Sally’s specific injury claim

It pays to know your policy

Sally fractured her arm in a cycling accident. While she only needed five days off work because of the injury, a conversation with her financial adviser led to Sally making a successful claim on her income protection policy.

Sally's income protection claim

As a newlywed couple looking to build a life together, Sally and her husband Greg both took out OnePath’s Income Secure in 2015 at the age of 30 on the recommendation of their adviser.

‍The flexibility of the product enabled them to choose waiting and benefit periods on their policies, which they intended to cover their mortgage repayments and normal living expenses should something happen that interrupted the steady income they received from their jobs.

What happened...

With the support of her adviser, Sally chose a:

  • Benefit period of up to age 65 – this means that should something happen to her, benefits will be paid on her insured income up to the age of 65 while she is disabled.
  • Waiting period of 30 days – this means that any benefits will be paid to her from 30 days after an incident – so in most cases the injury would have to put her out of work for more than 30 days for her to make a claim.

What Sally didn’t pay much attention to were the extra benefits that came with her policy, including the Specific Injury Benefit. This benefit pays a guaranteed amount if specific injuries happen to you, such as loss of sight in one eye or fractures to the leg or arm – regardless of the waiting period selected on a policy.

August 2017‍

A couple of years after taking out her policy, Sally was cycling to her job as a school teacher. She hit a bump in the road, wobbled, came off her bike and put her arm out to break her fall. Feeling a sharp pain, she called an ambulance and went to hospital for an X-ray.

Sally had suffered a radial head fracture to her right arm, which is at the top of the bone that connects the wrist and elbow. She needed 5 days off work to recover initially, and was then back to work in a sling for the next 5 weeks. Knowing that her waiting period was 30 days, Sally didn't notify OneCare or her adviser about her injury, which only put her out of work for 5 days.

During her regular policy review with her adviser, Sally mentioned her injury in passing. Sally’s adviser explained that OneCare’s Income Secure covers begin the regular benefit payments after the waiting period, but certain conditions covered by the Specific Injury Benefit will pay automatically. In Sally’s case the Specific Injury Benefit covered “fractures of the upper arm including the elbow and shoulder bone” for a guaranteed payment period of 2 months.

April 2019‍

20 months after the injury occurred and now back at full strength, Sally, with the support of her adviser, lodged a claim for the Specific Injury Benefit.

Our decision

The claims consultant Violeta recognised that this, like the majority of the claims received, was a straightforward case and could be sorted out over the phone using the simple tele-claims service, meaning Sally did not have to complete any excessive paperwork.

Sally sent identification documents and copies of her X-rays and doctors’ reports directly to Violeta. Having received the necessary information required to make a confident decision.

The claim was paid within 12 days of it being lodged – which meant 2 months' income (over $10,000), directly into Sally’s bank account.

At OnePath, we have the top-rated claims team in the country, and are proud to be there for our customers when they need us most.

Whilst the names have been changed to protect the individual claimant, this case study is based on the actual circumstances of the claimant. This is for illustrative purposes only, and claims will be assessed based on the specific circumstances of each individual case.

OneCare is issued by Zurich Australia Limited (Zurich) trading as OnePath Life (OneCare) ABN 92 000 010 195, AFSL 232510. OneCare Super is issued by OnePath Custodians Pty Limited (OnePath Custodians) ABN 12 008 508 496, AFSL 238346.  Zurich and OnePath Custodians are not related bodies corporate.

We recommend that you read the OneCare Product Disclosure Statement and Policy Terms available at or by calling 133 667 before deciding whether to acquire, or to continue to hold the product.