If illness or injury has left you unable to work, an income protection policy may entitle you to ongoing payments while you recover. Many Australians have income protection cover without fully understanding what it provides or how to access it, and insurers don’t always make the process straightforward.
Income protection insurance pays a regular benefit, typically a percentage of your pre-disability income, for a defined period when you are unable to work due to illness or injury. The policy may be held privately or through your superannuation fund, and the terms vary considerably between policies. Getting proper advice before lodging a claim can make a significant difference to the outcome.
Who Can Claim
You may be eligible to make an income protection claim if:
You have been unable to work due to illness, injury, or a psychological condition
You hold an income protection policy privately or through your superannuation fund
Your employer provided income protection cover as part of your employment benefits
You have been partially incapacitated and are earning less than your pre-disability income
Both total and partial disability are covered under most income protection policies, though the definitions vary and need to be checked carefully against your specific policy wording.
How a Claim Works in NSW
Income protection claims are not governed by the workers compensation scheme but by the terms of your insurance policy and, where the policy is held through superannuation, by the Superannuation Industry Supervision Act 1993 and relevant trust deed provisions.
Identify your policy or policies. Many people have income protection cover through their super fund without realising it.
Obtain a medical certificate and supporting documentation from your treating doctor confirming your inability to work.
Lodge your claim with the insurer or fund within the required timeframe specified in your policy.
Receive regular benefit payments, typically monthly, for the duration of your disability up to the maximum benefit period.
If your claim is denied or payments are reduced or cut off, dispute resolution options are available through the Australian Financial Complaints Authority (AFCA) or the courts.
Why You Might Want a Specialist Lawyer
Income protection insurers have significant financial incentive to minimise or deny claims, and policy definitions are often drafted in ways that favour the insurer. Common reasons for denial include disputes over the definition of disability, arguments about pre-existing conditions, and disputes over how income is calculated.
We help you:
Identify all policies under which you may have cover, including through superannuation
Ensure your claim is lodged correctly and supported by appropriate medical evidence
hallenge insurer decisions that deny, reduce, or prematurely terminate your benefits
Pursue disputes through AFCA or litigation where the insurer’s position is not justified
What Compensation Could You Receive?
Depending on your policy terms and circumstances, you may be entitled to:
Monthly benefit payments of typically 75 to 85 percent of your pre-disability income
Back payment of benefits from the date your disability commenced
Ongoing payments for the duration of your disability up to the maximum benefit period, which may extend to age 65 in some policies
FAQ
I didn’t know I had income protection insurance. How do I find out?
Check your superannuation statements or contact your super fund directly. Most Australians with superannuation have some form of default insurance cover, which may include income protection, total and permanent disability, and life insurance. We can help you identify what cover you hold.
My insurer says my condition is a pre-existing one and has denied my claim. What can I do?
Pre-existing condition exclusions are one of the most common grounds for denial and one of the most frequently overturned. The insurer must demonstrate that you were aware of the condition before the policy commenced. We can review the denial and advise on your prospects of a successful dispute.
My income protection payments have been cut off even though I am still unable to work. What are my options?
Insurers sometimes terminate payments on the basis of surveillance, independent medical examinations, or reassessment of your capacity to work. These decisions can be challenged. We can review the basis for termination and pursue the matter through AFCA or the courts where appropriate.
