[AMA] I'm a senior claims assessor for a super fund

Worked in the industry for 8 years.
Death, TPD, Income Protection, Terminal Illness, Financial Hardship.

Happy to assist where I can.

closed Comments


    What's the strangest claim you've come across?

    • +3 votes

      We had a huge amount paid out for total and permanent disability to a woman who worked in a jewellery store on the basis that the perfume her store were pumping through the airco were triggering her allergies.

      Store denied it. Allergist report showed no actual allergies.

      Somehow found proof the shopping centre were doing it and a doctor willing to support there were side effects.

      • +1 vote

        How does TPD pay out for an allergy?

        • +2 votes

          Depends on the TPD definition in place.

          In this case, it came down to whether the Member was able to work in her occupation or anything she was reasonably suited for by training, experience or education.

          She was late 50s with a learning disability, left school at 14 and worked as a shop assistant that whole time.

          Someone who had a full education, maybe some background in reception work or something would not have been as lucky.

          • +1 vote

            @Throwaway86: Thanks for sharing!

            …maybe some background in reception work or something would not have been as lucky.

            Are you saying she was approved for TPD?

            Even with the "own occupation" definition, her problem (if it really existed) would've just been with that particular shop - so she could still work as a shop assistant somewhere else, couldn't she?

            • +3 votes

              @bobbified: In theory, probably. I'm not convinced the argument that given most shopping centres would do this, it's unreasonable to expect her to be able to look for work is the most accurate.

              In practice, it probably comes back to how risk averse the fund is and what the sum insured is.

              If they're insured for 50k and it costs 60k to contest it in court, easier to save the 10k….


        In a former role I saw a TPD benefit get paid out to a guy who was not working because he was an alcoholic. Many others are able to stop drinking and lead productive lives so I'm still unsure why the insurer paid out on this?

    • +3 votes

      Second this, post up strange and weird shit.

      • +1 vote

        Saw one the other day where bloke on his first day in prison, decided to get into an arm wrestling match and got his arm badly broken.

        Caused a huge panic at board level as we are one of the few funds to pay claims from prison related shenanigans.

        I.e….. If I had a policy to age 65, got jailed within six months of employment, ensured I ended up copping a shiv in the shower block, I'm on claim until I'm at least released.

        In this particular case, I'm required to assess him against his capacity to do his regular pre disability duties. Problem is, his public job prevents him from ever being employed again as a result of his criminal record. We still disregard that.

        • +1 vote

          Interesting one…

          Is this income protection policy part of his employment?

          I would've thought that upon imprisonment, his employment would be terminated along with his insurance policy. Continuation option?

          In this particular case, I'm required to assess him against his capacity to do his regular pre disability duties. Problem is, his public job prevents him from ever being employed again as a result of his criminal record.

          In this case, when he recovers from the injury and the doctor certifies him fit for pre-injury duty, it's his criminal record that's actually preventing him from not being able to work rather than a total and permanent disability. Why would insurance continue paying for that?

          I'm actually really interested in seeing how the PDS is worded. If there's no risk of unmasking your identity by providing the policy document, do you mind sharing (or linking)?

          • +1 vote

            @bobbified: Hi,

            • whilst it was linked to his employer, the policy would have been identical as a personal member.

            • also depends on the policy definition of unemployed. Some will be unemployed at date of disability, others will provide 3, 6 or 12 month grace periods (Both for assessing eligibility to claim and also calculating their income which usually is significantly reduced as a result).

            • I suspect it's an oversight on the policy that will be updated at next revision. Most funds will exclude claims arising from criminal activity, most industry specific ones will stop payments for loss of accreditation or licensing.

            • in this instance he was determined totally or partially disabled rather than total and permanent disablement, which are pretty easy to meet usually. Most will come back to incapacity to do one income producing duty of their occupation. Most however like you say will preclude on the basis of his criminal record.

            As it's a hot topic internally currently, I'll err on the side of caution distributing sorry.

  • +1 vote

    Is Death relatively easy to assess or has there been challenges?

    • +3 votes

      If you nominate a legally binding beneficiary. Easiest job in the world more often than not.

      Otherwise, usually murky as hell.

      Had a same sex couple who went to Greece for our claimant's fathers funeral, who chose that time to come out to their family. The family were more than vocal in their disapproval.

      The couple then went swimming. Both drowned.

      Greek coroner for whatever reason determined that our claimant time of death was twenty minutes prior to that of his partner. I suspect based on time of inspection.

      Based on that, we paid to his partner's estate based on his will, which was then distributed to the surviving family of the partner.

      The will is not binding in the super space. Our claimants family disputed the coroner's findings and we had the decision overturned to pay to them based on natural order of proceedings.

      • +8 votes

        There’s a movie to be made there.


        OP, Thanks for the AMA.

        If you nominate a legally binding beneficiary. Easiest job in the world more often than not.

        A hypothetical question. Suppose both had nominated each other as legally binding beneficiary, and both had policies you have to assess. Otherwise, the case specifics are the same as you have mentioned.

        Will each of their payout goes to the other's estate? Or will his partner's "legally binding beneficiary" nomination be disregarded, since he was deemed to have passed first (so partner's payout will be determined based on will alone)? Thanks.

        • +1 vote

          In my view, and I suspect there'd be plenty to try and challenge it, but given that it was a single event that caused both deaths, there is not enough grounds to overturn two valid legally binding agreements.

          I suspect most trustees would take the view that they have upheld their end of the bargain, provided the funds to where they needed to go and the executors of the two estates can go fight it out in court.


        Not sure able survivorship rules in Greece, but I understand that generally the youngest is the survivor. Was this the case in this scenario?


          Good question. I really can't remember what logic was confirmed in the end. I still believe that based on the twenty mins between autopsies and twenty mins between time of death recorded, it was just the first freezer opened/luck of the draw.

          Superannuation Complaints Tribunal ruled we didn't have sufficient evidence to prove one had died before the other.

      • +1 vote

        Wow. Not going to comment on claim rules, but the time of death has me shook.

        Here, unless expressly witnessed, Pathologists won't commit to specific times of death because the science isn't there. Definitely not in the realm of 20 minute differences anyway! More like, rigor plus insects = approx 3 - 4 days ago. Won't be on the death certs or most reports though.

        Legal date of death on the other hand is the date in which the death is certified, so can actually be long after someone has passed away if they're not found for a while.


    What percentage of expenses / overheads do claims constitute? Is it different for different types of policies?


      Case by case. Largely dependent on sum insured and what they're claiming for.

      Royal commission has made it very difficult to organize surveillance for mental health claims when most would be subject to it previously.

      Rarely will we approve independent medical exams or even surveillance for default cover.

      You underwrite for a sum that justifies us sending you to an occ therapist….

      • +1 vote

        what do you expect to find through surveillance for a mental health claim?

        you can be chronically depressed and mentally frozen and still go out to lunch with a friend. doesn't mean sh1t all tbh

        • +3 votes

          Depends on what they're claiming are their symptoms that prevent them from doing duties, rather than the diagnosis.

          If they're claiming they're afraid to leave the house, have phobias of being out in public and around people, yet they're off at the shopping centre every day, questions need to be asked.

          Sometimes, it may just be confirming their social interactions are so impaired or poor in any day to day setting. 75% of it is grubby though, and I'm glad the royal commission stamped it out.


    Are non-dependent parents as beneficiaries likely to get your full payout?


      Of the deceased?

      In the case there's no other surviving financial dependants or will it's more likely than not.

      If there is, very unlikely. In the case there's young children involved, the trustee might throw you a bone and ask you to act as signatory or co signatory over a trust account for them.

      Grant of probate or executor of estate helps


        There was some advice/urban myths (quite a few years ago) not to nominate your mother or random workmate Bazza as a super life insurance beneficiary as they wouldn't get anything unless they were a dependent. Not even including the case of a contested will, but basically super life insurance payouts aren't the lotto jackpot for a friend that we might expect?

        • +1 vote

          There's a chain of command as such that needs to be adhered to.

          Legally binding beneficiary first and foremost (noting only certain relationships can be nominated here).

          From there we look to financial dependants. Partner, kids, in some cases ex partners or parents meet this.

          If they're not around. Can we pay to the estate. Will, executor, Grant of probate? Great not our problem.

          If none of those are relevant, then we can consider non dependents.

          If you've nominated Bazza from work as a non binding beneficiary, and those above apply, we need sufficient proof why them, and not family. Bazza will probably get a cut of the takings but not much.


    How do you deal with pre-existing conditions?

    I'm currently investigating life insurance for myself and wife (currently have none, single low income + Centrelink benefits), but given she has a chronic/genetic condition I'm nervous that any other health problems arising in the future are all going to be blamed on her (ongoing & worsening) condition and we'll be left in the rain regardless.


      Lot of factors to consider there.

      If it's default cover from an employer sponsored super fund…provided you joined the fund within 6 months of commencing with your employer, generally, you're OK. (Ongoing contributions received from employer and premiums deducted from balance aside). Each fund will have varying degrees of difficulty though.

      Most funds will also allow you to increase your base cover to a certain limit without the need for underwriting too. Review this.

      If you're going through underwriting, be honest. No matter how minor and legit the condition is, if you've ticked no to everything, I'm going to hold up the claim by months to request your clinical notes to prove both the condition and that you haven't lied on the app.

      Not a lot to be gained from retail products either.


    Do you think “any occupation” TPD insurance is basically a scam and consumers are poorly informed not having proper “own occupation” TPD insurance?


      @Skramit - Any occupation isn’t a scam. It’s less likely to be claimed on than own occupation but the premium is half the cost.

      For any occupation the claims assessor has to take into count your experience, training and ability to do that new job.

      If premiums doubled to offer own occupation then less people would be insured.

      If someone really wants own occupation then they can go through a retail fund. But the cost is crazy especially for non white collar occupations, so it’s not very common.


        I’m more referring to the fact that most people I know have any occupation TPD and don’t understand the difference. They think they have coverage but it’s much harder to get a payout with any occupation. If you can stack shelves at woolies….


          @Skramit - This is the downside to the super system as there's no advisor to guide the person.

          I don't think you really understand what Any Occupation means. They can't just tell you to stack shelves in Woolworths. They need to factor in your work history, age and qualifications and possibly re-train you. If you want Own occupation go through a retail product but expect to pay for it.


          Its any occupation you are reasonably qualified to do based on education, training and experience. Own occupation is really only for highly specialist occupations such as surgeons.

          Plenty of TPD claims get paid out, but plenty get denied too as proving a condition is permanent and will prevent you working again is a high bar.

    • +1 vote

      I tend to agree with StonerWizard's points below.

      There's a lot more nuance to it than just any or own. Lot of policies will have the Education, Training and Experience criteria. A number are now adding another definition that requires them to comply with their internal rehab program which is generally reskilling or job seeking assistance.

      My thoughts on TPD as a whole is that if you get hit by a car, you've got TAC, if you get hurt at work, Workcover. Cancer is either going to be terminal or income protection, rarely in between. Have it for the situations that fall between the cracks and where you see appropriate and likely/relevant to your situation.

      Also far less a pain in the ass than obtaining trauma cover, less expensive and not dealing with (probably) AMP.


      I've read articles similar to https://www.afr.com/companies/financial-services/veterans-bi...

      Does some of the facts from this article have any basis? I'm just concerned if I make TPD claim whether not the insurer will deem flipping burgers as possible retraining when I'm use to an office job.


        I haven't seen a burger flipper one yet. I don't think I'd want to have that discussion.

        The retraining clause is heavily reliant on what is deemed "reasonable".

        That's largely based on what the labour market deems at the time. I think the biggest victims of that are women aged 20-50, who are almost always going to be told they can go work in an office because Seek is overflowing with job options and they spent some time answering phones before in the last decade.

        If claimants take ownership of the rehab options available to them, and convince them to reskill in a course they want to do before they're sent off to do something that happened to be on Seek that day, it's helpful.

        Short answer, I think it's overstated currently. Usually by bitter declined claims that had no basis. But it's definitely heading in that direction.


    Can I open a SMSF, but leave $10k in my old fund and keep my current insurance (against the fund with $10k), or does the fund need to be activley receiving new contributions?


      Depends on the policy. Check with your fund. Definitely some out there that will maintain cover so long as premiums paid.

      Majority will need to be underwritten or elected cover though.

      Also, if your current fund doesn't have it, be careful about rolling it over to one that does. A lot of eligibility clauses will be updated to ensure you joined the fund within 6 or 12 months of joining your pre disability employer.

  • +2 votes

    Is it true that the insurance company is actively trying to find a reason not to pay your claim?

    • -1 vote

      @elctriccurio - I work in the industry (not claims) and with the exception of CommInsure I’ve yet to hear/see an insurer go out of its way to deny a claim. Like anywhere, there are bad eggs in every basket.

      The claims Process can be complex depending on the type of claim. In my experience a lot of people downplay their medical history on applications or don’t fill them in properly which leads to longer claims times as there’s more double handling and non disclosures.

      The top 3 insurers in Australia paid over $3Bn in claims combined last year. That alone should answer your question.

      • +8 votes

        "The top 3 insurers in Australia paid over $3Bn in claims combined last year. That alone should answer your question."
        That proves nothing without knowing how much was claimed. If the claims were for $6Bn then 50% of claims were rejected.

        • -1 vote

          @cheapskate Paul - Fair point, but if they look for a reason not to pay a claim then that figure would be a lot less.

          $3Bn is a lot of money and thats just from the top 3 companies, remember there are 11 retail insurers alone. Plus all the additional super funds.


      Not really, no.

      In my current role, we're accepting 98% of claims, with the remaining 2% requiring a "please explain" to the trustee. The extra amount of work required probably sees a lot of junk claims approved that shouldn't be.

      There's definitely no KPI on approval amounts or declines. The only time it's ever considered is when the underwriter shows the fund how much is being paid out and how much everyone's premiums are going up but that doesn't ever flow on to assessment


      Insurers are bound by their contract of insurance. It's a contract like any other.


      I also work in the claims insurance industry and can state that we do not have a culture of trying to deny claims. If anything we are trying to support it but some people are out there purely for insurance fraud and because we do not know who these people are everyone is subject to the same process to ensure the legitimate ones are paid.

      If you look up the numbers the insurance industry as a whole, and the same with my company, is losing money. Increased numbers in claims with ongoing legislation/practice changes (and more to come!) has not helped. There will be increases in premiums because of negative growth and it is not a sustainable model. Serious changes are needed to enable assessors to do their job properly and claimants need to be held accountable for their statements and actions.


    Interesting job, how'd you get into it?

    and how does it pay, roughly?

    what other pathways could you move to?


      Started on phones in call center. Went into admin. Moved up from there.

      Claims admin (I.e. setting up claims paperwork, call centre) is about 60-65k

      Assessor is about 80-85. Senior or technical expert varies significantly depending on how many types of claims you manage, what your background is, and also approval limits. 85k to 110k I'd imagine.

      Lot of varied backgrounds. Legal, medical, accounting, admin. Some go into underwriting policies, trustee offices looking at the relationship between fund and insurer. Plenty go to AFCA (industry ombudsman). Lot of growth in the rehab aspect too.


        What are your hours like? Lots of overtime and crazy hours or 9-5 Monday to Friday?

        • +1 vote

          At this time of year, Maybe ten hours a week overtime unpaid. It's a busy 9 to 5 though. My internet at work time has dwindled considerably.

          EOFY I may as well bring a tent.


            @Throwaway86: Are you saying there're just more work needs to get done around EOFY or there're more claims received around this time?


              @PAPower: Lot more claims stemming from people getting their statement and realising they had cover.

              Other issue is that we can't lock in advance payments that cross over financial years until we've confirmed the income tax rates for that year.

              If Barry is confined to a wheelchair and their doctor has told us he's off work for 9 months. Great, I can lock in 9 months of payments to be released and give him a call every few months to see how he's going. Very easy.

              But for the month of July, every claim has to be manually assessed and paid once the tax rates are given, which is probably four times the workload to a usual month.

              Throw in every one panicking they haven't received a PAYG summary by 12.01am July 1 and constantly hassling us for it too..


        Switch sides. There's triple and more that to be made.


    Hi, my husband had a payout for a work injury (small amount because they said his lifestyle could have added to the injury, not just caused by carrying up to a tonne by hand everyday) by the time the lawyer took their share, he didn't even have enough to have surgery (which may improve or worsen the injury), his lawyer suggested he make a claim on TPD but wanted us to pay them upfront (they said around $5000). He has had to take a very stressful office job with lower pay due to his injury and he has days where his shoulder hurts that much that he can't sleep, he can't take strong pain killers because he needs to drive to work. How hard would it be for him to make a claim for TPD. Thanks

    • +1 vote

      What was his prior occupation? Heavy manual it sounds like? What sort of timeframe was he off work between taking a lesser role?

      Without knowing the TPD definition, it's difficult to say for certain. Other factors are going to be his education/training/experience and the likely argument that they've managed to redeploy him into a less demanding role.

      Lawyer led claims are not worth the money you pay. You're effectively paying a graduate top dollar to send an email or call once a week asking "is it done yet? If not why?".

      My advice would be to let the claim progress on its merits, handle it yourself, know the timeframes under Life Code the insurer has for responses, hold them accountable, and if you're not satisfied, refer to AFCA for them to take a look.


        He left school early to work as a builders labourer, so not qualifications. The job he was working for when his injury occurred was handling heavy items (loading on and off trucks, so hands constantly above his head), he worked for this company for about 13 years, when he was injured they were told to put him on light duties but his boss made him continue with his old job and made his life hell, they said there were no other jobs for him so he quit as soon as he found a new non manual job. He hasn't made a TPD claim, he is just living with the pain as there is no way we can pay over $25000 for the operation and afford for him to have months of rehab.

        • +1 vote

          I think there's a good chance you can get it approved. Especially if the office job is significantly less income than prev role, and was medically supported as a necessity career change.

          I'd be making some enquiries as to the waiting period of the TPD benefit- 3 months or 6 months. And whether it's based on pre disability occupation or any employment paid or otherwise.

          Being off all work for 6 months to take a punt on a TPD claim is a huge risk. Hope it works out for you


    How to assess the cover amount for Life & TPD? Is buyback options a good thing? Is Income Protection better than TPD?


      @IP and TPD are two seperate products.

      IP is easier to claim on but it's more expensive as a result. TPD gives you a lump sum payment, IP is an ongoing monthly payment. Depending on your needs, one might be better than the other.


      Nowhere near qualified to give an exact figure there. Depends on your circumstances - mortgage, kids, how much would your home require changes if you became wheelchair bound, what's the cost of a full time carer out your way.

      My basic calculation method for my own was (years to 65 x annual income) + any amount that would be left over owing on the mortgage after that figure.

      I'm generally of the view that unless you horde your leave balances, should always have the lowest waiting period available on your income protection. Whilst things have come a long way, there's a huge assumption, that a 30 day waiting period means claim assessed in 30 days. By law we have up to 60 days from all paperwork being received.

      Buybacks are handy if you've got an ancient TPD policy with very generous terms in comparison to new products on the market today. I'd get an advisor to look at the product and confirm whether that's the case. Almost a necessity for trauma products.


    Thanks for AMA. I am in severe financial hardship due to job loss (contract not renewed a bit over two years ago) and don’t qualify for anything from Centrelink as my partner has a job, but I have many thousands of dollars in super. I’m well off retirement age at 48 but have disability and multiple chronic illnesses, and can’t get a job anyway, so I’m wondering if you know of any way I could access my super early?

    • +3 votes

      Sorry. Financial hardship won't happen without Centrelink.

      Compassionate grounds limited to medical expenses,funeral expenses or mortgage foreclosure.

      That's industry wide (Govt cracked down on it a few years ago after Sunsuper were basically giving it away).

      Ridiculous that if you can't pay the rent you can't get an early release but can to get cosmetic dental done.

    • +1 vote

      Checked to see if you have income protection?


        Thanks for your advice. I was pretty sure that was the case but figured there was no harm in asking! The income protection might be worth looking into. I’ve got nothing to lose - literally!


    I've heard lots anecdotally about accessing super for medical treatments (weight loss surgery, cosmetic dental) - how easy is it? Are there many hurdles?


      Provided your doctor advises it's necessary, the costings are shown. You haven't done it within 12 months, they're pretty unlikely to say no.

      The tax rate isn't fantastic.


    Read that you started from low level.
    How can I enter straight to higher level? What qualities would they need, and where is it advertised?
    (Hope it's not Seek.Com)

    • +1 vote

      @Pumpkin - Unless you're from the allied health industry or got claims experience you generally won't be able to make the immediate jump.

    • +1 vote

      Industry is desperate for more bodies on desks currently. Not as silly as I assume the troll intended.

      Legal background, medical, any insurance, claims or warranty background would be considered.

  • +1 vote

    Can you explain why standard TPD insurance doesn't really cover people working office jobs well? For example: If Don lose his arm he probably can't perform his high performing data analyst job like he use to, but you won't pay out on that because he can do ANY other office job. However if he was a Cabinet maker or the like you'd pay out immediately.


      Heavy manual is probably paying 2.5x the premium that a professional is, and does t have access to the auto approved limits that professional or white collar ratings do.

      I'm also making the assumption the office worker wants to return to work, and are probably likely to get a lot more rehab funding approved if it's a feature of the policy.

      In that instance, it wouldn't be reasonable to suggest a data analyst on 120k isn't TPD as they could do a 45k office admin job.

      I suspect it'd be declined in most policies under the clause that they've declined modifications or rehabilitative aids to do their job. A workplace assessment would find 2-3 things that could be done in most cases.


    Have you, or your Organisation, ever stuffed-up?
    If you can share thanks!


      I usually overpay someone at least once a month largely because I'll take their word for when they're returning to work rather than wait for the Employer to fill out paperwork which will tell me they actually went back a few weeks earlier.

  • +5 votes

    I don't have a question, but I would just like to say this is a top quality AMA in terms of the excellent answers provided. Thanks!


    I recently had my application to increase my Life Insurance and TPD Insurance denied by TAL (through CBUS) due to "having suffered symptoms and / or received for depression, anxiety and OCD within the last 12 months".

    Are all insurance companies (going through a superannuation fund) likely to be the same, and would you recommend any?

    Thank you.

    • +1 vote

      Each will have different limits, and different approaches.

      Some will apply exclusions. Some will add premium loading. Others will want your doctor to provide more info about your treatment.

      Without knowing the circumstances, it's probably more to do with amount applied.

      You should have a re-review date on the letter. If not, request one. The tricky part now is every other insurer will probably asked if you've been declined recently by anyone else. Looks better to get TAL to reconsider and then explore your options.

    • +1 vote

      Also, re: recommendations. Difficult to say given a lot of industry shake up since RC.

      Still wouldn't recommend touching AMP with a bargepole.

      • +1 vote

        Fair enough, I'll see what I can find out and will definitely avoid AMP.

        Thank you for taking the time to answer my questions.


        Are the industry super funds better in terms of getting TPD, death insurance etc compared to retail super?


    How have you found working with the revised Life code of practice? Has the mergers and acquisitions of major insurers affected you? Are you dealing with nasty financial advisers in your role?


      On the whole, great ideas that will see great outcomes for policy holders (can't say I enjoy speaking to claimants every 3 weeks to tell them no news because it's out of my control).

      But terrible execution that will inevitably cripple the industry as it requires probably 3 times the pre-RC staffing to implement it and gave next to no notice.

      Only takes one person to call in sick with a handful of claims due for assessment by COB that day, and another handful all requiring an update, and the domino effect is savage.

      MLC/AMP/IOOF/AON/Comminsure changes are noticeable but probably a million times worse once in a year.

      I like the financial planners and advisors. They're getting paid regardless, it's not adversarial and have a pretty good idea of what's reasonable and what's not.

      The ambulance chasers off TV are scum of the earth. More funds should pursue them as vexatious litigants.


    Is there a difference between super based insurances and out of pocket insurances?

    As in, is it better to not have super based insurances and get one from (let’s say) a bank or specialised insurance company?


      Main differences but not exclusively:

      Can hold a variety of products through retail that super cant legally offer. trauma, child trauma, Own occupation TPD.

      The insured amounts are usually higher, as are the premiums, expiry age, and you can hold products for multiple policy holders (ie husband and wife) not just whose super it's in.

      Super, premiums are deducted from your super balance, the income protection premiums are tax deductible for the fund, so a lot cheaper than retail.

      The other good thing is the default provided cover. What really irks about the Morrison Govt policy changes about removing default cover for young Australians is that CBUS for example, will provide cheap default cover to a heavy manual labourer that would cost 10x more if you came off the street and bought a policy. No one reads their super docs until they need it.

      I really wish people looked at child trauma insurance more, as it's just such a horrible prospect to have to go back to work so soon after something happens to your child. That's the one thing retail have over the super insurance.

      Unless you want a huge payout, it's not worth the terrible experience retail usually provides.

    1. Why would someone need TPD when they have income protection which would fulful a similar role?

    e.g Person becomes permanently disabled through a Stroke and unable to work. Wouldn't Income Protection provide ongoing income vs Single Lump Sum from TPD?

    1. How do you manage mild sleep apnea? Some companies would straight out deny an application for Income protection while others provide loading?

      You can claim on both concurrently.

      Say you put a claim in for both for your bad back, you're off work waiting for surgery to fix a lumbar disc.

      We might say yep clearly you're approved for income protection, but we want to see how the surgery goes, so we'll park your TPD until we see the results and professional opinion.

      By the time you've had the surgery, done your rehab, checked in with your surgeon, assessed other surgery options as being relevant or not, and then finally determined you're TPD, you're probably at the end of your IP benefit period.

      Re: sleep apnea. Lot to figure there. Ongoing treatment and BMI being the main two. BMI is stable, I'd probably look to exclude. Obese to morbidly obese, I'm applying a decent sized loading or declining outright.


    I'm an office worker and have have young kids, super is with HostPlus and considering taking Death, salary continuance and maybe TPD.

    Based on what you've said, it seems like TPD would be a waste of time due to the claim rules for white collar etc.

    Do you think it's still worth getting salary continuance and death through my super?

    Also any opinions of HostPlus, their online insurance tool redirects to metlife.com.au so I'm guessing they just resell?


      Most funds will have an underwriter. They can't handle such a huge level of risk by themselves. MetLife would meet and develop a policy with Hostplus specific for Hostplus though rather rebadging a generic MetLife product.

      I certainly think there's merit in IP based on what you've said.

      TPD is difficult to give you a set answer. Each fund is going to have upward of a dozen different definitions depending on the date cover commenced, the date of your disability and whether it's a pre existing condition or new event. The competing fund will have another dozen more too.


    How binding are "binding" death benefit nominations?

    For example, if a surviving spouse was 100% binding beneficiary do you automatically just pay out once the death certificate is produced?

    Can adult children dispute the binding nomination?


      Generally the only wriggle room is to contest the legitimacy of the document rather than the preference.

      In the situation you raise, if the adult children are not claiming as financial dependents, we'd probably make our decision to award to the binding nomination and issue procedural fairness. Unless there's proof there's criminal activity, we're not reversing that decision I suspect.

      Even if they're financially dependent, we might ask the nominated beneficiary if they are open to another split, but I doubt we're doing too much beyond due diligence.


    What is the ratio of claims between white and blue collar? Cheers.


      Depends on the fund. Industry specific funds like Equip, HESTA or Hostplus are going to have much higher blue collar claims to white collar. And of course LegalSuper, NGS and Guild will be at the other end of spectrum.

      Will be more likely to be 3:1 blue collar to white collar as my estimation owing to the fact that default cover is listed as a blue collar occ for the popular funds, which has to be manually changed.


    How do I tell whether my insurance through super is "junk" or not ?



      Wasn't able to read the article but the underwriter of the product is always identified in the PDS.

      A lot of the names mentioned in the first paragraph are fairly ordinary but rarely underwriting for the major super companies - which will be MLC, MetLife, TAL, Comminsure and AIA.

      If they've got AMP or Asteron, chances are it's because it's a niche little fund with no negotiating leverage and end up with something cheap and nasty because they can now advertise "Hey cheap premiums" if nothing else.

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