Claims Management, the low down

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Trauma, TPD, Critical Illness… what does it all mean and how does it help me if I’m sick or injured?

 Ok, so you’ve heard all these phrases and you know they might be important to you one day. But what if today is that day? Or tomorrow?

Let’s clarify what each of these mean and what they could offer you. Then we’ll tell you how we can help.


Called different things but they basically mean the same thing. A lump sum payment in the event that you get one of the specified illnesses. The lump sum is designed to help you cover medical costs, rehabilitation costs as well as general cost of living for you and your family. This provides you with some financial relief so you can focus on your recovery and get back to work.

Each insurance provider has their own list of illness they’ll cover, but most generally cover:

  • Cancer
  • Stroke
  • Heart conditions
  • Major head injury

There are around 50 different medical conditions covered by the major insurers.


TPD covers just that, a complete and permanent injury or illness that has disrupted your life and means you cannot return to work. The lump sum payment, similar to Trauma insurance, is there to help you pay medical and rehabilitation costs, cover your debts, make required renovations to your home and provide ongoing financial cover for you and your family.

Once again, each insurer will have their own definitions and there are two options when you take your policy out. You can opt for either ‘own occupation’ or ‘any occupation’. Own occupation means that you cannot return to the role you were trained for, for example a surgeon may not be able to return to work if they lose their vision or use of their hands. Any occupation means that you’re unable to return to work in any capacity that your suited to in terms of education, training and experience, for example the surgeon mentioned above may be able to work as a GP, Consultant or in medical education.


Generally, Income Protection will pay you 75% of your salary if you’re unable to work due to illness or injury. The purpose of this insurance is to help you maintain your standard of living and not have to worry where money is coming from to pay for bills, food etc.

Some believe it can be paid if you have been made redundant or lost your job, but this is not the case.


Because there is always some. There may be waiting periods before you can claim on your Income Protection, some will pay for a limited time and others may pay up until age 65.

If you have pre-existing conditions or certain conditions that run in your family, your insurer may either add an exclusion or loading. An exclusion means they will cover you, but if you have say, a heart condition or family of history of cancer, they won’t cover you for those events. If they add a loading, this means they’ll cover you for these conditions, but you will pay a higher price as the insurer is taking a risk on covering you.


Then you have come to the right place. We have a dedicated Claims Management business that work on a no win, no fee basis.

If you have been ill or injured and want to claim on your personal insurance then please, give us a call. We will meet with you (at our cost) and go through the details of your illness or injury to see if you will be able to claim. There’ll be some research on our end to look at the definitions of your policy and we’ll let you know if we think you should put in a claim.

We’ll then work with you to complete and submit the paperwork, we’ll liaise with the insurer using the relationships we’ve built to get the best possible outcome for you. Have a look at our Claims Management page for more information on how this process works.

It is very important that you understand that the information above is general in nature and does not take into account your personal situation. You should consider whether the information is appropriate to your needs, and where appropriate, seek professional advice from a financial adviser. It is also worth noting that the Australian financial and taxation system is ever changing, and the information above may no longer be relevant. Again, we suggest seeking professional advice from a financial adviser before proceeding.

Contact us today and see how we can help

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