How to Claim Life Insurance Benefits & Understanding Insurance Claims

Published: July 6, 2018

When you make an insurance claim on your life policy, it can often be at a time of increased stress. To ensure that you receive your benefits justly and as soon as possible, it is essential that you understand every step of the claims process:

We show you how to claim life insurance, the documents you need, how long it takes and how you can prepare for the claims process and prevent delays.

Don’t have a life insurance policy yet? We can also help you quickly compare plans online.

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The no-nonsense way of making an insurance claim

A successful insurance claim is generally dependent on meeting the insurer’s definition of a claimable event, correctly completing the claim forms and providing all supporting documentation as soon as possible following the death, illness or accident of the insured person. First, you should check the policy documents to confirm that you are indeed the insured person or beneficiary of the life insurance policy.

When a person with a life insurance policy, perhaps a parent, spouse or child, passes away the nominated beneficiary is responsible for lodging an insurance claim with the relevant life insurance company.

The insurance claims process for death benefits

The life insurance claims process usually starts with the nominated beneficiary contacting the relevant life insurance company with all the policy owner’s personal information, including their policy number which can be found on the policy documents. The beneficiary must then obtain a certified copy of the death certificate and send that, along with the completed claim forms and original policy documents, to the insurer.

Below are the detailed steps you’ll need to follow when lodging a life insurance claim.

Step 1

Find the life insurance company name and policy number

The first thing you should to do when you need to lodge a claim is to look for the insured person's policy documents and confirm that they were indeed covered for death and that you are the beneficiary. If no beneficiaries are listed in the policy document, the payout will generally pass to the policy owner's estate, and it will typically be the executor of the estate who will need to lodge the claim. 

Have the policy number ready before contacting the insurer. Details of how to contact the insurance provider will be mentioned in the policy documents and on their website.

If you can't find a copy of the policy documents, but you know the name of the company, call the insurer with all the details you do have. If you don’t know the company name, you may be able to find proof of premiums paid when checking the insured person’s bank statement.

Step 2

Contact the life insurance company

You can usually let the life insurance company know of your intention to claim either via phone or email. Take note, if you prefer calling make sure that everything is clearly understood, so there is no room for misunderstanding.

The insurer will then send you the claim forms to be completed, as well as a list of documentation they require.

Step 3

Get the death certificate or medical report

The insurer will usually need a certified copy of the policyholder’s death certificate to confirm the legitimacy of your claim. In certain circumstances, a death certificate may take a while to obtain, in which case life insurance companies generally accept a medical certificate from a doctor or specialist listing the cause of death.

Step 4

Fill out the paperwork

Here’s where things might get a bit tricky. Life insurance claim forms include a lot of complicated insurance terms. If you are a ComparingExpert customer, please contact us. Our advisers are always on hand to answer any queries related to your claim.

Claim forms and additional documentation

The claim forms that will be sent, generally have two sections:

  1. An applicant’s section: This includes a Medicare form and a Pharmaceutical Benefits Schedule (PBS) form. Only include dates up until the policy commenced.
  2. A treating doctors report, which your doctor will need to fill out, and include relevant test results and reports.

You'll also need to send a copy of the original policy document to show that you are indeed the beneficiary.

As it may take some time to receive a death certificate, it is advantageous for your beneficiary/executor to send through your completed claim forms, even if you are still waiting on the death certificate.

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Step 5

Send the paperwork to the insurer

Fax or email the completed claim forms, death certificate and supporting documentation the insurer’s claims department. Call to confirm all information was received and be sure to keep dated copies of everything you sent.

If you’re a customer of ours and you’ve completed your forms, you can send them to us to check. We'll make sure you have included all the necessary details and documents so you can feel confident that your claim will be processed as quickly as possible.

Request the funeral advancement benefit

You will generally receive a Funeral Advancement benefit at the time of sending your fully completed forms and death certificate. This benefit will usually be a percentage of the full life insurance benefit and can be used to pay for funeral arrangements.

Step 6

Wait for the assessment

Once the insurer has received your completed forms, they will assess the eligibility of your claim. If the policy is less than 3 years old, they will typically verify the details the policy owner provided at application time as part of his/her duty of disclosure.

Before you enter into a contract of insurance with an insurer, you have a duty under the Insurance Contracts Act 1984, to disclose to the insurer every matter that you know, or could reasonably be expected to know, as relevant to the insurer's decision to accept the risk of insuring you, and on what terms.

When assessing the policyholder's duty of disclosure, the life insurance company will generally check their medical history by:

  • Accessing their Medicare and PBS records.
  • Writing to the GP that they attended at application time.

If the policy is more than 3 years old, the process to check the duty of disclosure may not be required, depending on whether a fraud assessment needs to be conducted or not.

Step 7

Get paid

Every life insurance company has their own life insurance claims process; sometimes it takes weeks or even months before a valid claim gets paid. There are also a few things that can delay the claims process, including claim forms that are partially or incorrectly completed and the life insurance claims assessor still waiting on the supporting documentation.

Once your claim has been accepted, payment will be speedily made to the nominated beneficiary(s).

However, in some cases, a claim may be declined, for example, if the insured person did not disclose a pre-existing medical condition when they applied for the policy or if the event is not covered under the policy terms and conditions. 

What percentage of life insurance claims do get paid?

According to ASIC 498 report (2016), the percentage of claims successfully paid is generally higher for retail (advised) policies, like the ones we compare, as opposed to direct (non-advised) or group policies. This is further supported by the latest claims statistics shown below.

Life insurance claims statistics in Australia

Source: APRA and ASIC life claims statistics (1 January 2017 to 30 June 2017)
Claims Advised (Retail) Non-advised (Direct) Group
Death 98% 88% 98%
TPD 86% 67% 84%
Trauma 87% 84% -
Income Protection 95% 83% 96%

How to make an insurance claim for TPD, trauma and income protection insurance

Your claim will be assessed differently depending on what type of insurance policy you are claiming for; life insurance, TPD, trauma cover or income protection insurance.

The criteria by which your claim will be assessed is usually outlined in the insurer’s PDS (Product Disclosure Statement). However, if you claim any combined policy, for example, life and TPD, the total benefit amount you may be entitled to will generally get reduced by the claim that was paid, as will the overall cost of your premium.

While the above 7 steps should be completed for all insurance types, except for the death certificate, there are a few other factors you’ll need to consider depending on the kind of insurance you're claiming for.

How do you lodge a TPD claim?

To claim for total and permanent disablement (TPD), you’ll generally need to provide evidence that you are unable to work due to an illness or injury causing incapacity, either in your own or any occupation. Lodging a successful claim for a TPD policy purchased outside of Super usually requires you to be absent from work for at least 3 to 6 months, depending on the insurer.

Take note; a standalone TPD policy usually requires that you survive at least 14 days after the accident or illness, for a claim to be valid.

According to the Australian Securities and Investment Commission (ASIC, 2016), TPD claims received the highest decline rate. To improve your chances of making a successful claim outside of your superannuation, you’ll typically need to complete the following steps:

  • Get the necessary forms from your insurer and have ComparingExpert or a financial adviser help you correctly complete the forms.
  • Provide your medical practitioner's statement verifying your illness or injury and that it renders you unable to work.
  • Include proof of employment.

How long does a TPD claim take?

A TPD claim can take months to assess because of all the information required, plus there's the waiting period you have to serve. Your claim will generally get evaluated after your forms have been fully completed and sent to the insurer, your Medicare and PBS documentation have been received, and you have met the eligibility definition outlined in your PDS.

Usually, life insurance companies will have pre-defined criteria regarding a valid TPD claim. Be sure to read your PDS and talk to a specialist to help you determine whether you meet the requirements.

Critical illness insurance claim

For a critical illness claim you’ll first need to request the correct type of claim form and gather the following supporting documentation:

  • A certified copy of the evidence of illness. For example, your treating doctor’s medical report.
  • Copy of your most recent radiology or histology report, if applicable.
  • Proof of identity, as well a copy of your original policy documents.

Income protection claim

For an income protection claim, you may be required to provide relevant financial evidence of your prior year or years of income, if it has not already been submitted, for example, your pay slips or tax returns and tax assessments.

When claiming income protection, the insurer will generally require evidence of the illness or accident that resulted in your inability to work.

Generally, once your waiting period ends, your benefit period will begin. With the commencement of your benefit period, you will usually receive your first monthly benefit at the first available date that your life insurance company issues its monthly payments following the end of your waiting period.

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How to avoid your life insurance claim getting rejected

  • Comply with your duty of disclosure

    When you purchase a life insurance policy, make sure you disclose all essential and relevant information. Do not try and make yourself sound healthier than you are. Withholding information could lead to your claim being denied.

  • Review your PDS and Ts & Cs

    Before lodging a claim, carefully read through your policy terms and conditions to make sure the event you want to claim for is covered in your policy. There might be some exclusions in place, for example, life insurance companies will generally not pay a death benefit if death was due to suicide 13 to 24 months after policy commencement.

  • Check the waiting period

    Make sure your policy doesn't have a waiting period attached. Some policy types, like TPD, usually have a minimum waiting period you need to serve before you can claim any benefits.

  • Make sure your premiums are up to date

    Life insurance is a legal contract between you and the insurance company. In exchange for paying your monthly, quarterly or yearly premium, the insurer covers you against the risk of death, illness or injury, depending on your policy type.

FAQ’s about making an insurance claim

When should you start the life insurance claims process?

Immediately or as soon as possible. Review your PDS to confirm you’ve experienced one of the claimable events listed and then contact the relevant insurance company either by phone or email. If you’re claiming for an illness or accident be sure to get the medical reports when you’re seeing the doctor or specialist, otherwise you might have to pay for it when requested later on.

How do you find unclaimed life insurance monies?

ASIC holds money from life insurance policies that have been left unclaimed for seven years. You can search ASIC’s unclaimed money database using the insured person’s name or the original transaction number (OTN).

What does a life insurance claims assessor do?

An insurance claims assessor conducts investigations into your life insurance claim to ensure its validity and estimated payout. They'll usually evaluate information given at application time against the claim forms and medical information sent at claim time.

How long does it take for an insurance company to pay out claims?

The life insurance claim time is dependent on several variables, including when your completed claim forms and supporting documentation were received, how complex the assessment process and whether additional information is required. Once a claim has been accepted, the benefit amount will be paid promptly into the nominated beneficiary's bank account.

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