La argumentación en las ciencias sociales

Life Care

To make a Life claim, you/your client will generally need to provide:

• an original Policy Document

• an application for policy payment

• a full death certificate – showing cause of death

• documentary evidence of the deceased’s date of birth

• a Medical Attendant’s Statement – completed by the deceased’s personal doctor(s) for the five-year period ending risk commencement date

• Medical Information authority

• Health Insurance Commission (HIC) authority

• a Tax File Number (for superannuation claims)

• any other information required by the Trustee (for Total Care Plan Super). Where an estate is claiming:

• under $50,000 – a Will (if applicable) + section 211/212 Statutory Declaration

• over $50,000 – a probate or letters of administration.

Following the initial assessment, we may have further requirements, such as:

• a Health Insurance Commission (HIC) report

• a police report and/or a full coroner’s report

• a doctor/s’ report.

TPD Cover

To make a TPD claim, you/your client will generally need to provide:

• an initial claim form, which includes sections for your client, their treating GP and their treating specialist to complete

• their original Policy Document

• Medical Release form

• Health Insurance Commission (HIC) authority

• Employer Statement – completed by their last employer or a self-employed questionnaire

• proof of age

• copies of their tax returns for the last three financial years.

For ‘any occupation’ claims, we also require a full resume including details of your client’s education, training and work experience for assessment.

Following the initial assessment, we may have further requirements, such as:

• a Health Insurance Commission (HIC) report

• additional medical reports from treating doctor/s

• a referral for an independent medical examination and/or vocational or functional assessment.

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Trauma Cover

To make a Trauma claim, you/your client will generally need to provide:

• an initial claim form, which includes sections for your client, their treating GP and their treating specialist to complete

• the original Policy Document

• Medical Release form

• Health Insurance Commission (HIC) authority

• proof of age.

Following the initial assessment, we may have further requirements, such as:

• a Health Insurance Commission (HIC) report

• copies of pathology and/or test results

• additional medical reports from treating doctor/s

• a referral for an independent medical examination. Income protection/Business Overheads Cover

To make an income protection or Business Overheads claim, you/your client needs to provide an initial claim form which includes sections for them and their treating doctor to complete, as well as relevant authorities, identification and any information specified in our requirements letter. Following the initial assessment, we may have further requirements, such as:

• further information from a treating doctor or specialist

• an independent examination

• financial information, including full copies of business and personal taxation returns

• information from an employer

• details of medical history

• information from any other insurer, such as Workers Compensation. Once the claim forms have been reviewed, the Case Manager will conduct an assessment interview with your client by telephone. In some instances, the case manager may then arrange for an external consultant to conduct a face-to-face interview

Ongoing management

The Case Manager will establish an individual management plan. Our focus is always on supporting a return to work and good health, and the management plean assists us in being proactive and planning ahead to prevent unncessary difficulties during the recovery process.

The individual management plan:

• outlines all necessary steps and support for your client’s recovery and return to work

• is designed for your client’s condition and individual needs

• may include discussions with your client’s doctor or physiotherapist, referrals for vocational retraining or independent specialist assessments.

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1. Notify us of your client’s claim as soon as possible after they become disabled or pass away. The claim will be directed to a Case Manager, who will spend some time discussing your client’s situation and explaining how we assess the claim and what information we may need.

2. We send either you or your client a claim kit, generally by email or post, within 48 hours. This pack will include a letter explaining the next steps, relevant claim forms and FAQs. 3. Our Case Managers will review the

information provided in the claim form and start the assessment of the claim. 4. We let you and your client know the

outcome of their claim. For accepted claims, we pay the benefit.

We aim to assess all claims within five business days of receiving the completed form. The claim decision may be deferred if we need additional information to complete the claim assessment.

On occasion we may need to decline a claim, which happens when a client doesn’t meet the definitions within a policy. For declined claims, we will let you and your client know the reason why, and we are happy to review any extra information which may impact our decision. We will also inform you of independent internal and external bodies for you to contact if you wish to raise your concerns or resolve any dispute.