INSURANCE. Income protection and business expense claims. Your step-by-step guide

Transcription

1 INSURANCE Income protection and business expense claims Your step-by-step guide

2 Income protection and business expense claims process Step 1 Contact your adviser or call our Claims Helpline To make a claim contact your adviser or call our Claims Helpline on and: Quote your policy number as this will help us to locate your policy details quickly. For privacy purposes you will need to give your name, your relationship to the life insured, the insured s date of birth and address, together with such other information that may be required. Provide, where possible, the date of the event that caused the claim, and brief details if known. Within 24 hours of receiving the call, we will send the appropriate claim form, with a covering letter detailing our specific requirements to the address you advise. Step 2 Correctly complete the forms we send to you and provide any other information we need To assess your claim we require the following documents: Your fully completed claim form. If the life insured is an employee, the Employer s Statement is also to be completed and returned. The Treating Doctor s Statement is to be completed by the life insured s family doctor and not their specialist physician. Note: The cost of obtaining this Statement is borne by you. The Privacy Statement attached to the claim form. A copy of the life insured s current driver s licence or passport, or any other form of identification we specify. Any requirements stipulated in the covering letter, including completion of authorities in order for us to access relevant information to process your claim.

3 Step 3 We assess the claim Once we receive the completed claim form and the initial documents requested, we will begin to assess the claim. The initial assessment is based on the life insured s condition or event meeting the definition(s) in the Policy Terms. In some circumstances additional information may be required, which may delay the assessment of your claim. In some cases we require a report from Medicare Australia on the life insured s Medicare and/or Pharmaceutical Benefits Schedule history. On receipt of these records we may require further information from the service providers listed. We may also require details of any claims lodged with other insurers, for example WorkCover. Additionally, on a case by case basis, we may require an independent medical examination and/or financial evidence. Once all the requirements have been met and considered, a decision is made on the claim. Step 4 Determine who receives the benefit We will pay the benefit to the policy owner or their estate as the case may be. If the policy is owned by OnePath Custodians Pty Limited (OnePath Custodians) we will pay the life insured directly on behalf of OnePath Custodians. Step 5 On successful assessment we pay the insured amount If the claim is accepted, monthly benefits will be paid 30 days after the end of the waiting period. For example, if the waiting period is 30 days, the first monthly benefit payment is due 60 days after the commencement of the claim. For ongoing claims benefits are payable monthly in arrears. A covering letter will be provided with each benefit payment. The policy owner may elect to have payments made by EFT to their personal bank account.

4 Answers to commonly asked questions Q What if the life insured continues to be disabled? A A monthly Progress Claim Form will be sent with the payment. Please use this form to provide us with details of the life insured s progress since the previous form was completed. It is essential to then return the completed form to us if continuing payments are to be considered. You will be notified of the date on which the form is being returned. Remember details must be provided by you and the life insured s family doctor. Q How regularly does the life insured need to see a doctor? A The life insured must seek medical advice and treatment from a registered and qualified medical practitioner (family doctor) at least once a month, for as long as you are on claim. We require a progress form to be completed each month. This is essential if we are to continue to pay the monthly benefit. Q How long will benefits continue? A Each month your claim will be assessed against the evidence, and benefits continue while: the definition(s) within the Policy Terms continues to be met the life insured has not returned to work the benefit period has not expired the policy has not ceased or been terminated.

5 Q What happens when the life insured returns to work either full time or part time? A When the life insured returns to work in either a partial or full time capacity, you must inform us in writing. We will then inform you of the necessary requirements which may include: partial disability claim form proof of income other financial and/or medical information. For business expense claims only: Q Do I need a Business Expense Claim Form? A We will forward a Statement of Business Expenses Form for you to complete if Business Expense Cover exists in your policy and you wish to claim this benefit. Other financial information may also be necessary to assess the benefit.

6 We understand that when you need to make a claim, it s not always straightforward. We would like to help make things easier.

7 Five easy steps 1. contact your adviser or call our Claims Helpline 2. correctly complete the forms we send to you and provide any other information we need 3. we assess the claim 4. determine who receives the benefit 5. on successful assessment we pay the insured amount. A policy can only be taken out after completing an Application Form contained in the Product Disclosure Statement (PDS) and the application is accepted by OnePath Life Limited (OnePath Life) and a policy schedule is issued. To learn more about your benefit, please refer to your Policy Schedule and the Policy Terms. A Product Disclosure Statement is available at onepath.com.au. You should consider the PDS before deciding to acquire or continue to hold the product.

8 How do I make a claim? To make a claim contact your adviser or call: Claims Helpline (Weekdays between 8.30am and 5.00pm, Sydney time) Where do I send my claim documents? OnePath Life Retail Claims GPO Box 4148 Sydney NSW 2001 OnePath Life Limited (OnePath Life) ABN AFSL Kent Street, Sydney NSW 2000 This information is current at November 2010 but is subject to change. Updated information will be available free of charge from onepath.com.au. It may not be reproduced without prior permission of OnePath Life. Australia and New Zealand Banking Group Limited (ANZ) ABN is an authorised deposit taking institution (Bank) under the Banking Act 1959 (Cth). OnePath Life is owned by ANZ it is the issuer of the product but it is not a Bank. Except as set out in the issuer s contract terms (including the PDS), this product is not a deposit or other liability of ANZ or its related group companies. None of them stands behind or guarantees the issuer. L0147/1110 onepath.com.au