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 and committed to a fair result for every HESTA member, every time.

this is how it works

Choose your claim type:

 

 

Claim submitted

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

 

Claim assessed

Insurer assesses your claim.




Claim approved

Insurer advises of approval.
Applicable waiting period served.
Payments begin.

 

the HESTA difference - 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.

If HESTA disagrees with the initial decision of the Insurer, HESTA will refer the claim back to the Insurer for further consideration until we are satisfied with the Insurer’s decision.

3. You will be advised directly of the claim outcome and the reason.

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 lodge a written complaint with HESTA. If you’re not satisfied with the response, you can lodge a complaint with the Superannuation Complaints Tribunal (SCT) on 1300 884 114, for a further independent review.

Death

HESTA acknowledges and understands the loss of a loved one is a very difficult time and offers 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.

 

Claim submitted

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

 


Claim assessed

Insurer assesses your claim.




 

Claim approved

Insurer advises of approval.
HESTA decides who should
receive the death benefit.
Payment is made.

 

the HESTA difference - 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 been declined and will provide all evidence relied upon in assessing the 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 the deceased member’s individual circumstances and the thoroughness of the medical evidence provided.

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

If HESTA disagrees with the initial decision of the Insurer, HESTA will refer the claim back to the Insurer for further consideration until we are satisfied with the Insurer’s decision.

3. HESTA insurance specialists will advise of the outcome and the reason.

Once a decision is reached, HESTA will advise any parties associated with the claim directly of the outcome. If HESTA successfully challenges the Insurer’s decision and the claim is approved, HESTA will advise the dependants or legal personal representative.

If HESTA agrees with the Insurer’s decision to deny the claim, we will explain the reasons the claim was declined. If the dependents or legal personal representative is not happy with our decision they can lodge a written complaint with HESTA. If they are not satisfied with our response, they can lodge a complaint with the Superannuation Complaints Tribunal (SCT) on 1300 884 114, for a further independent review (time limits apply).

 

Claim submitted

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

 

Claim assessed

Insurer assesses your claim.



 

Claim approved

Insurer advises of approval
(if you have death cover).
Payment made.

 

the HESTA difference - 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, and the thoroughness of the evidence provided.

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

If HESTA disagrees with the initial decision of the Insurer, HESTA will refer the claim back to the Insurer for further consideration until we are satisfied with the Insurer’s decision.

3. HESTA insurance specialists will advise you directly of the outcome and the reason.

Once a decision is reached, HESTA will advise you directly of the outcome of the claim. If HESTA successfully challenges the Insurer’s decision and the claim is approved, HESTA will advise you of this and how you move to the benefit payment stage.

If HESTA agrees with the Insurer’s decision to decline the claim, we will explain the reasons your insurance claim was declined. If you are not happy with our decision you can lodge a written complaint with HESTA. If you are not satisfied with our response, you can lodge a complaint with the Superannuation Complaints Tribunal (SCT) on 1300 884 114, for a further independent review.

 

Claim submitted

Raise claim through HESTA.
HESTA provides claims pack.
Send completed forms back to HESTA.

 

Claim assessed

Insurer assesses your claim.



 

Claim approved

Insurer advises of approval.
Payment instructions confirmed.
Payment is made.

 

the HESTA difference - 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 been declined 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.

If HESTA disagrees with the initial decision of the Insurer, HESTA will refer the claim back to the Insurer for further consideration until we are satisfied with the Insurer’s decision.

3. HESTA insurance specialists will advise you directly of the outcome and the reason.

Once a decision is reached, HESTA will advise you directly of the outcome of the claim. If HESTA successfully challenges the Insurer’s decision and the claim is approved, HESTA will advise you of this and how you move to the benefit payment stage.

If HESTA agrees with the Insurer’s decision to deny the claim, we will explain the reasons the claim was denied. If you are not happy with our response you can lodge a written complaint with HESTA. If you are not satisfied with our response, you can lodge a complaint with the Superannuation Complaints Tribunal (SCT) on 1300 884 114, for a further independent review (time limits apply).