Our Claims Philosophy

Members’ claims deserve to be managed efficiently:

• Recognising that the assessment of claims can be delayed through waiting for medical and other required information, ensuring that all claims are assessed within a reasonable timeframe.
• Maintaining confidentiality of all information.
• Working closely with the employer and the insurer to progress the claim.
• Ensuring all genuine claims are paid as soon as possible.

Members should expect help and support through the assessment process:

• Supporting Members by treating them with dignity and respect.
• Keeping Members regularly updated on the progress of their claim.
• For disability claims, utilising allied health professionals in the assessment of claims, to evaluate the level of disability and identify prospects for returning to work.
• Pursuing all legitimate insurance claims with the insurer. It is not in the best interests of the Plan Membership as a whole to pay out non-genuine claims.
• For disability claims, working with the employer to assist in a return to work when safe to do so.

Members are entitled to a transparent and fair approach to claims settlement:

• Reaching conclusions that are based on facts and sound reasoning.
• For disability claims, focusing on independent information from treating medical practitioners and medical specialists and independent medical experts.
• For death claims, focusing on identifying appropriate beneficiaries who are most affected financially while taking into account the Member’s wishes and superannuation law requirements.
• Reassessing claims where new information is provided or the Member requests a review.

The Trustee continues to manage both insured and self-insured claims.

As required by Prudential Standard SPS250, in selecting insurer(s) the Trustee places a strong focus on the claims philosophy of the insurer(s). The Trustee requires that the insurer(s) philosophy should be clearly articulated and aligned with the philosophy applied by the Trustee.