Claims philosophy

 

Our philosophy

Cbus recognises that its members and beneficiaries making an insurance claim are experiencing a life-altering illness or injury, or the death of a loved one. We know that you will likely have limited time, ability and focus to manage a claim. We will treat all claimants with compassion, dignity and respect, and provide a claims process that is straight-forward (or easy to understand), timely and transparent. We will also observe the principles of privacy and confidentiality in our dealings with you.

Our approach

We will explain the claims process to you and set reasonable expectations. We will help you understand the requirements and how to make a claim and ensure that the insurer* conducts a fair, reasonable and timely assessment. We will communicate with you in a proactive, open and empathetic way, ensuring that you are kept informed throughout the process.

Paying legitimate claims

If you are eligible and have a legitimate claim, we will do everything we can so that it is paid in a timely and efficient manner.

Help when you need it

With our assistance, and advocacy when needed, we will support you to deal with any issues that may arise in relation to your cover or claim. This means you do not need to engage a lawyer, although it is your right to do so if you wish. 

If your claim may be declined, we will give you an opportunity to review the evidence obtained and make submissions or provide additional evidence before a final decision is made. We will explain the process to do this or assist you if required. If your claim is declined, we will have the decision reviewed by appropriately skilled and experienced staff, and if we consider the claim has reasonable prospects of success, we will take all reasonable steps to pursue it on your behalf.

If your claim has been declined and new evidence is provided, we will work with the insurer so that the decision is thoroughly and properly reviewed considering all existing and new evidence.

If your claim is accepted but we believe that the decision has been unreasonably delayed, we will proactively pursue a claim for interest on your behalf.

Our disability insurance

We offer our members access to the following types of disability cover:

  • Total and permanent disablement (TPD) cover, designed to provide a safety net for eligible members whose working life is cut short by disability, and
  • Income protection cover, designed to provide a safety net for eligible members whose working life is interrupted by disability.

About TPD cover

Our intention in providing access to TPD cover is for our insurer to pay a lump sum benefit to an insured member who has suffered a serious injury or illness that prevents them from working or doing certain everyday activities, and the realistic likelihood is that they will never again be able to engage in any regular suitable work taking into account their education, training or experience.

TPD cover is provided to:

  • eligible Industry, Sole Trader and Corporate Super members, and
  • eligible Personal Super members who apply for cover and are accepted.

To be paid a benefit, a member must have TPD cover at the date of disablement and must, in the opinion of our insurer, satisfy the relevant policy definitions, terms and conditions.

For more on TPD eligibility requirements, how to make a claim, how certain terms are defined and how our definitions are applied in practice, read our Applying for TPD payments  fact sheet.

About income protection cover

Our intention in providing access to income protection cover is for our insurer to pay a monthly income replacement benefit to insured members who suffer an accident or illness that prevents them from working in their occupation or engaging in any business activity. A portion of the benefit will be paid as a super contribution to help put the member in a financial position closer to where they would have been had the disablement not occurred.

Income protection cover is provided to:

  • eligible Sole Trader and Corporate Super members, and
  • eligible Industry Super members.

Income protection cover is not currently available to other membership categories because a significant portion of those sectors have cover as part of their employment conditions.

To be paid a benefit, a member must have income protection cover when they become sick or injured and must, in the opinion of our insurer, satisfy the relevant policy definitions, terms and conditions.

For more about income protection eligibility requirements, how to make a claim, how certain terms are defined and how our definitions are applied in practice, read our Applying for income protection payments fact sheet.

 

Insurance cover is issued under a group policy with our insurer, TAL Life Limited ABN 70 050 109 450, AFSL 237848.