how to make a claim

1. Log in to your account, go to the 'Insurance' tab and then go through to your AIA insurance portal. 
2. Select the type of claim you’d like to make, confirm your details and level of cover and you’ll be advised of next steps.
3. Then insert:
   • the date you were medically certified by your doctor that you could no longer work
   • the date you were last at work
   • the date you were diagnosed with your medical condition, and
   • the date you last worked in your normal duties.
4. Download the forms you require, complete them and then upload them into your online account. Your treating doctor and your employer will be notified by email to complete their part of the forms. Once you press submit the insurer will verify your information and begin assessing the claim. You can track the progress of your claim at any time.

1. Contact HESTA on 1800 813 327 to raise a claim, where you’ll be asked for the following:

• the date you were medically certified by your doctor that you could no longer work
• the date you were last at work
• the date you were diagnosed with your medical condition, and
• the date you last worked in your normal duties.

2. We’ll email a claims pack to you.

3. Download the forms, complete them and then upload them into your online account. You can choose for your treating doctor and your employer to be notified by email to complete their part of the forms. Once you press ‘submit’ the insurer will check your information and begin assessing the claim. You can track the progress of your claim at any time.

The Insurer assesses your claim for an Income Protection (IP) benefit. The Insurer may request further evidence from you, your doctor or your employer to complete this step.

Your claim is accepted by the Insurer and any Income Protection insurance benefit is paid monthly in arrears into your bank account. Your payments will commence once you have satisfied the appropriate waiting period.

Income Protection payments can be reduced

If you have Income Protection Cover and become eligible to receive a benefit, your claim payments cannot exceed:

•  the lesser of your sum insured and
• 85% of your pre-disability income

Your payments may be reduced by other income or benefits you receive during the claim period.

For example, your Income Protection benefits could be reduced if you are receiving workers compensation payments, other income support payments, income from a graduated return to work or the income component of any lump-sum payment that is paid to you.

Read Insurance options at hesta.com.au/pds for more information.

Ongoing evidence for temporary disability

For payments to continue, you need to provide periodic medical certification confirming ongoing temporary disability. You will also need to advise the Insurer if you return to work, even in a reduced capacity, as your benefits will be reduced. At the end of two years, the definition of temporary disability changes and your claim will be fully reassessed if you have Income Protection Cover with a benefit period of up to five years or through to age 60 or 67.

Making a claim for permanent incapacity

In some circumstances where two doctors advise that you are unlikely ever to engage in gainful employment, you may wish to lodge a claim to access your super account balance on permanent incapacity grounds. You should consider whether you would like to maintain a HESTA account balance to continue to maintain death and terminal illness cover or total and permanent disablement cover (where eligible). You can download the permanent incapacity guide and forms here: Permanent incapacity benefit guide (pdf)

Permanent Incapacity Support Benefit

Income Protection claimants who suffer a disabling event after 1 March 2018, may also be entitled to a lump sum payment of $10,200 after a qualifying period where they are unlikely ever to engage in gainful employment for which they are reasonably suited by their education, training or experience.

Call HESTA on 1800 813 327 to raise a claim.

HESTA will send you claim forms.

You will need to complete the forms and provide these along with a certified copy of the death certificate and a certified copy of the proof of age of the deceased. Potential beneficiaries will also be requested to provide other documentation.

HESTA will check claim forms for completeness. Where potential dependants have been identified they may be asked to clarify their relationship with the deceased at the time of death.

On receipt of completed forms, HESTA advises the Insurer and provides necessary documents for them to assess the claim (where cover exists).

Where death insurance exists, the Insurer will assess the claim.

When reviewing the claim, HESTA assesses who is eligible to receive a death benefit taking into account all evidence and any nominations made by the member.

Where necessary we will write to potential beneficiaries to advise them of the decision as to how the death benefit is to be paid. Potential beneficiaries then have 28 days to lodge an objection if they disagree.

If an objection is received, HESTA may confirm its decision or can vary its original decision. Potential claimants are then given 28 days to lodge an objection with the Australian Financial Complaints Authority (AFCA) for an independent review.

Payment takes place after the expiration of the 28 day period, if no objection has been received.

Call HESTA on 1800 813 327 to raise a claim. We will confirm whether you have death cover (including terminal illness) and advise you of the claim requirements. HESTA will send you a claims pack or you may obtain forms from Forms & brochures.

You, your treating specialist and general practitioner complete the forms.

You send completed forms to HESTA for checking before they are forwarded to the Insurer (where you have insurance cover).

The insurer assesses your claim and any medical evidence you provide to support your claim.

For an insured terminal illness benefit, your doctors must indicate that you are likely to pass away within 24 months where you are under age 70 in order to access your insurance cover. A 6 month prognosis is required if you are between age 70 and 74.

If you are between age 70 and 74 and your doctors indicate that you are likely to pass away within 7 to 24 months you can access your superannuation account balance but are unable to access your insurance cover. You may wish to ensure you maintain an account balance to pay for any death insurance cover so you can lodge a claim for an insured benefit when you do satisfy the 6 month eligibility requirement.

If you have Death Cover and your claim is accepted by the Insurer, any terminal illness benefit is paid to your superannuation account. Payment is made to you tax free.

1. Log in to your online account, go to the 'Insurance' tab and then go through to your AIA insurance portal.
2. Select the type of claim you’d like to make, confirm your details and level of cover and you'll be advised of next steps.
3. Then insert:
   • the date you were medically certified Totally and Permanently Disabled
   • the date you were last at work
   • the date you were diagnosed with your medical condition, and
   • the date you last worked in your normal duties.
4. Download the forms you require, complete them and then upload them into your online account. Your treating doctor and your employer will be notified by email to complete their part of the forms. Once you press submit the insurer will verify your information and begin assessing the claim. You can track the progress of your claim at any time.

Requesting claim forms from HESTA

1. Contact HESTA on 1800 813 327 to raise a claim, where you’ll be asked for the following:

• the date you were medically certified by your doctor that you could no longer work
• the date you were last at work
• the date you were diagnosed with your medical condition, and
• the date you last worked in your normal duties.

2. We’ll email a claims pack to you.

3. Download the forms, complete them and then upload them into your online account. You can choose for your treating doctor and your employer to be notified by email to complete their part of the forms. When you press ‘submit’ the insurer will verify your information and begin assessing the claim. You can track the progress of your claim at any time.

Insurer assesses your claim for a Total and Permanent Disablement benefit.

The Insurer may request further evidence from you, your doctor or employer.

If the Insurer believes evidence exists that does not support your claim you will have the opportunity to provide further evidence to the Insurer, a process known as ‘procedural fairness’.

The Insurer will request you provide any further evidence you have not previously submitted to support your claim.

The Insurer will continue assessing your claim based on any new evidence and may seek further clarification from your treating doctors and/or vocational specialists or your employer.

Your claim is accepted by the Insurer and any Total and Permanent Disablement.

Cover you are entitled to is paid into your superannuation account. HESTA will contact you to discuss your benefit payment options. Where your claim is successful any Death Cover you had with HESTA will generally cease (unless your death cover exceeds your TPD Cover then the residual death cover remains).