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 (e.g. 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): 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.
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.
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)
What happens after I submit my claim forms?
Once your claim forms are received we assign a dedicated Case Manager to assess and manage your claim. Your Case Manager will contact you within 24 hours of receiving your claim form to discuss your claim and advise you if any additional information is required to complete the claim assessment. This initial phone call is also an opportunity for you to ask any questions about your insurance policy or the claims process.
My Group Salary Continuance claim has been admitted. When will I start receiving benefit payments?
Benefits become payable to you monthly in arrears after the expiration of your waiting period. No benefits are payable during the waiting period.
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.
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, Centrelink, other insurance policies and in some circumstances, sick leave. You are not required to exhaust your sick leave before lodging a claim.
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.
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.
What is an Independent Medical Examination and why have I been asked 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.
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.
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 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.
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