Insurance How To – Submitting a Group Insurance Claim


In this Insurance How To, Donna Selby, from specialist insurance administration firm, Australian Group Insurance, shares with advisers her firm’s experience in how to best manage a client through a group insurance claim process, for an optimal outcome for both the claimant and the adviser…


At a glance

Provided by: Donna Selby
Company: Australian Group Insurance
Topics covered: claim forms and requirements, delays to claims, record keeping


In detail

In our experience, the best advisers are claims savvy. They know the claims process intimately and are proactive in the event of a claim. They also tend to have systems in place to handle claims and stay on top of the details. As a result, they add tremendous value to their clients and enjoy client loyalty.

We believe it is smart to manage your client expectations by educating them on the claims process from the beginning. Here are some practical considerations which may help:

Submitting a claim

Familiarise yourself with the insurer’s group risk claim forms.  Usually there are three initial claim forms to complete:

  • A member’s form (for claimant)
  • A treating doctor/medical attendant’s form (for claimant’s physician)
  • An employer’s form

A certified copy of a member’s proof of age (e.g. drivers licence, passport, birth certificate) is also usually required by the insurer. Death claims will require a certified copy of a death certificate.

Tell your clients to notify you of employees that are, or will be, unable to work for lengthy periods of time due to illness or injury. Encourage them to submit claim forms as soon as possible, even if they think that the claim may not be paid. The doctor’s form is usually sufficient for insurers to indicate whether a claim is likely to meet the policy criteria, but talk to your claims team.  Get your insurer’s claims team onside for a positive claims experience.

Forward thinking advisers do not accept insurers’ information at face value

Manage client expectations by reminding your clients that the claims assessment period is not instantaneous as insurers need to assess each claim on its merits. It will depend on whether they have all the information they need upfront and whether they need to request additional information.

Some of the things that slow down the claims process include:

  • Delays with medical information being provided by doctors and specialists
  • Delays with financial information being provided by accountants (particularly for salary continuance and TPD claims)
  • Delays with information coming from the claimant themselves (especially if the claimant is hospitalised)
  • Claimants being requested to undertake examinations with independent medical examiners appointed by insurers
  • Health insurance commission reports, which can take up to six weeks to be issued

Comprehensive evidence to support the claim as well as accurate information is vital. Inaccurate, incomplete or contradicting information provided by various parties spell unnecessary delays. Claimants should also promptly follow up third parties (e.g. doctors, accountants, etc) to ensure they provide the information requested by the insurer. Completed claim forms should be checked thoroughly before submission to the insurer(s).

Claim admittance, payments and ongoing requirements

Usually within a few days of submission the insurer will respond and either accept the claim, decline the claim or request more information.

For income protection and TPD claims, progress claim forms need to be completed by the claimant to receive ongoing payments.  It is a good idea to obtain the policyowner’s bank details in advance – electronic payments are the way to go.

Advisers and administration

Savvy advisers add value by implementing systems to manage their clients’ group risk claims. Forward thinking advisers do not accept insurers’ information at face value; checking all insurer claim payment calculations and keeping their own records.

In brief, we find that the best advisers are proactive and detail oriented at claim time, and as a result tend to grow their group risk business and maintain it, year after year.