Trauma Insurance Claims Advice

Trauma Insurance, also referred to as Critical Illness Insurance, provides a lump sum in the event of you being diagnosed with one of the predefined medical conditions listed under your policy. The purpose of this cover is to provide you and your loved ones with the means to access the medical attention you require, for you to have  buffer in place should extended time off work be required by you or your family as well as contributing to reducing debt levels so that you have room to breathe during this tough time.

At Curo Financial Services, we offer a service to those looking to claim their Trauma Insurance. We will manage the process from end to end, ensuring your claim is dealt with in an efficient manner, allowing you to focus on your health. We utilise our decades of experience and industry expertise to cut through and deliver outcomes that our client’s might not be able to receive elsewhere.

What Does Trauma Insurance Cover?

Trauma Insurance is payable should you be diagnosed with a critical illness that is named in your policy document. More comprehensive products cover as many as 50 different medical conditions. Each medical condition will be defined within the Product Disclosure Statement. The primary reason for claims are Cancer, Heart Disease and Stroke. Trauma Insurance policies will also often provide a benefit in the event that you are permanently incapacitated to the extent that you lose use of limb(s) or your sight.

Making a Trauma Insurance Claim

Making a Trauma Insurance Claim will require you to provide evidence that you have met the definition provided in the Product Disclosure Statement. Navigating these definitions can be cumbersome if you have never dealt with this before. Although making a claim is designed to be as easy as possible, it is a highly technical area which can often lead to a claimant underestimating the process or the effort required. 

The Requirements

In order to successfully make a Trauma Insurance Claim you will need to have your treating medical specialist complete the prescribed claim forms. In these forms, your specialist will need to provide the insurer with details regarding your diagnosis and medical history. Often insurers will apply a qualifying period to certain medical conditions listed in a trauma contract, this typically results in no claim being payable should your symptoms present within the first 90 days of the policy.

 

Dealing with a Rejected Trauma Claim

As with all Life Insurance claims, you have the right to appeal a claims decision and have it reviewed. We managed many claims where it was initially declined only to be later approved. There are a number of reasons why this might happen which is why it is crucial to have an expert on your side to ensure the process goes as smoothly as possible. If you feel your claim has been assessed unfairly, speak with us to see if we can assist.

Is a Trauma Insurance Payout Taxable?

Generally no tax is payable on trauma insurance payouts. Typically tax will only be payable should the policy be held for business purposes where CGT tax may apply. As a result of this, Trauma Insurance premiums are also generally not tax deductible.

How Much Will I Receive from my Trauma Insurance Claim?

The amount you will receive from a Trauma Insurance claim is determined byt he the benefit you are insured for. Generally this amount is agreed upon at the start of the policy and is reviewed as time goes by. More comprehensive Trauma Insurance Policies have both full and partial payout. A full payout refers to when you are eligible to claim the entirety of the amount you are insured for while partial payments are for ‘less serious’ trauma’s where only a fixed percentage of your benefit is paid out. When you have received a partial payment under your trauma contract, you may well be entitled to retain the remaining portion of your benefit for future claims. However, your benefit will likely reduce by the amount that you have already claimed.

How Long Will My Trauma Insurance Claim Take To Be Paid?

If handled correctly, a trauma insurance claim can be settled within a few days of the appropriate paperwork being submitted. However, if you do not understand the process intimately and have experience in anticipating further requirements from the insurer, these payments can be delayed for a number of months. Trauma claims are seldom as simple as they seem which is why it is vital to engage the services of a professional prior to putting your forms together.

When can you claim Trauma Insurance?

Trauma insurance is payable upon meeting the definition provided in your policy document. As mentioned previously, many definitions contain waiting periods which might make you ineligible for a payment should you fall ill within a certain time of the policy starting. More comprehensive insurance products contain clauses that allow for discretion to be applied by the claims assessor should your illness not fall within the specific parameters provided by the insurer. For example, your cardiologist might advise you that you have had a heart attack without meeting the traditional criteria such as raised markers in your blood test. These clauses provide greater scope for the insurer to act in good faith and allow their medical definitions to remain dynamic and up to date. 

Can I get Trauma Insurance Again After I Have Claimed?

You can often apply for the reinstatement of your Trauma policy once a claim has been paid. This is a feature of the product and is not standard amongst insurers. Generally, you will be required to wait 12 months before your benefit can be reinstated. Further, you will generally not be covered for the same medical condition that you previously claimed, preventing you from being able to have two bites of the cherry.

Does Trauma Insurance Cover Death?

Although Trauma Insurance is often linked to life insurance, Trauma Insurance is not designed to payout in the event of death. Some Trauma Insurance contracts include a small benefit that is payable in the event of death and is often capped at an amount of $10,000.

Trauma Insurance Claims Statistics

Although these statistics are hard to compile due to privacy restrictions that are inherently associated with such sensitive data, Zurich Life has advised that in 2014 the most common reason for a Trauma claim were:

Males

  • Cancer – 51%
  • Heart attack – 24%
  • Heart bypass – 6%
  • Angioplasty – 5%
  • Stroke – 3%

Females

  • Cancer – 80%
  • Stroke – 9% 
  • Heart attack – 3%
  • Parkinson’s disease – 2%
  • Muscular distrophy – 2%

Source: Zurich

Trauma Insurance claims stats

Find Out More

If you feel you have a valid Trauma insurance claim and would like further assistance and expert advice from an experienced claims advisor, get in touch with us today. If you would like to speak with one of our financial advisers, please call us on 1300 665 356 or click here to fill out a contact form.

 

General Advice Disclaimer

General advice warning: The advice provided is general advice only and in preparing it we did not take into account your investment objectives, financial situation or particular needs. Before making an investment decision on the basis of this advice, you should consider how appropriate the advice is to your particular investment needs, and objectives. You should also consider the relevant Product Disclosure Statement before making any decision relating to a financial product.

Interested in Learning More?

Fill in the form below and one of our advisers will get in touch to assist you further.