Jessica is a 35-year-old dance instructor who was involved in a biking accident. For the time being at least, she has to take a break from work. Since she no longer has a steady income, she decides to file an insurance claim. Luckily, she has trauma insurance.
Let’s look at what she needs to do to get a payout from her policy.
Step 1: Contact the insurer
First, Jessica needs to contact the insurer. This is simply the person or company she bought the insurance policy from.
That might be:
- An insurance company, if she bought the policy from an insurer
- A broker or financial advisor, if she bought the policy through them
- Her super fund manager, if she bought her policy through her super
- Her employer, if she has insurance through her work
Whoever she talks to, Jessica will need to ask how she can file a claim, which forms she needs to fill out, what information she needs to provide and how she can submit it.
She also needs to have her policy number ready, as the person she contacts will likely ask for it in order to look up her account.
Step 2: Gather details
If she wants the insurer to approve her claim, Jessica will have to prove that she (1) got into an accident that left her seriously injured, (2) makes a certain amount at her current job and (3) can no longer work at that job.
The person she talks to should tell her what information she needs to provide. That may include:
- Her medical reports and test results
- Her doctor’s contact information
- A description of her current job, including her physical duties and how many hours she works
- Payslips and tax returns proving how much she makes
Her insurer may also require her to be examined by an independent medical specialist, who will then report to the insurer.
If Jessica were filing a life insurance claim (as a beneficiary), she would also need to provide a death certificate or medical report showing the cause of death.
Step 3: File a claim
After talking to her insurer and gathering the necessary information, Jessica will need to fill out the required forms and send them in to the address (or email address) provided by the insurer.
Once everything has been submitted, the insurer will probably get back to her within two months of receiving her claim, or within two months after the waiting period is over.
Hopefully, Jessica has some savings set aside for situations like this. But if she doesn’t (or doesn’t have enough) and is struggling to make ends’ meet while she waits for her claim to be approved, she can ask her insurer or super fund manager for help—and provide documents (such as bank statements) showing her need for urgent help. Her insurer may be able to speed up the claims process or give her an advance payment.
What if her claim isn’t approved?
If Jessica’s claim isn’t approved, or if she doesn’t feel that the insurer made the right decision about how much to pay her, she should complain to her insurer as soon as possible.
If this doesn’t help, she can contact the Australian Financial Complaints Authority (AFCA) and lodge a complaint and get free dispute resolution.
