Did you know that each year approximately one in every five Australians will experience a mental illness? As a society, we are becoming more aware of the prevalence of mental health issues, but the stigma associated with mental health is still there.
What happens if you need to stop working due to your mental health condition?
Who will cover your daily expenses? Can you lodge an Income Protection Claim?
Our work shows that insurers continue to routinely avoid paying Income Protection for Mental health conditions.
Having the right life insurance and income protection policies in place could help relieve your financial pressure, enabling you to focus on the most important thing. Your peace of mind and mental wellbeing.
Despite the difficulties placed by insurers to try and stop you from claiming Income Protection, we can suggest you follow these 3 steps to making your claim stand the best chance of success.
Step 1: Find out about your Income Protection cover and entitlements to make a claim
First step may seem quite obvious, but we see day in day out people not realising they have Income Protection or not knowing their entitlements to that cover.
There are two ways to get Income Protection Cover;
- Automatic Default Cover within your Superannuation: Most Australians have Life Insurance cover as part of their Superannuation account. Yet this is not clearly indicated or advised by your Superannuation provider. Hence it is up to you to contact your Superannuation provider and ask them if you are insured for Income Protection. If you have automatic default Income Protection cover then you should also ask them:
a) How much are you covered for? Ie; $4,000 a month? ; AND
b) How long are you covered for? ie; is cover up to 2 years or 5 years or until age 65?
The answer to these questions is quite important because whenever you make an Income Protection claim, you will know your entitlements and know what you are claim for.
2. Other method to have Income Protection Cover is for you purchase it from an Insurance provider. Now if you purchased an Income Protection cover then chances are more than likely that you know the entitlements of that cover.
Step 2: Providing Initial Documents
You must provide your insurer will all the necessary documentation that they ask for. This could include things such as:
- the initial Medical Practitioner’s report;
- a certified copy of your identification and proof of age;
- the Policy Schedule;
- all standard claim forms and other documentation or reports
Your insurer will rely on the documents you provide therefore it is important to provide them with as much as detail as possible about your injury or illness to claim Income Protection.
Step 3: Understand the claim process
When making an Income Protection claim, your policy would most likely have an Eligibility criteria and an Income Protection definition criteria.
The Eligibility criteria refers to whether or not are you eligible to make an Income Protection claim. Some example of the criteria may be:
- Age: Most policies would provide Income Protection cover to people below 70 or 65.
- Exclusion clause: These clauses may include who is excluded from making such Income Protection claims. Ie; if someone had a complicated pregnancy then they may not be eligible to claim Income Protection as per the Eligibility criteria.
- Waiting period: This means that your policy may have a waiting period before you can make a claim. ie; if you are injured or ill on 1 June 2020 and your policy’s waiting period is 60 days then you cannot make an Income Protection claim before 1 October 2020. If you recover from your injury or illness within 60 days then you cannot claim Income Protection because you did not pass the waiting period as per your policy document.
Please note the Eligibility criteria may vary from different insurance providers and policy documents.
If you meet the Eligibility criteria, you will then be required to meet Total Disability or Partial Disability definition as your policy document. This is where the insurer will check whether your injury or illness is considered as an injury or illness as per your policy document.
Bonus tip: You should also follow up with your insurance provider on a regular basis in relation to your claim. Insurance providers do not have the best reputation for clear and ongoing communication. Hence if they have not contacted in a while then that doesn’t necessarily mean they are working on your matter; it may be possible your file has not been looked at by any of the claim assessor. So please follow up on a regular basis. More information about how a claim assessor should handle your matter can be found in the Life Insurance Code of Practice. Contact us if you need guidance how to access the Life Insurance Code of Practice.
Talk to a Personal Injury lawyer at Shaheen Legal on (02) 9854 5552
We understand how complex the policies from Insurance providers can be. We will fight hard to prove that your Mental health condition is genuine and that it was not related to previous illnesses that may fall under the exclusion.
