Claims philosophy
At Australian Ethical Super we are committed to supporting our members and their beneficiaries in times of need.
The Trustee of Australian Ethical Super advocates on behalf of our members, claimants and/or their beneficiaries during the insurance claims process and provides assistance with any issues that may arise in relation to your cover or claim.
-
To treat you with respect and provide guidance throughout your claim in a way that reflects your unique circumstances
-
To thoroughly assess your claim on its merits and strive to achieve the fairest outcome possible
-
To ensure your claim is assessed quickly and efficiently
-
To provide you and your dependants with clear and timely information about the claims process
-
To provide you with a primary point of contact with the skills and expertise to assist you during the process
-
Every claimant has the right to lodge a claim and have it assessed fairly.
-
We understand how challenging making a claim can be. We will appoint a case manager to help you through the claims process. Your case manager is available to support you through the steps, as required.
Prior to the Christian Super transition to Australian Ethical Super, the appointed insurer for several years was Hannover Re. Hannover Re will continue to assess insurance claims where the date of disablement or date of death is prior to 25 November 2022. We have included a copy of Hannover’s claim philosophy here.
It’s important to partner with the right insurer that shares the Australian Ethical’s philosophy and is focused on paying legitimate insurance claims as fast as possible. We have worked with MetLife Insurance Limited for several years and believe their claims philosophy is aligned with ours and meets our expectations. To review MetLife’s claim philosophy, click here.
Understanding the types of insurance
Financial protection for you and your family means understanding the different types of insurance and how to make a claim. Have a read through our FAQs below to understand the process for the type of insurance claim you’re making.
We understand this may be a difficult time for you and your family and we are happy to help you through this process.
For claimants with a non-English speaking background who need assistance in making a claim, visit Contact.
A death benefit is the money payable on the death of an Australian Ethical Superannuation member and is made up of the amount of super in the member’s account including any insured benefit – if not opted out (minus any fees and taxes).
We understand that losing a loved one is a very difficult time for you, so we’re here to help. Here we explain the steps you need to take if you’re applying for a payment following the death of a family member.
If the deceased member didn’t have a will (or there was no executor named), the administrator of the deceased estate can apply to make a claim. Australian Ethical can only pay the death benefit to another person if there are no dependants (as defined under superannuation law) or a Legal Personal Representative (LPR).
A dependant, according to superannuation law, includes:
- a spouse (de facto or same sex partner)
- a child (stepchild, your de-facto’s child or an adopted child)
- a financial dependant (someone who is wholly or partially financially dependent on the deceased)
- a person the deceased had an interdependent relationship with (where two people have a close personal relationship and live together, and one or both persons provide the other with financial, domestic or personal support. There are some exceptions to these requirements, including whether one or both of them suffer from a physical, intellectual or psychiatric disability or they are temporarily living apart.)
Non-binding beneficiary
A member can nominate a person or persons who they’d prefer to receive a payment if they pass away. We'll consider all nominated beneficiaries (as long as they meet the definition of 'dependant' under superannuation law), but we are not legal bound to this nomination. If the nominated person isn’t a financial dependent, then preference is generally given to other claimants who were financially dependent on the member at the date of death and expected to continue to receive financial support from them.
Binding beneficiary
A member can complete the Binding Beneficiary Nominations Form to nominate who they want to receive a payment if they pass away. If it’s valid, their nomination is legally binding which means we must pay the person or persons nominated as long as the person nominated is classified as a dependent under superannuation law (see above). If the people nominated are dependants or the Legal Personal Representative (LPR) of the member, the payment has to be made as instructed by the member, even if there are other financial dependents.
See our Binding Beneficiary Nominations Form on our website for more information.
A binding nomination will only be valid if it hasn’t expired (3 years maximum) and if the person nominated is a dependant or Legal Personal Representative (LPR) at the time of the members passing. It’ll be treated as a non-preferred (non-binding) nomination if the binding nomination has expired or is not valid for any other reason.
You should know there may be tax implications of receiving a death benefit so it’s worthwhile getting advice from a licenced financial adviser.
You don’t need a lawyer but if you choose to, it won’t guarantee a shorter assessment period, influence the outcome or the amount paid on a claim. You should also consider the cost involved in having your own lawyer.
When it comes to assessing claims, one of our responsibilities is to ensure our members’ interests are front of mind at all times. This means we’ll make sure any decisions are fair and comply with the conditions set out in the fund’s insurance policies, our trust deed and relevant laws.
We want to make the claims process as easy and convenient for you as possible, so the steps are outlined below.
- Contact us – the best thing to do is give us a call on 1800 021 227 so we can talk you through the claims process, check if there is any insurance on the account and explain the documents and information you need to get started.
- Complete the forms we send you – we’ll send you the forms you need to complete with a letter outlining the information you need to provide back to us, e.g., a certified copy of the member’s death certificate, a certified copy of the Will, and/or Probate (if applicable). If the member held a valid binding beneficiary nomination at the time of death, then we won’t need as much information. We’ll let you know if this is the case.
- Case management – you will be assigned a case manager to help you through the process. Your case manager will be in contact with you to provide you with an update, respond to your enquiries or request additional information.
- Our Insurer will assess the claim for the insured component – if the member had insurance through their super, the role of the Insurer is to decide if the death benefit is payable. They will assess the claim with reference to the policy terms and conditions of the policy.
- We’ll review your application – when deciding who to pay, our role as Trustee is to review and consider the deceased member’s circumstances, the relationships with the deceased member, any nominations in place or other documented wishes, and who relied on the deceased member for financial and/or other support at the date of their death. If insurance was held through the member’s super account, we’ll also complete an independent review of the Insurer’s decision. We may ask for clarification or challenge the decision on your behalf if the claim is declined. You may receive a letter from us requesting further information.
- Claim decision – when a decision is made, we’ll write to the beneficiaries to let them know the outcome of the claim.
If there is more than one beneficiary, the decision will be sent to all parties with an interest in the death benefit payment. All beneficiaries are provided with 28 days from receipt of the notice to object to the decision. We’ll review any objections but if a claimant still disagrees with our decision, they’ll have 28 days from receiving notice of our final decision to make a complaint to Australian Financial Complaints Authority (AFCA). No payment will be made should a complaint be made to AFCA until the outcome of the external dispute resolution is known.
- Payment – If all parties have accepted our decision, we’ll make a payment within five business days either via Electronic Funds Transfer (EFT) directly to your nominated account or via cheque.
It is possible a death benefit payment may result in financial or tax implications so you may want to consider seeking independent financial advice.
The claims process will start once we’ve received all the relevant documents and information requested.
The time it takes for a death benefit claim to be decided varies depending on the complexity. We’ll be in touch to provide you with updates and progress of the claim.
If you’re diagnosed with a terminal illness you may be able to access your super and any death benefit you are insured for.
A Terminal Illness insurance benefit is the amount of money you’ll receive if you’ve been medically diagnosed with less than 24 months to live. You can choose to receive your benefit as a lump sum or a pension.
If you’re not insured through your super account, you can apply to have your account balance released due to suffering a terminal medical condition.
Here we explain the steps you need to take when making a Terminal Illness insurance claim.
You’ll need to meet the definition of a ‘terminal medical condition’ under the superannuation laws as outlined below.
You can apply for a payment if:
-
a registered medical practitioner and a registered medical specialist have both certified, either jointly or separately, that you suffer from an illness, or have incurred an injury that’s likely to result in your death within a period (known as the certification period) and ends not more than 24 months after the date of the certification.
-
the specialist is practising in the area related to your illness or injury
-
the certification period hasn’t ended.
You don’t need a lawyer but if you choose to, it won’t guarantee a shorter assessment period, influence the outcome or the amount paid on a claim. You should also consider the cost involved in having your own lawyer.
When it comes to assessing claims, one of our responsibilities is to ensure our members’ interests are front of mind at all times. This means we’ll make sure any decisions are fair and comply with the conditions set out in the fund’s insurance policies, our trust deed and relevant laws.
- Contact us – the best thing to do is give us a call on 1800 021 227 so we can talk you through the claims process, check if there is any insurance on the account and explain the documents and information you need to get started.
- Complete the forms we send you – we’ll send you the forms you need to complete with a letter outlining the information you need to provide to us, e.g., statements from two of your attending medical practitioners, one of whom is your attending specialist.
- Case management - you will be assigned a case manager to help you through the process. Your case manager will be in contact with you to provide you with an update, respond to your enquiries or request additional information.
- Our Insurer will assess the claim for the insured component – if you have insurance through your super, the role of the Insurer is to decide if the Terminal Illness benefit is payable. They will assess the claim with reference to the policy terms and conditions of the policy.
- We’ll review your claim – our role as the Trustee is to review your claim once all the relevant information is received. If insurance was held through the member’s super account, we’ll also complete an independent review of the Insurer’s decision. We may ask for clarification or challenge the decision on your behalf if the claim is declined. You may receive a letter from us requesting further information.
- Claim decision – when a decision is made, you’ll receive a letter letting you know the outcome of the claim and information about how to access your funds.
- Payment – If your application is approved, any insurance proceeds will be paid into your super account. You’ll need to complete the withdrawal form, provide a copy of your bank statement and certified proof of identity to access your funds.
Generally, it will take five business days to arrange a payment after receiving the above information.
It’s possible your Terminal Illness benefit payment may result in financial or tax implications so you may also want to consider getting independent advice.
For your own piece of mind, we prioritise Terminal Illness claims. Hopefully all the necessary information requested by us is provided with your claim, but if not, we’ll help you by getting in touch with you as soon as possible.
You can help us shorten this time frame by including all relevant medical documents when you send us your application, and by responding to our requests for supporting information as soon as possible.
You are responsible for any costs associated with completing and providing the initial claim forms and any associated documents that we reasonably request for assessment of your claim. You may be asked to provide other evidence at your own expense. If the insurer directly requests information from a treating medical practitioner, then they will pay this cost.
A TPD benefit is a payment you may be eligible to receive if you are injured or ill and permanently unable to work.
When it comes to insurance it’s important to understand that strict rules apply to TPD payments. To receive an insurance benefit payment, you’ll need to satisfy the eligibility criteria and the TPD definition in the insurance policy (unless you opted out of insurance, or your insurance was cancelled due to inactivity or non-payment of premiums).
There are two aspects to a TPD claim you need to know about. These are:
- whether you meet the ‘permanent incapacity’ condition of release under superannuation law to access your super account balance, which is:
- you cease gainful employment and we’re satisfied that you are unlikely, because of ill health, to engage in gainful employment that you are reasonably qualified for by education, training or experience.
- whether you have TPD insurance in your super account and if you meet the conditions that apply.
- Your ability to meet certain definitions at the start of the policy, such as first eligible, receiving an on -time employer contribution which could affect your eligibility to claim or you may be subject to limited cover. It’s worth taking the time to read and understand the terms of your policy. These are set out in our Insurance Guide.
These types of benefits and their tax treatments can be complicated depending on your circumstances so you might want to speak to your financial and/or tax adviser. To understand these types of payments and their implications in more detail, you can visit ato.gov.au.
You don’t need a lawyer but if you choose to, it won’t guarantee a shorter assessment period, influence the outcome or the amount paid on a claim. You should also consider the cost involved in having your own lawyer.
When it comes to assessing claims, one of our responsibilities is to ensure our members’ interests are front of mind at all times. This means we’ll make sure any decisions are fair and comply with the conditions set out in the fund’s insurance policies, our trust deed and relevant laws.
- Contact us – the best thing to do is give us a call on 1800 021 227 so we can talk you through the claims process, check if there is any insurance on the account and explain the documents and information you need to get started.
- Complete the forms we send you – we’ll send you the forms you need to complete with a letter outlining the information you need to provide to us, e.g., paperwork from your doctors describing the nature and extent of your disability or illness, a certified copy of your birth certificate, driver’s licence or passport plus any medical reports you have. Our Insurer will rely on the information you provide when making their assessment, so it’s important to include all relevant medical evidence in your application.
- Case management - you will be assigned a case manager to help you through the process. Your case manager will be in contact with you to provide you with an update, respond to your enquiries or request additional information.
- Our Insurer will assess the claim for the insured component – if you have insurance through your super, the role of the Insurer is to decide if the TPD benefit is payable. They will assess the claim with reference to the policy terms and conditions of the policy.
- We’ll review your claim – our role as the Trustee is to review your claim once all the relevant information is received. If insurance was held through the member’s super account, we’ll also complete an independent review of the Insurer’s decision. We may ask for clarification or challenge the decision on your behalf if the claim is declined. You may receive a letter from us requesting further information.
- Claim decision – when a decision is made, you’ll receive a letter letting you know the outcome of the claim and information about how to access your funds.
- Payment - If your application is approved, any insurance proceeds will be paid into your super account. You’ll need to complete the withdrawal form, provide a copy of your bank statement and certified proof of identity to access your funds.
Generally, it will take five business days to arrange a payment after receiving the above information.
It’s possible your TPD benefit payment may result in financial or tax implications so you may also want to consider getting independent advice.
The claims process will start once we’ve received all the relevant documents and information requested.
The time it takes for a TPD claim to be decided varies depending on the complexity. We’ll be in touch to provide you with updates and progress of the claim.
You can help us shorten this time frame by including all relevant medical documents when you send us your application, and by responding to our requests for supporting information as soon as possible.
You are responsible for any costs associated with completing and providing the initial claim forms and any associated documents that we reasonably request for the assessment of your claim. You may be asked to provide other evidence at your own expense. If the Insurer directly requests information from a treating medical practitioner, then they will pay this cost.
An Income Protection benefit payment is a monthly payment you may receive if you are temporarily unable to work due to injury or illness.
Here we explain the steps to take when making an Income Protection insurance claim.
To make a claim, you’ll need to meet some of the definitions of disablement set out below (this is not an exhaustive list of all policy terms).
Total Disability:
- unable to do at least one aspect of your income producing work
- not working in any capacity, for reward or otherwise
- under the regular care and following the advice of a medical practitioner
You might be eligible for a partial disability benefit payment if you are:
- disabled for at least seven days out of the first 12 working days of the waiting period
- has ceased to suffer Total Disability, and
- has resumed partial employment or, in our opinion, is deemed capable of returning to partial employment duties, and
- as a result of the Injury or Illness that caused their Total Disability has received, or could in our opinion receive, a Post-Disability Income that is less than their Monthly Income, and
- is under the continuous and regular care of a Doctor undergoing the appropriate treatment
Please note waiting periods apply.
It’s worth taking the time to read and understand the terms of your policy. These are set out in our Insurance Guide.
You don’t need a lawyer but if you choose to it won’t guarantee a shorter assessment period, influence the outcome or the amount paid on a claim. You should also consider the cost involved in having your own lawyer. When it comes to assessing claims, one of our responsibilities is to ensure our members’ interests are front of mind at all times. This means we’ll make sure any decisions are fair and comply with the conditions set out in the fund’s insurance policies, our trust deed and relevant laws.
- Contact us – the best thing to do is give us a call on 1800 021 227 so we can talk you through the claims process, check if you have insurance and explain the documents and information you need to get started.
- Complete the forms we send you – we’ll send you the forms you need to complete with a letter outlining the information you need to provide to us, e.g., paperwork from your doctor describing the nature and extent of your disability or illness, a certified copy of your birth certificate, driver’s licence or passport plus recent payslips to confirm your earnings and any medical reports you have. Our Insurer will rely on the information you provide when making their assessment, so it’s important to include all relevant medical evidence in your application.
- Case management - you will be assigned a case manager to help you through the process. Your case manager will be in contact with you to provide you with an update, respond to your enquiries or request additional information.
- Our Insurer will assess your application – the role of the Insurer is to decide if the Income Protection benefit is payable in accordance with the policy definitions. They will review your application against the information you provided, and the medical information received from your treating doctor(s)
- We’ll review your claim – once your claim has been reviewed, you’ll receive a letter outlining the decision or requesting further information.
- Claim decision – when a decision is made, you’ll receive a letter letting you know the outcome of the claim.
If your application isn’t approved, we’ll undertake an independent review of the Insurer’s decision. We may ask for clarification or challenge the decision on your behalf. You’ll be contacted with the outcome of our review and be given a reason for the decision. - Payment – If your application is approved, the Insurer will pay the benefit directly into your nominated back account. They will deduct any tax payable to the ATO and may pay a Superannuation Guarantee Contribution to us.
The claims process will start once we’ve received all the relevant documents and information requested.
The time it takes for an Income Protection claim to be decided varies depending on the complexity of the claim. We’ll be in touch to provide you with updates and progress of the claim.
You can help us shorten this time frame by including all relevant medical documents when you send us your application, and by responding to our requests for supporting information as soon as possible.
Your monthly Income Protection benefit payments will be reduced by the amount of any income that you’re entitled to be paid in a month that your Income Protection benefit is payable (whether you received it or not in that month). This includes benefits payable under another Income Protection policies, workers’ compensation, motor accident compensation or other payments under legislation.
The Insurer may deduct tax from your benefit. You may receive a PAYG statement at the end of the financial year.
Depending on your situation, it’s possible Income Protection benefit payments may result in financial or tax implications so you may want to consider getting independent financial advice.
Once your benefit payments start, the Insurer will regularly review your progress to ensure you continue to be eligible for payments. You and your doctor may need to complete progress certificates, but your case manager will let you know when these are needed. If you remain eligible, your payments will continue up to the end of your benefit payment period.
Your payments will cease if your benefit period expires, or you become ineligible to claim.
You are responsible for any costs associated with completing and providing the initial claim forms and any associated documents that we reasonably request for the assessment of your claim. You may be asked to provide other evidence at your own expense. If the Insurer directly requests information from a treating medical practitioner, then they will pay this cost.