how to make a claim

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.

Once your Income Protection claim has been approved, here's what happens next:

1. Your waiting period must be completed first.
2. Once it ends, your monthly payments will begin.
3. Payments will be deposited directly into your bank account.

Income Protection payments can be reduced

If you have Income Protection Cover and become eligible to receive a benefit, your Income Protection 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.

For example, your Income Protection benefits will be reduced if you're 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 5 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'd like to retain 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.

Review and complete the Terminal illness claim form (PDF). 

You may be eligible to access your superannuation balance before retirement and claim on any death cover insurance you have through HESTA.

Make sure your treating specialist and general practitioner complete the forms.

On receipt of completed forms (and supporting documents from your treating specialist and GP), HESTA will check for completeness and advise the Insurer (if you have death insurance cover).

If you need help completing the forms or have questions, we're here to help. Contact us.

We assess your claim and any medical evidence you provide to support your claim.

You’re considered to be terminally ill when two Medical Practitioners, one of whom is an appropriate specialist (practising in an area related to the injury or illness suffered) have jointly or separately certified you suffer from an illness, or have incurred an injury that is likely to lead to your death within the period designated by your age (see below), and for each of the certificates the certification period has not ended:

• Prior to age 70 — the illness or injury is likely to lead to death within 24 months of the date of certification; or

• Between age 70 and up to age 75 (benefit expiry age) — the illness or injury is likely to lead to death within 6 months of the date of certification.

If you have Death Cover and your claim is accepted by the insurer, any terminal illness benefit is paid to the member's HESTA account. Payment is made to you tax free.

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 (even if you do not have TPD insurance). You should consider whether you would like to keep a HESTA account balance to continue to maintain your insurance. You can download the permanent incapacity guide and forms here: Permanent incapacity benefit guide (PDF). 

Making a claim for TPD insurance

If you make a claim for a Total and Permanent Disablement benefit, the insurer will make their assessment. They may request further evidence from you, your doctor or employer.

To access any TPD insurance paid into your superannuation account, HESTA will assess your claim on permanent incapacity grounds.

The insurer assesses your claim for a Total and Permanent Disablement benefit. They may request further evidence from you, your doctor or employer.

If the insurer believes evidence exists that does not support your claim you can 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're entitled to is paid into your superannuation account. HESTA will contact you to discuss your benefit payment options and confirm whether you meet permanent incapacity eligibility criteria. Where your claim is successful, any Death Cover you had with HESTA will generally cease (unless your death cover exceeds your TPD Cover — in wich case the residual death cover remains).