How to make an income protection insurance claim

Having income protection insurance is a way to give yourself a financial safety net that may support you and your loved ones in case you’re unable to work due to sickness or injury. For instance, you can cover up to 70% of your monthly income, up to $15,000 per month, with Guardian Insurance. But if you’re wondering how the claims process works, you might be worried that it’s overly complicated.

Here, we’ll walk you through the steps for lodging an income protection insurance claim, including what you need to prepare and what to expect throughout the entire process.

What is an income protection insurance claim?

An income protection insurance claim is a request for financial benefits under your income protection insurance policy. It’s an insurance intended to replace a portion of your income if you’re unable to work because of illness or injury. The benefits from income protection insurance can help cover the cost of things like your living expenses, mortgage and rent, groceries, schooling, and a range of other financial obligations while you recover.

When you make an income protection insurance claim, your insurer will start by assessing your situation to determine your eligibility based on the policy’s terms and conditions. The benefit amount and benefit period depends on the policy you have. Because income protection insurance isn’t a one-size-fits-all product – differing in terms of cover, waiting periods, benefit periods, exclusions, etc – you’ll want to be across all the essential paperwork.

3 steps before making an income protection insurance claim

1. Review your policy: Familiarise yourself with the terms and conditions of your policy, including any waiting periods, exclusions and benefit limits. Knowing the specifics of your policy can help you set realistic expectations and means you’re able to prepare the necessary documents in advance.
2. Speak to your doctor: Get medical paperwork that confirms your inability to work. This will be required as part of your claim. Your doctor must provide a detailed medical report that outlines your condition, symptoms, treatment and prognosis.
3. Gather essential documents: Collect all the relevant paperwork, including your policy details, personal ID, medical documents, proof of income and more. Sending through incomplete or inaccurate documents is one of the most common reasons for a claim being delayed or denied. Make a checklist of these documents and double-check everything before submitting them.

What are the documents I need to make a claim?

• Policy documents: Original policy documents and schedules. These cover the terms and conditions of your insurance, including any specific clauses that might affect your claim.
• Identification: Certified copies of your identification, including birth certificate, driver’s licence and passport. Certification means that a recognised authority has verified that the copies are true and correct versions of the originals.
• Medical reports: Detailed medical reports and a practitioner’s completed confidential medical report. Your doctor will need to fill out sections of the claim form themselves, giving a thorough account of your medical condition and the impact it has on your ability to work.
• Proof of income: Copies of your income tax returns, payslips or other proof of earnings for the previous two financial years. This information will help your insurer verify your pre-disability income, which is used to calculate your benefit amount.
• Claim form: This is the completed claim form, ensuring all sections are correctly filled out. For example, with a Guardian Income Protection Claim Form you’ll need to make sure to avoid incomplete answers like “refer to doctor” or “see above”. Clear and detailed responses will prevent misunderstandings and ensure there are no unnecessary delays.

How to make an income protection insurance claim successfully

There are a few straightforward steps you will need to follow in order to submit your claim successfully, including:

1. Fill out the claim form accurately: Most claim forms are divided into parts: Part A must be completed by you, and Part B by your treating medical practitioner. Pay attention to every detail and give precise answers to every question.
2. Submit the form and supporting documents: Send the claim form to your insurance provider, making sure to keep copies for your own records. It’s a good idea to send your documents via a trackable delivery service.
3. Communicate: Respond straight away to any requests for extra information from your insurer. This can help avoid delays in processing your claim.
4. Stay informed: Keep track of your claim’s progress by staying in regular contact with your insurer. Regular follow-ups are a good idea to help things move forward.

Waiting periods and exclusions

Most income protection insurance policies will include a waiting period, which is the time you need to ‘see out’ before you start receiving your income benefit payments. With Guardian Income Protection Insurance, you can apply for a waiting period of 30 or 90 days.  

Also be aware of any exclusions that might apply, such as if you have a pre-existing condition or if there’s a specific type of injury or illness that isn’t covered. Exclusions are outlined in your product disclosure statement.

How long can the claim process take?

The claim process – and specifically the amount of time it takes – will depend on several things, including whether your documentation is completed in full, as well as the complexity of your case and claim. These are the stages you’ll end up going through:

1. Initial review: Your insurer reviews your documents and might need to request some additional information.
2. Medical assessment: A medical assessment by your doctor or independent medical examiner is required. Your insurer might need you to take some further medical evaluations to confirm the severity of your condition.
3. Financial assessment: This step is all about reviewing the financial documents you’ve provided to verify your pre-disability income and calculate the benefit amount.
4. Decision: Your insurer will make a decision about the outcome of your claim. If approved, you’ll start getting your benefit payments according to the terms of your policy.

The best way to ensure a smooth claims process without unnecessary delay is to make sure you’re providing complete and accurate information from the outset. Most of the delays with income protection insurance claims are down to missing or incomplete paperwork.

Securing your financial stability during a period of illness or injury can be important, and income protection insurance is a way to have cover in place for a portion of your income (up to a certain amount) in that period.

Ready to learn more about Guardian Income Protection Insurance? Request a quote today.