how to make a claim

When you need to make a claim directly with an insurance company, it's easy to feel like you're on your own. But as a HESTA member, you're not alone. We're here with you. We're committed to a fair result for every HESTA member, every time.

this is how it works

 

Default Cover provides you Income Protection and Death Cover when you become eligible. Income Protection Cover provides a monthly benefit if you are sick or injured and can’t work. To claim you must have ceased work due to your illness or injury. Death Cover provides a lump sum to your beneficiaries if you die or suffer a terminal illness.

 

 

Choose your claim type:

 

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Submit a claim

OR
  Request claim forms from HESTA, complete them and send to the insurer.
 

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Claim assessed

Insurer assesses your claim.


 
 

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Claim approved

Insurer advises of approval.
Applicable waiting period served.
Payments begin.
 
 
 
HESTA acknowledges and understands the loss of a loved one is a very difficult time and offer our condolences. If you are a dependant of the deceased or the legal personal representative (i.e. the executor or administrator of the Estate), here are the steps to make a claim for a death benefit. If a deceased member holds insurance, HESTA will make a claim with the Insurer on behalf of the dependant or legal personal representative.
 

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Claim submitted

Raise claim through HESTA.
HESTA provides claim forms.
HESTA sends completed forms to Insurer.

 

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Claim assessed

If you are insured for Death, insurer assesses your claim.
 
 
 
 

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Claim approved

If you have Death cover and the Insurer advises approval, HESTA receives payment from the Insurer. HESTA decides who should receive the death benefit. Payment is made.

 

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Claim submitted

Raise claim through HESTA using the Terminal illness claim form (pdf).
OR
Request claim forms from HESTA. 
Return claim forms to HESTA. 
HESTA sends completed forms to Insurer.
 

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Claim assessed

If you have death cover, Insurer assesses your claim.
 
 
 

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Claim approved

If you have death cover and Insurer advises approval, HESTA receives payment from the Insurer. 
Payment is made.
 

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Submit a claim

OR
Request claim forms from HESTA, complete them and return.
 

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Claim assessed

If you are insured for TPD, insurer assesses your claim.

 
 
 

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Claim approved

If you have TPD Cover and the insurer advises approval, HESTA receives payment from the Insurer. Payment instructions confirmed. Payment is made.

 
 

 

 

 

 
 

how we step in if your claim is not approved

 

1. HESTA insurance specialists reassess the Insurer's decision with a complete and independent review of the claim.

The Insurer will advise HESTA the claim has not been approved and will provide all evidence relied upon in assessing your claim to HESTA for an independent review.

HESTA insurance specialists will then conduct an independent review of the claim through HESTA's formal Claims Review Committee. The Committee will thoroughly review the reasons provided by the Insurer and will make an independent assessment of the reasonableness of the Insurer's decision, taking into account your individual circumstances, the thoroughness of the evidence provided and your ability to return to work.

 

2. If HESTA disagrees with the Insurer's decision, HESTA insurance specialists will dispute the decision directly with the Insurer on your behalf.

HESTA will refer the claim back to the Insurer for further consideration until we are satisfied with the Insurer's decision.

 

3. Once a decision is reached, you will be advised directly of the outcome of the claim.

If HESTA successfully challenges the Insurer's decision and the claim is approved, the Insurer will advise you of this and your benefit payment will commence.

If HESTA agrees with the Insurer's decision to decline the claim, HESTA will advise you directly and explain the reasons the claim was declined. If you are not happy with our decision you can make a complaint.

 

 

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