Starting your claim
Once we’ve confirmed your eligibility to start the claims process you will be offered a choice of how you would like to provide your initial information. If you prefer to provide this information online we will send you a link so you can apply online. However, if you prefer to complete your initial information via paper forms we’ll get some paperwork to you and ask for supporting documentation and other important information to help the process run smoothly.
We will need the following information:
- Your full name and date of birth
- Your member number would be helpful but it's not required
- Details about your injury or illness
- The date on which your injury first occurred or your illness first presented itself
- Details and the date of your diagnosis
- Details about your work status
- The date you last worked
- The number of hours you worked per week leading up to your injury or illness and sometimes personal questions.
There is no set time frame for how long an insurance claim takes.
The Insurer will assess your application
The Insurer will use the information you provided when making an assessment. The insurer may also request relevant information from other sources, such as independent experts and insurers you’ve had other claims with. You will be informed of any such steps taken to assess your claim.
The information you provide will be assessed to determine whether you’re eligible to apply for either:
- a TPD payment – made up of both your insured amount plus your account balance; or
- a Permanent Incapacity payment made up of your account balance only.
You may also be asked to provide further information such as:
- Tax return and assessment notices
- Specialist medical reports
- Independent medical reports
- Clinical records
- Worker’s compensation records
- Pharmaceutical Benefits Scheme (PBS)/Medicare records
- Reports from your doctor(s),
- Information from your employer,
- And you may be asked to attend medical examinations.
The Insurer’s decision
Once your application has been assessed, you’ll be advised whether it has been successful.
If your application is declined
If your application is declined, this generally means that the Insurer has not formed the opinion, based on all the evidence provided, that you meet the conditions for a TPD payment. The insurer will explain its reasons for the decision and your application will be referred to the legalsuper Trustee. The Trustee has a responsibility to review the Insurer’s decisions, to ensure they are reasonable and meet the conditions set out in the legalsuper Trust Deed and insurance policy.
You have the right to request the legalsuper Trustee or the insurer to reconsider any decision to decline your claim, and this request can be accompanied with new evidence or further submissions as to why you consider you meet the conditions for payment of a TPD benefit.
If your application is accepted
You will be asked to provide us with instructions as to how to make payment to you.