If your doctor expects you to be unable to work due to an illness or an injury, for at least the waiting period specified in your policy, then notify us as soon as practicable.
It is important that you obtain a medical certificate from your doctor which confirms your inability to work. The reason for this is that your waiting period commences from the date specified in the certificate. Any delay in obtaining the certificate will cause a delay in starting your claim payments.
If your disability is due to an accident, it is important to lodge a claim with ACC before you make a claim under your policy. The reason for this is that ACC is the primary insurer in New Zealand for injury-related disabilities. Your policy is designed to make up any difference between your ACC payments and your total cover.
The majority of income protection claims, however, are due to illness (which ACC does not cover). For illness, your benefits will be sourced solely from your insurance cover.
To process your claim, a case manager will be assigned to your claim, and in the first instance will phone you to discuss your condition. The case manager will then send you a letter which details the information needed to assess your claim. The information required includes the following:
Following receipt of the above information, further medical, occupational or financial information may be requested by the case manager, including an assessment by an independent medical specialist. If your disability was caused by an accident, details of your ACC claim and assessment will be requested.
Your claim is assessed following receipt of all required information. On acceptance of your claim, monthly benefit payments commence (in arrears) by direct-credit to a bank account you nominate on the Disability Claim Form.
As your subsequent monthly benefit payments depend on a range of factors (such as any sick leave or ACC payments you receive, and any part-time income you earn), each month you will need to complete and return an Individual Declaration Update PDF. You may also be requested to regularly or periodically provide updated medical certificates from your doctor or specialist.
An important aspect of your policy is that it goes beyond income protection payments and encompasses your recovery and timely return to work. Your case manager will assist you in preparing a rehabilitation plan, which may include involving occupational specialists. For example, if an occupational medical specialist advises that you are unable to return to work, then vocational retraining may be an option if you are medically able.
The entire claims process can be illustrated as follows: