How to make a claim

Making an insurance claim

This article outlines the process involved how to make a claim if the unexpected happens. It’s as easy as 1, 2, 3.

When something does go wrong, you will want to understand what you’re covered for and you’re not covered for, so we always recommend your first step is to give us a call on 0800 477 488 and let us know what has happened, even if you’re unsure you are eligible to make a claim.

Once we have established you are entitled to claim, we will send you a claim form to complete. Once completed, send it back to us. If you have difficulty in completing the claim form. let us know, one of our advisors can come to you and help you complete the form. if you have any supporting documents such as a hospital discharge letter, send these to us as well.

The claim form will have a section that needs to be completed by your medical practitioner, you will need to organise this at your own cost. Once a claim is received by the insurance company, they will go to your medical practitioner to obtain a copy of your medical records to verify the claim is genuine and to verify that there are no non-disclosure issues, such as, records of a pre-existing condition that you may have omitted to tell them at the time of application.

How long does the claim process normally take?

The claims process generally take 5- 10 working days. If you have an urgent health insurance claim please let us know the date you are booked in for and we can help push your claim through to obtain pre-approval.

The claim process can vary for each insurance type as outlined below:

Health Insurance Claim process

If you’re going to see a specialist we will require a GP referral letter to the specialist depending on the type of cover you have. If you have specialist cover and you see a specialist but it doesn’t lead to surgery, that is covered. If you only have hospital cover and see a specialist, the specialist visit will not be covered, it will only be covered if you end up requiring surgery within a certain time frame, normally six months before or after surgery.

Life Insurance claims process

There is generally a wait period for death claims. If your loved one passes away, let us know. Upon written notification the insurance company releases the bereavement benefit first. The amount of bereavement benefit varies from company to company. It can be the anywhere between $10,000 to $25 000. This amount is paid out up front and is normally deducted from the full insurance pay-out. The remaining insurance money normally gets paid out once we receive a completed claim form with a copy of the death certificate. The death certificate is normally lodged to the Birth, Deaths & Marriages office by the funeral directors and is done after the funeral. It can take about five to ten working days to obtain copy of the death certificate from the births and deaths office in Wellington.

Trauma Insurance claims process

You must survive the first 14 days of suffering the trauma before making a claim. After the 14th day the claim can be submitted to the insurance company. The insurance company will then follow the process to verify the claim with your medical practitioner. Once verified they will pay out the claim.

Income Protection claims process

The same general claims process applies for Income Protection claims; however your claim will be paid out depending on the wait period that you have chosen in your policy.

Summary

1. Give us a call so we can let you know what you can and can’t claim for.
2. Once we establish you can claim, we will send you a claim form to complete.
3. If you have difficulties completing the form, let us know, once of our advisors can help you.
4. There will be a section in the form that needs to be completed by your GP.
5. Once the form is completed and returned to us we will submit your claim to the insurance company.
6. If you have any supporting medical documents, such as a discharge document from the hospital, please send these to us.
7. Once submitted the insurance company will contact your GP to obtain a copy of your medical records to verify your claim is genuine and to make sure that you are not claiming for a pre-existing condition that was not disclosed a the time of application.

Disclaimer: The information contained on this page is an overview and general information only. It may not be relevant to your individual circumstances. Before making any investment, insurance or financial planning decisions, based on information provided here, please use your discretion and consult a professional adviser first. You can read our full disclosure statement here.