Claims FAQs

How long does it take to assess my claim?

Every claim is different, so it’s difficult to provide a specific timeframe, however, we understand that a timely decision is important to you and we will strive to provide you with the best possible claims experience. Some decisions may take longer because of:

  • Late lodgement of the claim and difficulty in obtaining historical information
  • Incorrect, incomplete or missing information relating to your claim
  • Delays in receiving other information requested from you or other parties.

We will keep you or the policy owner updated about the assessment of your claim and any outstanding requirements.

What is a waiting period?

A waiting period is the length of time that you must be off work due to injury or illness before a GSC benefit can be paid. Generally no benefits are payable during the waiting period.

Under Group Insurance, your employer or super fund elects the applicable waiting period for your policy. Examples of common waiting periods are 30, 60, 90 and 120 days.

How do other payments impact my insurance benefit?

If you are receiving a payment from any other source in relation to your illness or injury, this may impact the GSC benefit payable by OnePath.

Types of payments that may reduce your GSC benefit amount can include workers’ compensation, CTP insurance and other insurance policies covering illness or injury.

Can I earn other income while I am on claim?

If you have Group Salary Continuance insurance and  you return to work but are earning less than you were before your claim because of your illness or injury, you may be eligible for a partial disability benefit. This benefit is payable in addition to the income you receive from working.

The partial disability benefit is calculated based on a formula which is set out in your policy.

Other income that does not relate to work activities, such as shares or investment income, will generally not impact your payments.

Is tax deducted from my benefit payments?

This depends on the type of insurance benefit claimed. For example:

  • For Group Salary Continuance insurance, we will generally deduct tax from benefits that are paid directly to you.
  • For Group Life insurance (Death, Terminal Illness and TPD policies), we do not deduct tax before paying the policy owner. This will be the responsibility of the policy owner.

What if I don’t agree with your decision?

If you have a concern regarding our decision on your claim, or you would like us to review our decision or consider any further information in support of your claim, please:

If you ask us to review a decision on your claim and then don’t agree with the outcome of that review, you can lodge a complaint with:

How will my claim information be protected?

We are committed to ensuring the confidentiality and security of your personal information. As part of the ANZ Group, OnePath manages your personal information in accordance with ANZ’s Privacy Policy available here.

Can I provide feedback about my claims experience?

Of course, we value and appreciate your feedback.

If you have had a positive experience with our claims team or have some ideas on how we can improve our claims processes or services, we would like to hear from you.

You can give your feedback by:

  • contacting us on 1800 648 921, option 1,
  • emailing us at group.claims@onepath.com.au, or
  • writing to us at GPO Box 75, Sydney NSW 2001.

Underwriting FAQs

What is default cover?

Default cover is the automatic cover provided to you when you join the super fund/employer plan, as long as you satisfy the eligibility criteria. The default level of cover is not based on your unique current and future financial obligations, so you may want to check to see if it’s enough.

How long does the underwriting process take?

This depends on the information provided in an application. In some cases,  our electronic application system will provide this decision on the spot. Sometimes, however, we may require additional information from you or your GP about your application, and if so, how quickly we can process your application will depend on how quickly we receive this information.

Why do you need information about my health?

The purpose of insurance is to cover future unforeseen risks. Underwriters consider your medical history to determine the probability of future illness or injury. This risk is reflected in your premium and any special conditions or exclusions we may apply to your cover.

Why do you have to know about my insurance with other companies?

The purpose of insurance is to cover loss in an unforeseen event, not to place someone in a better financial position than they otherwise would have been in. By knowing about any other insurance you have, we can make sure you don’t end up being over insured.

Who pays for medical reports?

We will pay for any tests or reports we require as part of the application process and will pay the medical provider directly. If you request a review of our decision on your application, however, you may be required to pay for any tests or reports required.

You have requested a report from my doctor. Do I need to do anything?

You would not normally be required to take any action, unless your doctor makes a special request to see you.

Are pre-existing conditions covered?

Generally speaking, the purpose of insurance is not to cover pre-existing conditions. However, as part of the underwriting process, OnePath may choose to cover a pre-existing condition, cover a pre-existing condition with a premium loading, or exclude a condition from cover.

If I need a medical exam, what will I be asked to do?

The examiner will check your height, weight, waist measurement, chest expansion, blood pressure, and heart rate. You will also be asked to give a urine sample and you may be asked to take a blood test.

What happens if I don’t disclose a medical condition?

When applying for insurance, you have a ‘duty of disclosure’ meaning that you have to tell us things you know of that might be relevant to our assessment of your application and decision to insure you. Failing to disclose something relevant may result in a policy later being cancelled, a claim being denied, or the level of cover under a policy being reduced, so it’s important to make sure all relevant information is provided in an application and that all information provided is true and correct.

I am a New Zealand citizen living in Australia, can I apply for cover?

Yes, New Zealand citizens are treated the same as Australian citizens when applying for cover provided you meet the requirement to be residing in Australia. If you return to live in New Zealand, we ask that you notify us and we can confirm if we are able to continue your cover.

I am self-employed, can I apply for GSC?

Yes, you can apply for GSC. Our GSC policy is an ‘indemnity’ policy. This means your monthly GSC benefit amount will be calculated based on your pre-disability income, which will be assessed based on evidence obtained at claim time.

I am a casual worker, can I apply for GSC?

In some instances cover is available for casual workers. Please contact us with your particular circumstances for more information.

If I quit smoking, can I apply for non-smoking rates?

We ask for a statement/declaration confirming you have not smoked for at least 12 months before we can consider non-smoker rates.

Why are you concerned with a medical condition when my doctor isn’t?

If you have a medical condition that doesn’t require any immediate attention, your doctor may not be concerned. Many conditions change over time however and in future, your doctor may consider further treatment or evaluation. Because your doctor is continually reviewing your condition, their opinion may change over time. An insurer only has one opportunity to assess your condition for a policy that may be in force for many years. Insurers may therefore be more concerned because they have to consider the potential for change in the future.

What is an additional premium loading?

A loading is an added premium you pay to correspond with an additional risk of claiming. For example, a particular health condition may require a +50% loading. This means you will pay 1.5x the standard premium.

Why would you apply an additional premium loading instead of an exclusion?

Exclusions are generally applied for musculoskeletal injuries and conditions that are confined to a particular part of the body. Loadings are applied when there is a risk of spreading, systemic complications or an increased risk of other illness that cannot be easily excluded.

Why would you decline cover instead of just applying exclusions?

Sometimes we need a lengthy period of time between last symptoms and when we can offer cover. Insurers only get one opportunity to underwrite, so we need evidence that you have completely recovered, or that control of a condition will be sustained. Sometimes we can only do this by ensuring enough time has passed since last symptoms for us to make an accurate assessment of the likely future course of the condition.

My insurance had an exclusion or loading, can I get this reviewed?

We are always willing to review a decision at any time. Please contact us with your request and any additional information you may be able to provide.

Who can I contact to find out more?

Our forms and policy documents can be obtained from your employer/super fund. If you would like to speak to our underwriters you can call our hotline 1800 199 414 during office hours.

Group Life Insurance and Group Salary Continuance Insurance are issued by OnePath Life Limited, ABN 33 009 657 176, AFSL 238341.

This information is of a general nature and does not take into account your personal needs and financial circumstances. You should consider whether the information is appropriate for you having regard to your individual objectives, financial situation and needs. You should consider the Group Life Insurance Product Disclosure Statement and the Group Salary Continuance Insurance Product Disclosure Statement available to consider whether this information or these products are right for you.

Where information is summarised in a brochure, information guide, or document other than the insurance policy itself, it does not represent a complete description of the terms on which the insurance cover is provided. It is agreed that the insurance policy represents the concluded agreement between the policy owner and OnePath. For a copy of the insurance policy, please contact your super fund/employer.