How to make an insurance claim
This step-by-step article can assist you when you need to make an insurance claim through your account with us.
While we hope that it’s never needed, our flexible insurance can provide you and your loved ones with greater financial security in the event of your death, terminal illness or a disabling injury or illness. Insurance is offered on your super account through an agreement between LUCRF Super and our insurance provider, OnePath Life Limited.
If the worst was to happen, you’ll need to make an insurance claim with us in order to receive your benefit. Most genuine claims are straight forward and can be made directly through us.
Our responsibility to you
We have a duty to act in your best interests (known as our ‘fiduciary duty’). This includes ensuring that you receive all superannuation and insurance benefits that you’re entitled to.
Super fund trustees legally have to act in their members’ best interests, including in relation to the payment of insurance claims.
How do you make a claim?
Making an insurance claim is easier than you might think. Simply follow the steps below and remember that we’re always here to help you.
Step 1. Contact us first
If you want to make an insurance claim (or have any questions about your insurance) you should contact us first by calling 1300 130 780. We'll explain what happens when you make a claim and then send you the necessary forms and paperwork, either electronically or via post. We'll work with you to ensure that your claim is processed as smoothly as possible.
Step 2. Complete our forms and lodge your claim
After we’ve spoken to you, we’ll send you a claims pack containing all the forms you’ll need to complete. We may also send you a list of documents that you’ll have to provide so that our insurer can properly assess your claim. This might include medical reports and employment records.
Complete the forms and send them back to us, along with all the additional documents we’ve requested to support your claim. Most of our forms can be received and/or submitted electronically or in paper form.
If you’re unsure about any of the questions asked or need help completing the forms we'll be more than happy to help.
Tip: Your claim could be delayed if we have to clarify anything, or ask for more information. So before you send your paperwork to us, it’s worth spending a bit of extra time to make sure you’ve completed the forms accurately and fully and that you’ve attached all the documents we’ve asked for.
What happens next?
1. We coordinate your claim
We’ll check your application and, if you’re eligible to make a claim, we’ll forward your completed forms and documents to our insurer.
In most cases, we’ll be the contact between you and our insurer. However, it may be necessary for our insurer to contact you directly during the claims process.
2. Our insurer assesses your claim
Our insurer will make their assessment using the information you provided.
They’ll generally pay for any additional medical reports they request and any examinations they arrange for you to attend.
Our insurer may also:
- ask for reports from your doctor(s)
- ask you to provide more information
- ask your employer for more information
- make an appointment for you to have a medical examination with an independent specialist.
For death claims, we may also need to contact potential beneficiaries before making a decision on the distribution of any benefit.
3. Our insurer makes a decision about your claim
After considering all of the medical evidence and other information, our insurer will decide whether, in their opinion, you meet the relevant definition (for example, total and permanent disablement, or terminal illness) under their insurance policy.
They’ll then let us know how they’ve assessed your claim and whether it should be accepted, deferred or declined.
According to the Australian Securities and Investments Commission, 98% of death claims, 91% of TPD claims and 96% of income protection claims were paid out across the super industry in 2020.
4. We review our insurer's decision
We have a legal obligation to act in the best interests of our members. This means that we need to independently review your claim and form our own opinion as to whether our insurer’s decision is the right one.
Our review of the insurer’s decision may result in one of the following outcomes:
|What happens if your claim is|
|You’ll receive a letter from us to let you know. We’ll also send you information on how the benefit can or will be paid to you.|
|We may agree with our insurer’s decision to defer your claim for a period of time to determine the full extent of your disability and whether it’s permanent. Your claim will be reviewed again at the end of this period.|
|We’ll write to you stating the reason(s) why we agree with our insurer’s decision to decline your claim.|
5. Your claim is reviewed (if it's declined or deferred)
If your claim is declined or deferred, we’ll review the insurer’s initial decision on your behalf.
If we disagree with our insurer’s decision to decline or defer your claim, we may request that our insurer reconsiders the claim or asks for further medical evidence.
6. Final decision
When we finish the review process, your claim may be accepted or it may be deferred or declined. We’ll advise you of the decision in writing.
How long will the claims process take?
Please be assured that, along with our insurer, we’ll work as hard as we can to ensure your claim is processed as quickly as possible.
While some claims are fairly straightforward and can be completed within a matter of weeks, others may take a little longer. It all depends on the type, details and circumstances of your individual claim.
In any event, we’ll give you regular updates on the progress of your claim.
What happens to your premiums during the claims process?
Once you’ve submitted a claim form, your premiums will continue to be deducted from your account until your claim is approved. This will ensure that you’re covered for all other events during this period, even if your claim is denied.
What if you don't agree with our final decision?
To be eligible to receive a claim, you must satisfy the terms and conditions of the policy. If your claim is unsuccessful, you’ll receive a letter explaining the reason why it was declined. If you don’t agree with our decision, you can object in the following ways:
- request for an independent review by the claims review committee (CRC)
- go to the Australian Financial Complaints Authority (AFCA).
If you’d like to lodge an objection to our decision and request a review by our claims review committee, you have two options:
Call us on 1300 130 780. We’ll let you know if you need to send us more information.
Send your written objection, including the reasons for your objection and any additional information in support of your claim, to:
The Complaints Officer
PO Box 211
NORTH MELBOURNE VIC 3051
or email us at email@example.com
Your objection must be received by us within 28 days of your receiving the letter denying your claim.
Making a complaint
If you’re not happy with how your claim has been managed, you can make a formal complaint.
Do you have questions about the insurance claim process?
Contact us for assistance.Get in touch
Insurance cover is provided by OnePath Life Limited ABN 33 009 657 176 AFSL 238 341 (“OnePath”) and subject to the terms and conditions of the insurance policies issued by OnePath.