26
INSURANCE Our claim on claims A guide for advisers to help clients through an insurance claim
INSURANCE
Our claim on claimsA guide for advisers to help clients through an insurance claim
1
Our claim on claimsOur claims philosophy When a client suffers from an illness, injury or passes away unexpectedly, we appreciate it’s a time of high emotion, stress and financial pressure.
We also understand how difficult this time can be, and so we approach every claim with a commitment to do what ever we can to process it as quickly, and as efficiently as possible.
We do this by assigning each individual claim to a specialist claims assessor, who will work with you, your client and their family, from start to finish.
Where appropriate the Claims team can assess and finalise your client’s claim over the phone without the need to complete claim forms. This approach is used for short term income protection claims.
We also do this by requesting as much information as we can upfront, committing and delivering on our service standards and by upholding a personable and professional approach.
But your experience and expertise can make all the difference in helping us provide benefits to your clients sooner.
How to use this guideThis guide provides you with an overview of our claims processes and service standards. It also features some time saving tips and answers to frequently asked questions.
Throughout the guide symbols are used to make it quick and easy to read. The table below illustrates what they mean.
The team at OnePath is responsible
You, the adviser, are responsible
Our service standards
Time saving tip
More information can be found in the back of the brochure
There is a cost involved for the life insured
Our life insurance claims process 3
Our trauma, child and terminal illness insurance claims process 7
Our total and permanent disablement insurance claims process 11
Our income protection, living expense and business expense insurance claims process 15
When the policy is owned by the OnePath MasterFund 19
Answers to frequently asked questions 23
More support 24
*For both retail and group claims.
Contents
In 2014 we delivered over $660 million* to
over 10,800 customers and their families.
We look forward to delivering on thousands more
promises in the future.
2
Life insurance claims process
Step 1 – Notify the OnePath claims team
3
Call our claims hotline on 1300 555 250.
Make sure you have the following information on hand:
• policy number
• date of death
• cause of death.
The initial requirements will be confirmed to you over the phone. All forms will be emailed, faxed or mailed within 24 hours.
The more information you can provide to our claims assessor over the phone, the better equipped they will be in determining all of the possible requirements upfront.
Step 2 – Complete the requirements
Standard requirements include:
• completed claim form
• certified copy of the final Death Certificate
• certified copy of the Driver’s licence (or other acceptable proof of age)
• original policy documents (including the Policy Schedule and Memorandum of Transfer, but not required for OnePath MasterFund policies).
Other possible requirements could include:
• completed Medicare authority form and generic medical authority.
If the life insured and policy owner are the same person, the sum insured is more than $50,000 and there is no valid beneficiary nomination, we will also require the following:
• Probate (if there is a Will) or
• Letters of administration (if there is no Will).
Even if you don’t have all of the information, send us as much as you can, and we will start the assessment process.
Medicare reportWhat is it?
A report that provides a brief history of all of the life insured’s billed consultations for a specified period of time.
When is it needed?
On a case by case basis, however it is often required when the policy has been in-force for a short period of time.
Why is it needed?
To rule out misrepresentation of relevant medical history.
Treating doctor’s report What is it?
A tailored report on the life insured’s consultations with the treating doctor.
When is it needed?
When more detailed information is needed.
Why is it needed?
To rule out misrepresentation of relevant medical history.
The claims assessor will make regular contact with the doctor to follow the original request.
4
After reviewing the requirements the claims assessor will then decide either to make a claim decision (go to Step 4) or to request more information (see below).
What happens next will be confirmed within five business days.
Important note: A cheque for the Advance Assistance Benefit will be issued once satisfactory evidence has been received (only applicable to OneCare policies).
Step 3 – We assess the claim Step 4 – Claim decision made
When approved a cheque is sent.
Five business days.
If declined an ‘intention to decline’ letter is sent.
Five business days.
Reports from other insurersWhat is it?
A summary of general policy information and a request for any medical or financial evidence obtained by the insurer.
When is it needed?
On a case by case basis, however it is often required when the policy was accepted with takeover or replacement terms.
Why is it needed?
By gaining access to reports completed by other insurers we can speed up the assessment process.
It may be needed to rule out any misrepresentation of existing insurance or insurance that was meant to be cancelled.
The claims assessor will make contact with the insurer at least every four weeks after the original request.
Coroner/Post mortem report What is it?
A report on the investigations made by the coroner.
When is it needed?
Every time the death is subject to coronial enquiry. (Deaths caused by accidents, suicide and those which have unclear circumstances generally require a coronial enquiry.)
Why is it needed?
To assist the claims assessor understand the circumstances surrounding the life insured’s death.
The claims assessor will write and request the report within four business days.
It can take several weeks for the coroner to provide the report.
5
What kind of additional information can be required?
During the year I was privileged to assist clients in their time of need. My first claim occurred mid year where my farming client, age 56, died of cancer. OnePath paid his family $500,000 and I was extremely pleased with the assistance and promptness in settling.
Just recently another of my clients suffered a malignant cancer; he is a transport operator who OnePath had covered for $100,000. The claim was settled within 10 days of forwarding the claim form and medical requirements.
This was an amazing feat and I wish to congratulate the staff at OnePath for their professionalism.
The recipients of claims are depending on prompt settlements and very much appreciate OnePath’s special service, which complements our role as advisers and builds up a wonderful rapport for both myself and OnePath.Maurice Mawby, Mawby Financial Services.
6
Trauma, child and terminal illness insurance claims process
Step 1 – Notify the OnePath claims team
Call our claims hotline on 1300 555 250.
Make sure you have the following information on hand:
• policy number
• details of the illness or injury
• date when the injury occurred or when symptoms first became apparent.
The initial requirements will be confirmed to you over the phone. All forms will be emailed, faxed or mailed within 24 hours.
The more information you can provide to our claims assessor over the phone, the better equipped they will be in determining all of the possible requirements upfront. For trauma claims, if you have medical evidence available, like a histopathology or ECG report, the assessor can accept it by email instantly at this point and give you a pre-assessment. This reduces claim form requirements, helps you manage expectations and gets claims paid faster.
7
Income protection, living expense and business expense insurance claims process
Step 2 – Complete the requirements
Standard requirements include:
• completed claim form
• completed specialist medical form and copies of any tests used to confirm or diagnose the illness or injury (e.g. blood, biopsy, CT scans). The life insured will have to pay for the report
• certified copy of the Driver’s licence or (other acceptable proof of age)
• original policy documents (including the Policy Schedule and Memorandum of Transfer).
Other possible requirements could include:
• completed Medicare authority form and generic medical authority.
Even if you don’t have all of the information, send us as much as you can and we will start the assessment process.
The claims team frequently receive specialist medical forms without copies of tests. Speed up the assessment by stressing the importance of the tests to the life insured and to the doctor.
Medicare reportWhat is it?
A report that provides a brief history of all of the life insured’s billed consultations for a specified period of time.
When is it needed? On a case by case basis, however it is often required when the policy has been in-force for a short period of time.
Why is it needed? To rule out misrepresentation of relevant medical history.
Treating doctor’s report What is it?
A tailored report on the life insured’s consultations with the treating doctor.
When is it needed? When more detailed information is needed.
Why is it needed? • To confirm more information about dates,
consultations, diagnosis, and the prognosis.
• To rule out non-disclosure.
The claims assessor will make regular contact with the doctor after the original request.
The reports are completed faster when the adviser or claimant also contacts the doctor’s office to request it to be finalised.
8
Reports from other insurersWhat is it?
A summary of general policy information and a request for any medical or financial evidence obtained by the insurer.
When is it needed?
On a case by case basis, however it is often required when the policy was accepted with takeover or replacement terms.
Why is it needed?
By gaining access to reports completed by other insurers we can speed up the assessment process.
It may be needed to rule out any misrepresentation of relevant medical history for existing insurance or insurance that was meant to be cancelled.
The claims assessor will make regular contact with the insurer after the original request.
The reports tend to be completed faster when the adviser or claimant also contacts the insurer to request it to be finalised.
A Chief Medical Officer (CMO) reviewWhat is it?
An interpretation of a medical report or test completed by a specialist consulting doctor.
When is it needed?
Cases where circumstances require specialist review will be presented to the CMO for review.
Why is it needed?
To assist the claims assessor understand the life insured’s condition and provide medical expertise when required.
Five business days.
When approved a cheque is sent.
Five business days.
After reviewing the requirements the claims assessor will then decide either to make a claim decision (go to Step 4) or to request more information (see below).
What happens next will be confirmed within five business days.
Step 3 – We assess the claim Step 4 – Claim decision made
If declined an ‘intention to decline’ letter is sent.
Five business days.
What kind of additional information can be required?
98
11
We have just been in touch with our client and he has asked me to express his thanks for the way his recent claim was managed.
As advisers, it is nice to see the money flow through to clients so smoothly and quickly, especially when they are suffering a life obstacle.
Thank you OnePath, firstly for your product and secondly for the manner and efficiency in which you dealt with my client’s claim. Philip Featherstone, Featherstone Financial Services.
10
Total and permanent disablement insurance claims process
Step 1 – Notify the OnePath claims team
Call our claims hotline on 1300 555 250.
Make sure you have the following information on hand:
• policy number
• details of the illness or injury
• date when the symptoms first became apparent and the date last worked.
The initial requirements will be confirmed to you over the phone. All forms will be emailed, faxed or mailed within 24 hours.
The more information you can provide to our claims assessor over the phone, the better equipped they will be in determining all of the possible requirements upfront.
Medicare reportWhat is it?
A report that provides a brief history of all of the life insured’s billed consultations for a specified period of time.
When is it needed?
On a case by case basis, however it is often required when the policy has been in-force for a short period of time.
Why is it needed?
To rule out misrepresentation of relevant medical history.
Employability assessmentWhat is it?
A report compiled by an appropriate consultant that details current and transferable workplace skills.
When is it needed?
On a case by case basis.
Why is it needed?
To identify any work capacity in direct relation to their condition and transferable skills.
A mutually agreeable time is arranged with the life insured.
11
Step 2 – Complete the requirements
Standard requirements include:
• completed claim form, including the employer or self employed statement
• completed treating doctor’s form. The life insured will have to pay for the report
• certified copy of the Driver’s license or (other acceptable proof of age)
• original policy documents (including the Policy Schedule and Memorandum of Transfer).
Other possible requirements could include:
• completed Medicare authority form and generic medical authority.
Even if you don’t have all of the information, send us as much as you can and we will start the assessment process.
Speed up the assessment by providing as much information as possible on the life insured’s job and their individual duties.
Treating doctor’s report What is it?
A tailored report on the life insured’s consultations with the treating doctor.
When is it needed?
When more detailed information is needed.
Why is it needed?
• To confirm more information about dates, consultations, diagnosis and prognosis.
• To rule out misrepresentation of relevant medical history.
The claims assessor will make contact with the doctor at least every four weeks after the original request.
The reports are completed faster when the adviser or life insured also contacts the doctor’s office to request it to be finalised.
Independent medical examinationWhat is it?
A physical examination and report completed by an independent specialist, as arranged by OnePath.
When is it needed?
The need is assessed on a case by case basis.
Why is it needed?
To obtain a specialist opinion and to confirm the severity of the life insured’s condition in direct relation to their ability to work.
The claims assessor will make regular contact with the doctor after the appointment.
A Chief Medical Officer (CMO) reviewWhat is it?
An interpretation of a medical report or test completed by a specialist consulting doctor.
When is it needed?
Most cases will be presented to the CMO for review.
Why is it needed?
To assist the claims assessor understand the life insured’s condition and provide medical expertise when required.
Five business days.
12
If declined an ‘intention to decline’ letter is sent.
Five business days.
When approved a cheque is sent.
Five business days.
After reviewing the requirements the claims assessor will then call the life insured for an informal interview. This provides the claims assessor with a better understanding of the life insured’s circumstances and helps the life insured understand the claims process.
After the interview the claims assessor will then decide either to make a claim decision (go to Step 4) or to request more information (see below).
What happens next will be confirmed within three business days.
Step 3 – We assess the claim Step 4 – Claim decision made
Workers’ Compensation reportWhat is it?
A summary of general policy information and a request for parts of the claim file e.g. medical reports.
When is it needed?
When a Workers‘ Compensation claim is lodged.
Why is it needed?
By gaining access to reports completed by other insurers we can speed up the assessment process.
The claims assessor will make regular contact with the insurer to follow up after the original request.
The reports tend to be completed faster when the adviser or life insured also contacts the insurer to request it to be finalised.
Reports from other insurersWhat is it?
A summary of general policy information and a request for any medical or financial evidence obtained by the insurer.
When is it needed?
On a case by case basis, however it is often required when the policy was accepted with takeover or replacement terms.
Why is it needed?
By gaining access to reports completed by other insurers we can speed up the assessment process.
It may be needed to rule out misrepresentation of relevant medical history for existing insurance or insurance that was meant to be cancelled.
The claims assessor will make contact with the insurer to follow us after the original request.
The reports tend to be completed faster when the adviser or life insured also contacts the insurer to request it to be finalised.
What kind of additional information can be required?
1312
I am writing to you and your fellow colleagues at OnePath to say thank you for the manner in which you attend to life insurance claims. The promptness of your communications with our mutual clients and the sensitive manner in which you handle these communications is exemplary and impressive.
At the end of the day your claims department is instrumental in delivering the promise that a life insurance adviser makes. My experience with OnePath gives me and my staff the confidence to stay in this business.
Alex Braun, Halstead Financial Services Pty Ltd – Guardian Financial Planning.
14
Income protection, living expense and business expense insurance claims process
Step 1 – Notify the OnePath claims team
Call our claims hotline on 1300 555 250.
Make sure you have the following information on hand:
• policy number
• details of the illness or injury
• date when the injury occurred or when symptoms first became apparent
• date when the insured ceased work.
The initial requirements will be confirmed to you over the phone. All forms will be emailed, faxed or mailed within 24 hours. Where the claim looks like it can be assessed over the phone, a claims assessor will phone the insured person and complete a tele-interview. This verbal statement replaces forms. When this occurs, the assessor will request minimal medical evidence and basic requirements only. Payment is usually made within days of the notification.
The more information you can provide to our claims assessor over the phone, the better equipped they will be in determining all of the possible requirements upfront.
Treating doctor’s report What is it?
A tailored report on the insured’s consultations with the treating doctor.
When is it needed?
When more detailed information is needed.
Why is it needed?
• To confirm more information about dates, consultations and the diagnosis.
• To rule out misrepresentation of relevant medical history.
The claim assessor will make regular contact with the doctor after the original request.
The reports tend to be completed faster when the adviser or life insured also contacts the doctor’s office to request it to be finalised.
Medicare reportWhat is it?
A report that provides a brief history of all of the life insured’s billed consultations for a specified period of time.
When is it needed?
On a case by case basis, however it is often required when the policy has been in-force for a limited period of time.
Why is it needed?
To rule out misrepresentation of relevant medical history.
15
Step 2 – Complete the requirements Step 3 – We assess the claim
Standard requirements include:
• completed claim form
• completed treating doctor’s form. The life insured will have to pay for the report
• copies of any tests used to confirm or diagnose the illness or injury (e.g. blood, biopsy, CT scans)
• a photocopy of the life insured’s driver’s licence or passport
• completed Medicare authority form and generic medical authority.
For indemnity style income protection, flexiguarenteed and partial disability policies we will also require financial records as outlined in the policy terms. This could include:
• profit and loss statements
• individual tax returns and notice of assessments
• a letter from the employer
• 12 months worth of pay slips.
For indemnity style business expense policies we will also require:
• profit and loss statements.
Proof of business expenses may also be required. This could include:
• receipts
• copies of bills
• contracts or written agreements.
Even if you don’t have all of the information, send us as much as you can and we will start the assessment process.
After reviewing the requirements the claims assessor will then call the life insured for an informal interview. This provides the claims assessor with a better understanding of the life insured’s circumstances and helps the life insured understand the claims process.
After the interview the claims assessor will then decide either to make a claim decision (go to Step 4) or to request more information (see below).
What happens next will be confirmed within three business days.
Independent medical examWhat is it?
A physical examination and report completed by an independent specialist selected by OnePath.
When is it needed?
The need is assessed on a case by case basis.
Why is it needed?
To obtain a specialist opinion and to confirm the severity of the life insured’s condition in direct relation to their ability to work.
The claims assessor will make contact with the doctor at least every four weeks after the appointment.
Financial information What is it?
Additional financial records.
When is it needed?
• to confirm post disablement income
• when claiming partial benefits.
Note: We will never request financial information on a guaranteed contract to confirm the amount insured for total disability benefits. For a flexiguaranteed contract, proof of pre-application income needs to be provided.
Why is it needed?
The additional information is needed to confirm the eligible monthly benefit.
The claims assessor will make contact with the life insured at least every four weeks after the original request.
A Chief Medical Officer (CMO) review What is it?
An interpretation of a medical report or test completed by a specialist consulting doctor.
When is it needed?
When the insured’s condition is complex.
Why is it needed?
To assist the claims assessor understand the life insured’s condition and to confirm it meets the policy definition.
Five business days.
What kind of additional information can be required?
16
Step 4 – Claim decision made
When a payment is approved an EFT transfer is arranged.
Five business days.
If declined an ‘intention to decline’ letter is sent.
Five business days.
Step 5 – Ongoing claim
A progress claim form will be sent to the life insured monthly.
Once returned, we reassess the claim (go to Step 3).
Every 30 days.
Reports from other insurersWhat is it?
A summary of general policy information and a request for any medical or financial evidence obtained by the insurer.
When is it needed?
On a case by case basis, however it is often required when the policy was accepted with takeover or replacement terms.
Why is it needed?
By gaining access to reports completed by other insurers we can speed up the assessment process.
It is needed to rule out any non-disclosure of existing insurance or insurance that was meant to be cancelled.
The claims assessor will make contact with the insurer at least every four weeks after the original request.
The reports are completed faster when the adviser or life insured also contacts the insurer to request it to be finalised.
Workers’ Compensation reportWhat is it?
A summary of general policy information and a request for parts of the claim file e.g. medical reports.
When is it needed?
When a Workers‘ Compensation claim is lodged.
Why is it needed?
By gaining access to reports completed by other insurers we can speed up the assessment process.
The claims assessor will make contact with the insurer at least every four weeks after the original request.
The reports are completed faster when the adviser or life insured also contacts the insurer to request it to be finalised.
1716
19
OnePath’s rehabilitation services
Our rehabilitation team* are available at no extra cost, to assist the life insured back to the workforce. A rehabilitation program can be made up of:
• vocational counselling
• workplace assessment
• ergonomic modification that is essential to maintain work
• work conditioning program
• funding of short training courses
• job seeking assistance.
Our rehabilitation program is reviewed on a regular basis by our experienced consultants. This is to ensure all services provided are of a high quality and meet the needs of the life insured wherever they may live in Australia.
* For income protection claims only. 18
19
When the policy is owned by the OnePath MasterFund
When a policy is owned by the OnePath MasterFund, any money from claims can only be released to a member if it meets the requirements set out in the Fund’s trust deed and superannuation laws. When a payment is made by the trustee, the trustee will deduct any tax that may be applicable for example in the event of a TPD claim.
Why do the assessor and trustee act separately? The claims assessor and trustee represent different entities. The trustee is the owner of the policy and acts on behalf of the member, while the claims assessor assesses the claim for the insurer. It is worthwhile explaining this to clients who are often confused when the assessor and trustee work for the same brand.
Step 1 – Notify the OnePath claims team
Step 2 – Complete the requirements Step 3 – We assess the claim
When the insurer accepts the claim the trustee is responsible for confirming the beneficiaries. This is done in the following order.
When the insurer declines the claim the trustee is responsible for independently reviewing the insurer’s decision. Legal advice may be sought.
Did the member leave a valid beneficiary nomination?
No Yes – The claim is approved and paid to a valid dependant or estate/legal personal representative (go to Step 8).
Is there a valid legal personal representative?
No
Yes – If estate is solvent, claim is approved and paid to a valid estate (go to Step 8).
Is there a valid spouse(s)?
No Yes – Claim is approved and paid to the spouse(s) (divided equally between them if more than one) (go to Step 8).
The distribution of the benefits is decided in accordance with the trust deed. Generally, the trustee will look to pay to one or more of the member’s dependants; or if there are no dependants, to anyone else permitted under superannuation law.
Life insurance claims
When the trustee disagrees with the decision the claim is returned to the insurer with a request for further investigation.
When the trustee agrees with the decision the claim is declined (go to Step 8).
Step 6 – Trustee assesses claim
Total and permanent disability insurance and terminal illness claims
Step 4 – Claims assessor makes a decision
Step 5 – Claim decision sent to the trustee
• When the insurer accepts the claim the trustee is now responsible for confirming whether the life insured has met a specified SIS Condition of Release.
Generally, in order to meet the SIS definitions two independent doctors’ reports are required.
When the insurer declines the claim the trustee is now responsible for independently reviewing the claims assessor’s decision. Legal advice may be sought.
If the trustee decides that the life insured’s condition has met the definition the claim is approved (go to Step 8).
If the trustee decides that the life insured’s condition has not met the SIS definition the insurance needs to be rolled into a superannuation fund (go to Step 8).
When the trustee disagrees with the decision the claim is returned to the insurer with a request for further investigation.
When the trustee agrees with the decision the claim is declined (go to Step 8).
20
If declined by the insurer and the trustee
If approved by the insurer and the trustee
If approved by the insurer and declined by the trustee
An ‘intention to decline’ letter is sent.
Five business days.
A cheque is sent. When the money is to be rolled into a pension, a letter outlining the life insured’s options will be sent. A OneAnswer PDS will be sent for consideration.*
*Issues may apply for terminal illlness claims. Benefits paid under super may be subject to tax. For more information, please refer to OnePath PDS. Please note that tax can be payable for TPD benefits.
Five business days.
A letter outlining that the money must be rolled into a superannuation fund is sent. A OneAnswer PDS will be sent for consideration.
Five business days.
Life insurance and income protection
If approved by the insurer and the trustee
If declined by the insurer and the trustee
Life insurance
A cheque is sent to the beneficiary. When the money is to be rolled into a pension, a letter outlining the beneficiary’s options will be sent. A OneAnswer PDS will be sent for consideration.
Income protection
The benefit is paid to the fund by the insurer and the trustee releases the benefit to the member when they meet a condition of release less any tax applicable. Five business days.
An ‘intention to decline’ letter is sent.
Five business days.
Step 7 – Trustee sends the decision to claims team
Step 8 – Decision is processed
2120
TPD and terminal illness insurance
I just wanted to let you know I handed over the cheque to my client yesterday afternoon. Both he and his wife were so happy to receive the money so promptly. It will give the family the financial backing that is so needed in these situations (he now doesn’t mind the fact he had to pay premiums).
I want to personally thank you for your help and excellent cooperation you provided during the claim process.
Noelene Judd Watson, N and B Services – Genesys Wealth Advisers.
22
What is a certified copy? This is a signed photocopy of an original document. The photocopy needs to be endorsed as being a copy of the original document sighted and signed by a Justice of the Peace, Commissioner of Affidavits, notary, solicitor, accountant, doctor, pharmacist, police officer or bank manager or licensed financial planner.
What is the difference between final and interim Death Certificates? Sometimes, when someone dies as a result of an accident, or where there are suspicious circumstances, the Registrar will issue an interim Death Certificate.
The interim Death Certificate cannot be accepted in place of a final Death Certificate, as it is critical we understand the cause of death to ensure we pay genuine claims.
Where can my client get a copy of the Birth or Marriage Certificate? A copy may be obtained by application from the Registrar of Births, Deaths and Marriages in their state or territory.
What else is regarded as accepted proof of age? A certified copy of any of the following will be accepted however secondary identification confirming address will be required:
• a Birth Certificate
• an Australian Naturalisation or Citizenship Certificate
• a current Australian Passport
• an Australian Permanent Resident’s Visa.
Why is the original policy document (including the Policy Schedule and Memorandum of Transfer) required? They are required as proof of the entitlement to the benefits provided by the policy. The Memorandum of Transfer is required as proof that the policy has not been transferred or ownership assigned to another party.
What if the documentation is written in another language? The executor or next of kin is responsible for having these translated.
What is probate?When a person has been appointed as an ‘executor’ under a Will they will sometimes need to obtain ‘probate’ of the Will by making application to the Supreme Court.
A ‘Grant of Probate’ simply means the formal approval by the Supreme Court to the last Will lodged by the executor with
the Court. The formal approval allows an executor to collect the assets and pay the debts of a deceased person and then to distribute the estate as the deceased directs in his or her Will.
What are letters of administration? In certain circumstances, it is not possible to obtain probate. An alternative is to apply for letters of administration. This is typically done under the following circumstances:
• where there is no Will
• where the Will is found to be invalid
• where there is a Will but the executors are not able or willing to act.
What is an executor? An executor (executrix is a female executor) is a person appointed in a Will to act in respect of the estate of the Will maker (Testator) upon his or her death.
What is a legal personal representative?A person who is:
• an executor of another person’s Will
• the administrator of a deceased person’s estate
• the trustee of a legally disabled person’s state of affairs, or
• granted an enduring power of attorney.
For life insurance claims in the MasterFund, a person does not have a legal personal representative unless a grant of probate has been made, letters of administration have been issued, or the trustee is satisfied that the value of the estate is less than the trustee’s probate limit and the estate is solvent.
What does ‘intestate’ mean? To die without a Will or without a valid Will.
What do trustees do?A superannuation fund is a type of trust. As a result a superannuation fund must have a trustee or trustees. The trustee is responsible for dealing with the superannuation assets on behalf of members.
What is a trust deed? The trust deed sets out the rules of the fund.
What is the SIS definition of ‘permanent incapacity’ ? ‘Permanent incapacity’ means the trustee must be reasonably satisfied that a member is unlikely, because of their ill-health (whether physical or mental), to engage in gainful employment for which they are reasonably qualified by education, training or experience.
23
Frequently asked questions
24
Step by step guides for clients These are sent with the initial claim form and provide easy to read information on the claims process and answers to some frequently asked questions.
OnlineVisit onepath.com.au and find supporting claims information in adviser advantage.
The facts, figures and faces
The end of excuses
Claims paid by OnePath in 2014
Australian women – the facts about cancer
More support
For more information about our claims support material, speak to your OnePath
Business Development Manager.
What is the SIS definition of ‘temporary incapacity’?‘Temporary incapacity’, in relation to a member who has ceased to be gainfully employed (including a member who has ceased temporarily to receive any gain or reward under a continuing arrangement for the member to be gainfully employed), means ill-health (whether physical or mental) that caused the member to cease to be gainfully employed but does not constitute permanent incapacity.
What is the SIS definition of ‘terminal medical condition’?‘Terminal medical condition’ means that the following circumstances exist:
a. two registered medical practitioners have certified, jointly or separately that the person suffers from an illness, or has incurred an injury that is likely to result in the death of the person within a certification period that ends not more than 12 months after the date of the certification.
b. at least one of the registered medical practitioners is a specialist practising in an area related to the illness or injury suffered by the person.
c. for each of the certificates, the certification period has not ended.
INSURANCE
The end of excusesFive common misconceptions about insurance
INSURANCE
OnePath lives by its commitment to deliver on the promise insurance provides. In 2014, OnePath paid over $660 million in life insurance claims. Take a look at the figures below that reflect actual claims paid.
Insurance type Number of claims paid
Claims paid % of total $ paid
Average payment per claim
Retail: Death 388 $102,027,709 15% $262,958
Retail: Terminal illness 81 $25,332,551 4% $312,747
Retail: Total and permanent disability
148 $30,953,966 5% $209,148
Retail: Trauma 525 $100,156,123 15% $190,773
Retail: Income protection and business expenses*
2,955 $100,342,419 15% $33,956
Group: Life 770 $89,100,377 13% $115,714
Group: Total and permanent disability
1,216 $97,387,918 15% $80,088
Group: Terminal illness 140 $19,503,516 3% $139,310
Group: Salary continuance 4,144 $95,249,226 14% $22,984
Total 10,367 $660,053,805 100%
* Includes Living Expense Cover
Claims paid by OnePath in 2014
OnePath provides a range of insurance products to suit
your financial circumstances. Speak to your financial adviser
about tailoring a protection plan for you, to help safeguard what
you’ve worked so hard to achieve.
Australian women – the facts about cancer
January 2015
INSURANCE
onepath.com.au
OnePath Life Limited ABN 33 009 657 176 AFSL 238341
The material in this publication is current as at January 2015 but may be subject to change. It may not be reproduced without prior written permission from OnePath Life Limited. The case studies included are for illustrative purposes only and not based on any particular person.
OneCare is issued by OnePath Life Limited (OnePath Life) (ABN 33 009 657 176, AFSL 238341).
Before acquiring or deciding whether to continue to hold a OneCare policy you should refer to the current OneCare Product Disclosure Statement (PDS) available at onepath.com.au
This publication has been prepared without taking into account your objectives, financial situation or needs. Before making a decision based on the information contained in this publication, you should consider its appropriateness having regard to your objectives, financial situation and needs.
OnePath Life receives premiums for any insurance cover you obtain. Its employees and directors receive a salary. They do not receive commissions; however, they may be eligible for performance related bonuses and other staff related benefits.
Customer Services Phone 133 667 8.30am to 6.00pm (AEST) Email [email protected] Website onepath.com.au
Address OnePath Life GPO Box 4148 Sydney NSW 2001
L811
2/01
15
Do you need Trauma Cover?If you were to be one of the new cases projected for 2015, how would you cope financially?
Could you continue to pay the mortgage? Could you pay for the best medical treatment? Could your family continue with their current lifestyle?
If not, you should definitely consider Trauma Cover.
Trauma Cover pays a benefit if you suffer from a specified medical condition including cancer, heart attack or stroke.
Here are some key points for you to consider about OneCare’s Trauma Cover: • OneCare Trauma uses one of the broadest definitions of
cancer in the Australian insurance industry.
• OneCare Trauma was the first in the market to offer a partial payment for early stage breast cancer, and continues to set new standards in female cancer insurance.
In 2014 OneCare’s Trauma Premier was awarded ‘Adviser Choice Trauma Product of the Year’ at the Money Management Awards.
In 2014, OnePath Life paid over
$100 million in Trauma Cover claims. 17% of these claims
related to cancer. Of these cancer cases,
44% were female.
onepath.com.au
XXXX
X/XX
XX
Risk Adviser Services Phone 1800 222 066 Email [email protected]
Life Risk Claims Phone 1300 555 250 Email [email protected]
Address OnePath Life GPO Box 4148 Sydney NSW 2001
OnePath Life Limited (OnePath Life) ABN 33 009 657 176 AFSL 238341 OnePath Custodians Pty Limited (OnePath Custodians) ABN 12 008 508 496 AFSL 238346 RSE L0000673 242 Pitt Street, Sydney NSW 2000
This information is current at March 2015 but is subject to change. Updated information will be available free of charge from onepath.com.au or by calling 1800 222 066. It is for adviser use only and may only be reproduced with the permission of OnePath Life and OnePath Custodians. OneCare is issued by OnePath Life and OneCare Super is issued by OnePath Custodians. Potential policy holders should read the Product Disclosure Statement (PDS) available at onepath.com.au or by calling 133 667 and consider whether this product is right for them.
L813
0/03
15
