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.

 

planned services changes
until Sunday 1 June

 

Some of our services are temporarily unavailable while we make important changes to better serve you into the future — but we’re here to support you. We understand making a claim is a difficult time for our members and their beneficiaries, and we want to make it as easy as possible.

We’ll continue to progress claims during the limited services period, but there will be some delays. To enable us to progress your claim as soon as possible, please make sure that you have sent us all the required information. If you need help urgently, please contact us at claims@hesta.com.au

Services will begin returning on Monday 2 June. Processing times for some transactions may take longer than usual while we process outstanding requests received.

Thank you for your patience during this limited services period.

Find out more about the changes here.

 

If you need to make a claim
 

Please read the Terminal illness claim form (PDF). Before you submit the form, make sure you’ve:

  • obtained and attached two medical reports, one of which is a specialist report and the diagnostic test reports, and
  • completed, signed and dated the claim forms, and
  • filled out the Certifying your identification form (PDF).

 

Please read the Claiming a permanent incapacity benefit guide (PDF). Make sure you’ve:

  • obtained medical certifications from two different legally qualified practitioners, and
  • completed, signed and dated the claim forms, and
  • filled out the Certifying your identification (PDF) form. 

 

If you’re sick or injured and cannot work, Income Protection Cover provides a monthly benefit to help you and your family meet ongoing living expenses. We’ve teamed up with our Insurer AIA to ensure that HESTA members can continue to submit Income Protection claims during the limited services period.  

Find out how to submit below. 

If you were a HESTA for Mercy member as at Friday 18 April 2025, please contact us at insurance@hestaformercy.com

 

Please read through the Making a death benefit claim page. Make sure you read the claims process, and the document checklist in the Claiming a superannation death benefit guide and form. We can only progress the claim once we have received all required documents from all relevant parties.

 

 

 

 

 

this is how it works

 

In limited circumstances, you may be able to access your superannuation before retirement.

The types of situations include if you’re diagnosed with a terminal illness, if you’ re permanently incapacitated, or if you pass away, your beneficiaries may be able to claim your superannuation death benefit.  

In addition to accessing your superannuation before retirement, you may be able to claim on any insurance you have through HESTA. 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. For more information on available insurance cover through HESTA, refer to Insurance options at hesta.com.au/pds

 

 

Choose your claim type:

 

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Submit a claim

 

 

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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.
 
 
 
 
We understand the loss of a loved one is a very difficult time and offer our condolences. If you're a dependant of the deceased or the legal personal representative (i.e. the executor or administrator of the Estate), we'll take you through how to make a claim for a death benefit.
 
If a deceased member holds insurance, we'll 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 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, the Insurer assesses your claim. At the same time, HESTA will assess whether you are eligible to access your superannuation balance.
 
 
 

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Claim approved

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

 

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Submit a claim

  • If you are permanently incapacitated, you may be able to access your superannuation account balance early. And if you have Total and Permanent Disablement (TPD) insurance cover through HESTA, you may be able to claim that insurance.
  • You can download the permanent incapacity guide and forms here: Permanent incapacity benefit guide (PDF) or, if you have TPD insurance cover, until Monday 2 June, contact our insurer AIA on 1800 043 782 to start the process.

 

 

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Claim assessed

·         If you are insured for TPD, insurer assesses your claim. To access your superannuation and any insurance paid by the insurer, HESTA will assess your claim under Permanent Incapacity.

 
 
 

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Claim approved

If you have TPD Cover and the insurer advises approval, HESTA receives payment from the Insurer. Eligibility and 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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