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Making a claim

Claims the TAL way

TAL believes in managing all claims fairly, professionally and in a timely manner.  We appreciate that making a claim during a time of ill health or bereavement can be stressful, so it’s important to us that all cases are handled expertly, sensitively and as quickly as possible.

Our Claims Team

We have a team of over 40 highly skilled and experienced claims professionals dedicated to providing you with a personalised and empathetic service.

Once we receive your claim form, we assign a dedicated Case Manager to your claim to make sure you always deal with someone familiar to you and your circumstances.

Making a Claim

Once TAL is notified of your claim, we will advise you of the information we need to assess your claim.  The type of information you need to provide will vary depending on the claim you are making.  Your Case Manager will confirm specific requirements with you.

Assessment of your claim commences on receipt of all the required information.

If you are unclear about any of the information requirements, please contact our Claims Team on 1800 101 019.

Making a Claim FAQs

  1. What benefits does my insurance policy include?
  2. Does my insurance cover ongoing medical expenses?
  3. What is a waiting period?
  4. My GSC claim has been admitted. When will I start receiving benefit payments?
  5. How does TAL pay benefits?
  6. Can I receive other income while i’m receiving Group Salary Continuance benefits?
  7. Are benefit payments taxable?
  8. What is an Independent Medical Examination and why do I have to attend one?
  9. What can I do if I don’t agree with TAL’s decision?
  10. Can I obtain a copy of documents in my claim file?
  11. How can I provide feedback about my experience with TAL?

Note: The information contained in this website is of a general nature only and does not consider an individual’s objectives, financial situation or particular needs. All benefits provided are subject to the policy terms and conditions and may be subject to change. For further information in relation to the terms and conditions of your policy we strongly recommend you refer to the policy document which is relevant to your policy. In the event of any inconsistency between the information contained in this brochure and the policy document, the terms of the policy document shall prevail. While TAL will make every endeavour to assist you with your policy there may be circumstances where it is appropriate that you seek independent advice. The information provided in this website is current at the date of this publication and is subject to change from time to time.

  1. What benefits does my insurance policy include?

    The following information is a general guide to some of the benefits you may be eligible for under your insurance policy. All benefits provided are subject to the terms and conditions of your insurance policy. The terms and conditions are contained in the policy document and your Fund Administrator, Fund or Employer can answer any specific questions you may have about your personal level of cover or the policy.

    Death: Death cover provides a lump sum payment to your family or estate in the event of your death.

    Terminal Illness: Terminal Illness insurance pays a lump sum if you are diagnosed with a Terminal Illness by a registered Medical Practitioner and a Medical Specialist and satisfy the relevant policy definition.

    Total and Permanent Disability (TPD): TPD cover pays a lump sum if you are permanently unable to work and you meet the relevant definitions. What constitutes “Total and Permanent Disability” can be complex. Someone may receive a TPD benefit because they have experienced a permanent loss (eg eye sight), or because they have been absent from work due to illness for a certain period of time (usually six months or more) and are unable to ever work again. The relevant definition to apply is contained in the product disclosure statement and policy document relevant to your policy.

    Group Salary Continuance (GSC) (also referred to as Income Protection (IP)): GSC insures a limited portion of your salary to provide you with an income in the event that illness, injury or accident prevents you from working. A partial benefit may also be payable to you if you return to work in a reduced capacity.

    The monthly benefit amount payable to you will depend on the level of cover taken out by you or your employer and the income you were earning immediately prior to your disability.

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  2. Does my insurance cover ongoing medical expenses?

    Unlike other compensation schemes, the life insurance industry operates under a set of laws which specifically prohibit us from paying any medical expenses, including specialist appointments or hospital treatment.

    In the event that we require you to attend an Independent Medical Examination, we will pay the cost of this appointment and refund all reasonable travel expenses associated with your attendance.

    TAL also offers a comprehensive range of support services as part of our rehabilitation service, which can provide you with additional assistance to complement your treatment plan and recovery. We pay all reasonable costs associated with pre-approved rehabilitation services.

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  3. What is a waiting period?

    Your waiting period was chosen when your insurance policy was taken out and it refers to the amount of time that must elapse before your benefits begin to accrue. Your waiting period must be consecutive days in which you have been certified by a registered Medical Practitioner as unable to work due to illness or injury.

    TAL pays benefits monthly in arrears after the expiration of your waiting period.

    Here is an example of how a waiting period works under a Group Salary Continuance (GSC) claim:

    Date of injury

    1 April 2010

    Date ceased work

    1 April 2010

    Waiting Period

    3 months (90 days)

    Waiting Period commences

    1 April 2010

    Waiting Period ends

    29 June 2010

    Benefits accrue from

    30 June 2010

    First benefit payment due

    29 July 2010 (for period 30 June – 29 July)



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  4. My Group Salary Continuance claim's been admitted. When will I start receiving benefit payments?

    Benefits become payable monthly in arrears after the expiration of the waiting period. No benefits are payable during the waiting period.

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  5. How does TAL pay benefits?

    Depending on the policy arrangements, TAL may pay you or your employer directly. Benefit payments are transferred electronically into a bank account of your choice or paid to you by cheque. There is space provided on your Initial Claim Form for you to provide your bank details.

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  6. Can I receive other income while i’m receiving Group Salary Continuance benefits?

    Your policy may include a Partial Disability Benefit which allows you to receive some benefits in conjunction with your income following a specified period of Total Disablement. Partial Disability Benefits are calculated according to a formula set out in your policy. To apply this formula your Case Manager will require you to submit proof of income (e.g. pay slips).

    Any GSC benefits payable to you may be reduced by income you receive from other sources such as workers compensation, other insurance policies and in some circumstances, sick leave and some Centrelink payments.

    It is vital that you advise your Case Manager if you return to work in any capacity, or are receiving income from other sources, so that we can ensure your benefit entitlements are calculated accurately.

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  7. Are benefit payments taxable?

    Any benefits payable from your policy are usually assessable for tax purposes. TAL employees are not licensed to provide financial advice and, as individual circumstances may vary, we recommend you seek taxation advice from your Accountant or the Australian Tax Office.

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  8. What is an Independent Medical Examination and doI have to attend one?

    Independent Medical Examinations are often organised by insurance companies to better understand your condition and assist with the ongoing management of your claim, your recovery and return to work. Independent Medical Examinations allow us to obtain a current snapshot of your symptoms from someone who specialises in treating your particular medical condition. These appointments can offer valuable insights into treatment options or alternative ways of managing your condition.

    Independent Medical Examinations take approximately one to two hours. Your Case Manager will provide you with ample notice before scheduling an appointment, also taking into consideration your location and any necessary travel arrangements you will need to make. All appointments are at TAL’s expense and we also reimburse all reasonable travel costs associated with your attendance.

    Upon receipt of the medical examiner’s report, a copy may be forwarded to your treating doctor who can then discuss the findings with you during your next appointment.

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  9. What can I do if I don’t agree with TAL’s decision?

    TAL has rigorous processes in place to ensure that our claims decisions are fair and consistent. In situations where the evidence does not support a decision to admit the claim, the case is put before our Decision and Review Committee for consideration prior to a final decision being made.

    If you are subsequently dissatisfied with TAL’s decision you can write to our Complaints Resolution Department and ask that your case be independently reviewed under TAL’s internal dispute resolution process.

    If following completion of that process you remain dissatisfied, you then have the option of escalating your complaint to the Superannuation Complaints Tribunal (SCT) or Financial Ombudsman Service (FOS) as appropriate.

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  10. Can I obtain a copy of documents in my claim file?

    Under current privacy legislation you are entitled to access information we hold about you. TAL takes the protection of your personal and sensitive information seriously and we ask that you make your request in writing to assist us in identifying you. All requests for information should be addressed to:

    The Privacy Officer
    TAL Life Limited
    PO Box 142
    Milsons Point NSW 1565

    We will respond to your request as soon as possible and aim to comply with your request within 30 days. In some circumstances privacy legislation requires that we provide information and/or documentation to your nominated Medical Practitioner rather than direct to you and if this is the case you will be notified so you can discuss the matter with your Medical Practitioner.

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  11. How can I provide feedback about my experience with TAL?

    TAL takes customer service seriously and we value all types of feedback from our clients. If you have had a positive experience with our claims team or have some ideas on how we can improve our claims processes or service, please send your suggestions to:

    Claims Solution Team
    TAL Limited
    PO Box 142
    Milsons Point NSW 1565
    Email: claimssolutionteam@tal.com.au

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Case Studies

Young accountant reaps the benefits of TPD Cover*

As his plane left the Melbourne airport tarmac, 26-year-old Matthew Wilson exchanged a smile with his best friend and settled back in preparation for the long flight ahead. After months of careful saving and painstaking itinerary preparation, they were finally doing it – trading the Melbourne drizzle for a three-month summer jaunt through Europe. Filled with excitement at the adventures awaiting them, and with the pressures of his accounting job tucked firmly in the back of his mind, Matthew could not have imagined just how life changing this holiday would be.

Halfway through the trip, Matthew’s travel plans took a turn for the worse when a tandem parachute jump in Switzerland went horribly wrong. Matthew’s parachute collapsed partway through the descent and, bearing the brunt of his instructor’s full body weight on his back, he landed feet first. The impact of the fall resulted in severe spinal cord trauma which left Matthew a paraplegic.

Once the immediate distress of experiencing a serious injury so far from home had dissipated, Matthew was faced with the physical legacies of his injury; learning how to use a wheelchair and manage ongoing bladder neuropathy which produced, among other symptoms, incontinence. When Matthew returned to Australia he lodged a claim under his Total and Permanent Disability (TPD) policy. The claim was accepted and a considerable sum paid shortly thereafter. Although Matthew has not been able to return to work, his insurance cover has allowed him to afford ongoing medical expenses and make substantial modifications to his house to increase his physical mobility and enhance his quality of life.

* This claim scenario is based on an actual claim received by TAL’s Claims team. We have changed certain details to protect the individual’s privacy. Claims are assessed against the policy terms and conditions.

Financial relief and family time**

When Belinda Young, a seemingly healthy 35-year-old mother was advised to take out life and TPD cover, she could never have predicted how valuable it would become. Less than a year after taking out her insurance policy, Belinda developed breast cancer and shortly thereafter underwent a mastectomy. Belinda began to regain her strength after surgery but her health suffered another setback when the cancer returned to her lungs and spine.

Belinda’s husband Mark was self-employed and forced to close his business in order to care for his wife and their two pre-school aged children. While fortunate enough to find part-time work at a friend’s local winery, Mark’s modest weekly wage was barely enough to cover the family’s basic living expenses, let alone their ballooning medical bills.

After seven months of intensive treatment which left her unable to return to work, Belinda lodged a TPD claim under her insurance policy. Her claim was admitted and a payment of $757,500 made shortly thereafter.

Aside from offering immediate financial relief, this insurance payment has enabled the Young family to put a down payment on a campervan. They intend to travel around Australia and enjoy time together as a family while Belinda is still mobile.

** This claim scenario is based on an actual claim received by TAL’s Claims team. We have changed certain details to protect the individual’s privacy. Claims are assessed against the policy terms and conditions.

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