP E R ANNUATION Complete this form to withdraw part or all of your benefit as a lump sum, roll over to another GESB account and/or to another complying
More informationESSSuper Claiming a Disability Benefit. Proudly serving our members. Issued 1 October 2015
ESSSuper Claiming a Disability Benefit Proudly serving our members Issued 1 October 2015 Issued by: Emergency Services Superannuation Board ABN 28 161 296 741 as Trustee of the Emergency Services Superannuation
More informationYour Super Guide. Product Disclosure Statement 15 December 2014 Nestlé Super Insured Accumulation category. Contents. Important Information
Australia Group Superannuation Fund Your Super Guide Product Disclosure Statement 15 December 2014 Nestlé Super Insured Accumulation category Contents 1 About Nestlé Super p2 2 How super works p2 3 Benefits
More informationHow To Fill Out A Disability Claim Form
Initial Claim Form Income Protection March 2014 OnePath Custodians Pty Limited (OnePath Custodians) ABN 12 008 508 496 AFSL 238346 RSE L0000673 OnePath Life Limited (OnePath Life) ABN 33 009 657 176 AFSL
More informationEnergy Super Insurance Guide. Prepared and issued 30 April 2013
Energy Super Insurance Guide Prepared and issued 30 April 2013 Contents Insurance Overview 1 Death & Total and Permanent Disablement cover 1 Income Protection cover 9 Other insurance information 15 Definitions
More informationENERGY SUPER INSURANCE GUIDE. Prepared and issued 1 July 2015
ENERGY SUPER INSURANCE GUIDE Prepared and issued 1 July 2015 CONTENTS Insurance Overview 1 Death & TPD cover 1 Income Protection cover 10 Other insurance information 18 Definitions 19 ABOUT THIS ENERGY
More informationInsurance guide. SignatureSuper AMP Life fact sheet. Issued ₁ July ₂₀₁₅
Issued ₁ July ₂₀₁₅ Insurance guide SignatureSuper AMP Life fact sheet AMP Corporate Super Registered trademark of AMP Life Limited ABN 84 079 300 379. The information in this document forms part of the
More informationINTRUST SUPER PERSONAL ACCIDENT AND SICKNESS CLAIM FORM
1 of 7 INTRUST SUPER PERSONAL ACCIDENT AND SICKNESS CLAIM FORM This claim form consists of 3 parts and all sections must be completed in full. Section A Claimant Statement The claimant is to complete all
More informationWHOLE BALANCE TRANSFER TO A KIWISAVER SCHEME
WHOLE BALANCE TRANSFER TO A KIWISAVER SCHEME Issued 1 November 2014 Please use this form to transfer your whole superannuation balance to a KiwiSaver scheme. Transferring only part of your superannuation
More informationInsurance Guide Date of issue: 1 March 2015
www.mtaasuper.com.au Phone: 1300 362 415 / Fax: 1300 365 142 Insurance Guide Date of issue: 1 March 2015 The information in this document forms part of the Product Disclosure Statement for MTAA Super dated
More informationJourney Injury CLAIM FORM. Call ATC Claims for assistance on 1800 994 694. 1. You complete Section A.
INSURANCE SOLUTIONS CLAIM FORM Journey Injury EXTF052 Call ATC Claims for assistance on 1800 994 694 1. You complete Section A. 2. Your Medical Practitioner completes Section B. 3. Your Employer completes
More informationCLAIMING A BENEFIT FACT SHEET
Leaving your employer If you cease employment with your current employer, you can remain a member of Club Super. Your account will continue to receive investment earnings, and you will regularly receive
More informationMake a lump sum withdrawal or rollover For a transition to retirement income stream
CSC retirement income RI04 04/13 Make a lump sum withdrawal or rollover For a transition to retirement income stream Use this form if you have a transition to retirement income stream and wish to > > make
More informationTotal and Permanent Disability (TPD)
Total and Permanent Disability (TPD) What is a TPD Benefit? A TPD Benefit is a sum of money paid in situations where a Local Government Super (LGS) Accumulation Scheme member has to leave the wkfce early
More informationFirstChoice Employer Super Transfer of Insurance Cover Form
FirstChoice Employer Super Transfer of Insurance Cover Form B3BQFM 18 May 2015 This form is to be completed for applications to transfer insurance from an external superannuation fund and transfers from
More informationThe level of Death and TPD insurance members receive when they join Triple S is as follows:
> 1 Triple S Death and Total and Permanent Disablement (TPD) insurance provides cover to help ease the financial burden in case of your illness, injury or death. The level of Death and TPD insurance members
More informationHow To Fill Out A Worker Compensation Claim Form
UPlus Income Protection Claim Form Frequently Asked Questions How long will it take to complete my section of the form? We ve tested it -- it takes about 20 minutes. We want to settle your claim for you
More informationInsurance and your PSSap super
Insurance and your PSSap super Issued 1 July 2013 The information in this document forms part of the Product Disclosure Statement for the Public Sector Superannuation accumulation plan (PSSap), sixth edition,
More informationPROTECT YOUR INCOME IF YOU CAN T WORK
This document forms part of the NGS Super Member Guide (Product Disclosure Statement) dated 1 April 2014 PROTECT YOUR INCOME IF YOU CAN T WORK FACT SHEET 7 1 APRIL 2014 It s vital that you re prepared
More informationProtecting you and your family. Insurance guide. www.csf.com.au. Effective 1 April 2014
Protecting you and your family Insurance guide Effective 1 April 2014 www.csf.com.au Issued by CSF Pty Limited ABN 30 006 169 286, AFSL 246664, Trustee of the Catholic Superannuation Fund ABN 50 237 896
More informationCredit Card Repayment Protection
Credit Card Repayment Protection Product Disclosure Statement and policy wording Effective 13 July 2015 1 Introducing Credit Card Repayment Protection. What is it? Credit Card Repayment Protection is insurance
More information2015 Product Disclosure Statement
2015 Product Disclosure Statement Personal Division Issued 1 November 2015 Contents 1. About NSF Super 2. How super works 3. Benefits of investing with NSF Super 4. Risks of super 5. How we invest your
More informationTo find out more visit www.supersa.sa.gov.au IN THIS FACT SHEET
> 1 Income Protection insurance provides a fortnightly income of up to 75% of your salary while you are off work due to temporary or permanent incapacity for a maximum period of 24 months or to age 60,
More informationInsurance guide. SignatureSuper AMP Life Association and Personal fact sheet. Issued ₁ July ₂₀₁₅
Issued ₁ July ₂₀₁₅ Insurance guide SignatureSuper AMP Life Association and Personal fact sheet AMP Corporate Super Registered trademark of AMP Life Limited ABN 84 079 300 379. The information in this document
More informationInsurance in your super
Insurance in your super Fact sheet Information in this fact sheet is current as at 1 July 2015 Contents Overview 1 What is Life cover? 5 How your Life cover works 6 When is your insured benefit payable?
More informationWithdrawals. 1. Investor details
MLC Navigator Investment Plan MLC Navigator Retirement Plan MLC Navigator Access Investment MLC Navigator Access Super and Pension Withdrawals Please tick where appropriate: Account closure (Sections 1,
More informationunderstanding your workplace personal injury insurance policy A guide to your policy cover and conditions
understanding your workplace personal injury insurance policy A guide to your policy cover and conditions WPIIPG September 2013 contents About WorkCover Queensland 3 About your workplace personal injury
More informationConstruct Australia Income Protection Services Injury and Sickness Claim Form
1 of 6 Construct Australia Income Protection Services Injury and Sickness Claim Form This claim form consists of 3 parts and all sections must be completed in full. Section A Claimant Statement Section
More informationwe make it easy for you
Insurance Guide PDS Supplement we make it easy for you Dated 10 November 2015 CARE Super Pty Ltd (Trustee) ABN 91 006 670 060 AFSL 235226 CARE Super (Fund) ABN 98 172 275 725 PDS Supplement The information
More informationInsurance and superannuation claims
Fact Sheet Insurance and superannuation claims (excluding death claims) This fact sheet provides information about making claims for total and permanent disablement permanent incapacity, a terminal illness
More informationIssued ₁ July ₂₀₁₅. Insurance Guide. SignatureSuper AIA fact sheet. AMP Corporate Super Registered trademark of AMP Life Limited ABN 84 079 300 379.
Issued ₁ July ₂₀₁₅ Insurance Guide SignatureSuper AIA fact sheet AMP Corporate Super Registered trademark of AMP Life Limited ABN 84 079 300 379. The information in this document forms part of the product
More informationInsurance in your super
Insurance in your super Employer-sponsored and personal superannuation members. This document was prepared on 3 August 2015. The information in this document forms part of the Statewide product disclosure
More information2. For cancellation or amendment of travel arrangements due to you or your relatives illness /death (Complete Sections A, C D and E)
IMPORTANT: please read this before you start Use the check list below to help you complete your claims form, and identify you will need to attach. We don t want you to miss something. Delays can occur
More informationImportant news for MTAA Super members
Dear member, Important news for MTAA Super members I am writing to advise you of some important changes to your insurance cover with MTAA Super that will come into effect on 1 March 2015. MTAA Super understands
More informationFlexi Loan Repayment Protection
Flexi Loan Repayment Protection Product Disclosure Statement and policy wording 1 Effective 13 July 2015 Introducing Flexi Loan Repayment Protection. What is it? Flexi Loan Repayment Protection is insurance
More informationFirst Notice of Claim for Unemployment Benefits
How to help us process your claim Checklist Before submitting your claim form, make sure you can tick all the boxes below: Involuntary unemployment claims - documents required Section A: Statement of claimant
More informationCLAIM FOR COMPENSATION FOR A WORK-RELATED DEATH
CLAIM FOR COMPENSATION FOR A WORK-RELATED DEATH Seafarers Rehabilitation and Compensation Act 1992 Information about claiming compensation In this document, all references to the employer mean the employer
More informationWesley Mission Income Protection Claim Form
Wesley Mission Income Protection Claim Form INCOME PROTECTION CLAIMS In order to alleviate any delay in the processing time of your claim, please ensure the following: The claim form is returned with all
More informationSOUTH AUSTRALIAN AMBULANCE SERVICE SUPERANNUATION SCHEME
SOUTH AUSTRALIAN AMBULANCE SERVICE SUPERANNUATION SCHEME Product Disclosure Statement Product Disclosure Statement Date of issue: September 2015 IMPORTANT INFORMATION Issuer Super SA Board ABN 81 557 964
More informationAustralian Trainers Association Group Personal Accident Insurance Claim Form
ACE Insurance Limited ABN 23 001 642 020 28-34 O Connell Street Sydney NSW 2000 Australia GPO Box 4065 Sydney NSW 2001 Australia (02) 9335 3355 main (02) 9231 3697 fax www.aceinsurance.com.au A&H.claims.australia@ace-ina.com
More informationNotice of intent. Fact sheet and form. What this fact sheet covers. Who is this fact sheet for? When should I complete a notice of intent?
Fact sheet and form Notice of intent A notice of intent to claim or vary a deduction for personal super contributions (notice of intent) allows you to claim a tax deduction for your personal contributions,
More informationAdvance Retirement Suite Super Early Release Financial Hardship Application
Advance Retirement Suite Super Early Release Financial Hardship Application Trustee: BT Funds Management Ltd (BTFM) ABN 63 002 916 458 AFSL 233724 GUIDE TO COMPLETING THIS FORM > > Use this form if you
More informationCLAIM FOR WORKERS COMPENSATION
CLAIM FOR WORKERS COMPENSATION Seafarers Rehabilitation and Compensation Act 1992 Information about claiming workers compensation In this document, all references to the employer mean the employer against
More informationFirst Notice of Claim for Unemployment Benefits
How to help us process your claim Checklist Before submitting your claim form, make sure you can tick all the boxes below: Involuntary Unemployment claims - Documents required Section A: Statement of claimant
More informationFirst Notice of Claim for Unemployment Benefits
How to help us process your claim Checklist Before submitting your claim form, make sure you can tick all the boxes below: Involuntary Unemployment claims - Documents required Section A: Statement of claimant
More informationYour Government Super at Work. 1 of 9
ER 04/10 Application to the Commonwealth Superannuation Corporation (CSC) for approval of early access to preserved superannuation benefits on medical grounds To be used by preserved benefit members of
More informationLife Insurance. Go Protect. Product Disclosure Statement 24 October 2011. TAL Life Limited ABN 70 050 109 450 AFSL 237 848
Life Insurance Go Protect Product Disclosure Statement 24 October 2011 TAL Life Limited ABN 70 050 109 450 AFSL 237 848 Contact details You can contact TAL, 8:00am 7:00pm (EST), using the details below:
More informationContents. Union Representatives Workers Compensation Handbook
Contents Introduction......................................................... 4 Union Representative s role........................................ 4 Workers Compensation a new approach................................
More informationMember Details form. Member Application Form. Step 1 Your details. Complete this form to become a member of LUCRF Super.
Member Details form Member Application Form w Complete this form to become a member of LUCRF Super. Please complete all relevant sections using CAPITAL LETTERS and a BLACK or BLUE pen. Step 1 Your details
More informationCore Super MySuper. Insurance & Other Important Information 3 August 2015
Core Super MySuper Insurance & Other Important Information 3 August 2015 As a Core Super MySuper member you have Income Protection as well as Life and Total and Permanent Disablement [TPD] Insurance available
More informationGroup Journey Injury Insurance
Group Journey Injury Insurance Claim form All relevant sections are to be answered in full. Please print your answers. Zurich does not admit liability by the issue of this form. It is issued to enable
More informationTransferring your insurance cover into the Medical & Associated Professions Superannuation Fund
AMA Financial Services Medical & Associated Professions Transferring your insurance cover into the Medical & Associated Professions If you hold insurance cover in another superannuation fund or directly
More informationINSURANCE GUIDE INSIDE. Rebecca Farrell QIEC Super member
INSURANCE GUIDE INSIDE Cover your family How much insurance do you need? Discount insurance products Insurance basics Rebecca Farrell QIEC Super member Prepared 1 June 2012 by the Trustee QIEC Super Pty
More informationFamily law and superannuation
Family law and superannuation Fact sheet This fact sheet looks at the process of splitting a superannuation benefit under the family law process and the types of benefits that may be affected, including
More informationPersonal Accident and Sickness Claim Form
Corporate Services Network ABN 30 074 864 609 Level 2 280 George Street Sydney NSW 2000 Ph: 61 2 8256 1770 Fax: 61 2 8256 1775 www.csnet.com.au e-mail: claims@csnet.com.au Employer: Claimants Name: Job
More informationYour People, Protected. Sports group Personal Accident Claim Form
Your People, Protected Sports group Personal Accident Claim Form Sports group Personal Accident/Claim Form 2 Claim Form Dear Member, IMPORTANT INFORMATION, relevant to YOUR Claim, is contained on this
More informationProduct Disclosure Statement
Product Disclosure Statement Prepared and issued 15 June 2015 CONTENTS 1. About QIEC Super 2. How super works 3. Benefits of investing with QIEC Super 4. Risks of super 5. How we invest your money 6. Fees
More informationPayCover Income Protection Claim Form
PayCover Income Protection Claim Form Frequently Asked Questions How long will it take to complete my section of the form? We ve tested it -- it takes about 20 minutes. We want to settle your claim for
More informationIncome Protection Fact Sheet
Income Protection Fact Sheet Who should read this fact sheet? The information in this fact sheet applies to most Defined Contribution (accumulation) members of Energy Super. It is not relevant to Defined
More information