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:
We will keep you or the policy owner updated about the assessment of your claim and any outstanding requirements.
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.
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.
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.
This depends on the type of insurance benefit claimed. For example:
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:
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:
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.
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.
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.
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.
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 would not normally be required to take any action, unless your doctor makes a special request to see you.
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.
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.
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.
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.
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.
In some instances cover is available for casual workers. Please contact us with your particular circumstances for more information.
We ask for a statement/declaration confirming you have not smoked for at least 12 months before we can consider non-smoker rates.
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.
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.
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.
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.
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.
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.