skip to log on skip to main content
VoiceOver users please use the tab key when navigating expanded menus

How critical illness insurance claims work


Published June 2019

Making a critical illness insurance claim isn’t much more complex than any other insurance, but there’s some key points you need to know.

Critical illness insurance – also known as trauma insurance – will pay you a lump sum if you’re diagnosed with a critical illness that is defined in your policy. Payments are generally not subject to tax. 

In some cases you may only receive a partial payment for particular illnesses or injuries so make sure you know which ones these are by referring to the product disclosure statement before choosing a policy.

The lump sum payment has no restrictions on how you use it, so while it could help out with your medical bills, you could also use it to make structural changes to your home if your medical condition requires it, or to pay for a carer or support person, or anything else at all.

Unlike income protection insurance, which pays you a percentage of salary if you’re unable to work through illness or injury, critical illness insurance pays you a lump sum amount. Critical illness insurance also continues to cover you whether you are in paid employment or not, which is not generally the case for income protection insurance.

How to make a claim

In the unfortunate event you need to make a critical illness claim, you need to contact your insurer as soon as possible.

When you make contact, have your policy number ready as well as the date and details of the event that has caused you to make the claim. Your insurer will let you know what you need to do and what documents you need to provide in order to lodge your claim.

Lodging your claim

Your insurer will send you a claim form with sections that need to be completed by you and your doctor or specialist. Generally, your doctor will also need to provide a statement outlining your condition and your medical history.

Other information your insurer might require includes:

  • documents to verify the event that is causing the claim
  • proof of your identify, such as your passport or driver’s licence
  • any other documents relating to your medical history.

Be honest and upfront - if you have to change or correct your story later your insurer may have some doubts about your claim, and reject or delay processing it in order to make further inquiries. You will also need to co-operate with any specialists they may employ to assess your claim, such as a doctor or investigator.

Always confirm the next steps of the claims process with the insurance provider and the expected time of completion of those steps. This will help you to understand the timeframe involved with settling your claim.

Many insurance providers have subscribed to the FSC Life Insurance Code of Practice which contains minimum standards for handling your claim.

Why might my claim be rejected?

There may be occasions when an insurer denies a claim. One reason may be because you don’t satisfy the policy’s definition of a critical illness. This is why it’s important to fully understand the circumstances under which your insurer will pay your claim.

Other reasons a claim may be denied include:

  • an exclusion applies
  • relevant information wasn’t disclosed when buying the policy
  • the claim was made within an initial exclusion period.

What to do if your claim is rejected

If your claim is denied your insurer must specify the reasons why. There are actions you can take if you are unhappy with their decision. For example, you can object and ask for your claim to be reviewed by your insurer’s internal dispute resolution body. If your claim is still denied, and you wish to take it further, you can contact the Australian Financial Complaints Authority on 1800 931 678 or www.acfa.org.au

Critical illness cover offers peace of mind if you suffer a medical crisis. However, it’s important to fully understand what you will be covered for if you need to make a claim.

Find out more about ANZ critical illness insurance

13 16 14

Mon-Fri 8am to 7pm (AEST)

Learn more about life insurance

Article

How life insurance helped Karen regain her independence

With more than 40 years of equestrian experience, Karen never expected to be injured whilst gently trotting with her horse.

  

Article

Life insurance FAQs
 

Get the basics covered. Find out the cost of life insurance, the benefits, whether you need a medical exam, and more.

  

Article

What are the different types of life insurance?

Learn about the types of life insurance, including critical illness insurance, income protection insurance, and more.

  

The above content relates to policies issued from 1 June 2019 under the ANZ Recover Well Product Disclosure Statement and Policy Document (PDF 132kB) and is current as of today. Previous products (with the same name) may have different features and benefits. If you are an existing customer, please contact us if you have any questions about your cover.

ANZ Recover Well is issued by OnePath Life Limited (OnePath Life) (ABN 33 009 657 176, AFSL 238 341). We recommend that you read the ANZ Financial Services Guide (PDF 479kB) and ANZ Recover Well Product Disclosure Statement and Policy Document (PDF 132kB) (available online or by calling 13 16 14) before deciding whether to acquire, or to continue to hold, this product. This PDS relates to policies issued from 1 June 2019. Previous products (with the same name) may have different features and benefits. If you hold insurance based on an earlier PDS, please contact us if you have any questions or to have a PDS sent to you.

This information is current as at date of publication and is subject to change.

The issuer of this information is ANZ. While ANZ has taken care to ensure that this information is from reliable sources, it cannot warrant its accuracy, completeness or suitability for your intended use. To the extent permitted by law, ANZ does not accept any responsibility or liability arising from your use of this information.

Australia and New Zealand Banking Group Limited (ANZ) ABN 11 005 357 522 AFSL 234527 is an authorised deposit taking institution (Bank) under the Banking Act 1959 (Cth). The issuers of these products are not Banks. Although ANZ distributes these products, these products are not a deposit or other liability of ANZ or its related group companies. None of them stands behind or guarantees the issuers or the products. 

This information is of a general nature and has been prepared without taking account of your objectives, financial situation or needs. You should consider whether the information is appropriate for you having regard to your objectives, financial situation and needs. 

The ANZ App is provided by ANZ. Super, Shares and Insurance (if available) are not provided by ANZ but entities which are not banks. ANZ does not guarantee them. ANZ recommends that you read the ANZ App Terms and Conditions available at anz.com and consider if this service is appropriate to you prior to making a decision to acquire or use the ANZ App.

Apple, the Apple logo, iPhone and iPad are trademarks of Apple Inc., registered in the U.S. and other countries. App Store is a service mark of Apple Inc.