Claims paid

Policy definition not met: For Critical Illness insurance, if you suffer from an illness or injury, you will only be entitled to claim under a policy if the type and severity of the condition meets the definition in that policy. For example, low grade skin cancers are not likely to result in eligibility to receive a benefit under a Critical Illness/Trauma policy. This is because the policy is designed to cover serious events that result in a financial impact to you.

Qualifying period: For Critical Illness insurance, it’s common to be required to hold a policy for a specified period (also called qualifying period) before the cover starts in full.  If, for example, a qualifying period applies before cover starts for certain medical conditions, then a claim would not be payable if symptoms of the condition first occurred before or during the qualifying period; or if a diagnosis was made before or during the qualifying period.

Waiting period: For Income Protection, typically a waiting period will apply. Generally this means that you need to be unable to work for a specified period of time after an illness or injury before you’re entitled to a benefit under the policy. For example, if a waiting period of 3 months applies, then no benefit would start to accrue or be paid until the end of the 3 month period and will likely not be payable until a further month has passed.

Benefit period: For Income Protection, there will be a limitation on the maximum amount of time a benefit can be paid for. This is the length of time for which you may receive a benefit under the cover, if your claim is accepted. For example, if the benefit period under your Income Protection cover is 2 years, then once a benefit has been paid for 2 years, the benefit would cease, however you may be able to claim again if you suffer from another, unrelated condition in future. Typically benefits are only payable up to a particular age (e.g. 65), irrespective of how long the benefit period is.

Multiple claims: Some cover types only allow one claim under the cover for a certain illness, injury or event. In those circumstances, if you’ve already made a claim, your cover may end, or you may not be entitled to another benefit for the same condition.

Dangerous pastimes: Certain dangerous pastimes may not be covered by your insurance. For example, if you participate in recreational motocross activities, there may be an exclusion applied to your cover for injuries that occur as a result of this activity. 

Personal history: Your personal history prior to cover commencement may result in an individual exclusion being applied for a specific condition or event. For example, if you have a history of severe back pain, then Income Protection or Total and Permanent Disability Insurance policies may exclude you from making a claim relating to this cause. Some insurance policies won't provide cover for any pre-existing conditions.

Suicide or self-harm: Some cover may  exclude suicide or self-harm.

Personal history: If you've suffered an illness or injury prior to applying for certain types of cover and you do not disclose this to us, then you may not be entitled to a benefit if you make a claim for the same or similar illness or injury.

Lifestyle: If you undertake certain activities, such as smoking or have a dangerous hobby, and do not disclose this to us when you apply for cover, then you may not be eligible for a benefit if you make a claim caused by those related activities.

Policy definition not met: For Critical Illness insurance, if you suffer from an illness or injury, you will only be entitled to claim under a policy if the type and severity of the condition meets the definition in that policy. For example, low grade skin cancers are not likely to result in eligibility to receive a benefit under a Critical Illness/Trauma policy. This is because the policy is designed to cover serious events that result in a financial impact to you.

Qualifying period: For Critical Illness insurance, it’s common to be required to hold a policy for a specified period (also called qualifying period) before the cover starts in full.  If, for example, a qualifying period applies before cover starts for certain medical conditions, then a claim would not be payable if symptoms of the condition first occurred before or during the qualifying period; or if a diagnosis was made before or during the qualifying period.

Waiting period: For Income Protection, typically a waiting period will apply. Generally this means that you need to be unable to work for a specified period of time after an illness or injury before you’re entitled to a benefit under the policy. For example, if a waiting period of 3 months applies, then no benefit would start to accrue or be paid until the end of the 3 month period and will likely not be payable until a further month has passed.

Benefit period: For Income Protection, there will be a limitation on the maximum amount of time a benefit can be paid for. This is the length of time for which you may receive a benefit under the cover, if your claim is accepted. For example, if the benefit period under your Income Protection cover is 2 years, then once a benefit has been paid for 2 years, the benefit would cease, however you may be able to claim again if you suffer from another, unrelated condition in future. Typically benefits are only payable up to a particular age (e.g. 65), irrespective of how long the benefit period is.

Multiple claims: Some cover types only allow one claim under the cover for a certain illness, injury or event. In those circumstances, if you’ve already made a claim, your cover may end, or you may not be entitled to another benefit for the same condition.

Dangerous pastimes: Certain dangerous pastimes may not be covered by your insurance. For example, if you participate in recreational motocross activities, there may be an exclusion applied to your cover for injuries that occur as a result of this activity. 

Personal history: Your personal history prior to cover commencement may result in an individual exclusion being applied for a specific condition or event. For example, if you have a history of severe back pain, then Income Protection or Total and Permanent Disability Insurance policies may exclude you from making a claim relating to this cause. Some insurance policies won't provide cover for any pre-existing conditions.

Suicide or self-harm: Some cover may  exclude suicide or self-harm.

Personal history: If you've suffered an illness or injury prior to applying for certain types of cover and you do not disclose this to us, then you may not be entitled to a benefit if you make a claim for the same or similar illness or injury.

Lifestyle: If you undertake certain activities, such as smoking or have a dangerous hobby, and do not disclose this to us when you apply for cover, then you may not be eligible for a benefit if you make a claim caused by those related activities.