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Make a claim

It’s easier than you might think: When you let us know you’d like to consider claiming, we’ll pair you up with a dedicated case manager who personally oversees the process.

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ADF medical transition

Protecting your financial future if you're medically transitioning from ADF.

Read more about ADF medical transition

Defined benefit member guide to ADF Medical Transition and Retrospective Invalidity

The process, your options, and what happens post-transition.

Read more about Defined benefit member guide to ADF Medical Transition and Retrospective Invalidity

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If your treating doctors believe that your medical condition shows that you should be retired on medical grounds, you should make arrangements with your personnel section to be examined by an Approved Medical Practitioner (AMP) from one of our approved medico–legal service providers.

Your personnel section will make an appointment for you, and they will also give you a form to take to the assessment.

The results of the assessment will be sent direct to your personnel section. If, as a result of the assessment, the AMP thinks that you are, or may become, totally and permanently incapacitated, your personnel section will send us all the required documents to help us decide whether you should be retired on medical grounds. Any other supporting evidence you have, such as a report from a specialist or a general practitioner, must also be forwarded.

For more information, please refer to the documents below.

More information

Invalidity benefits

Look into your options if you are not likely to work again due to an incapacitating condition.

Death and invalidity benefits

This document outlines information on CSS death and invalidity benefits. It forms part of the CSS Product Disclosure statement.

This section contains:

Invalidity benefit claims—contributing members

Your employer will usually initiate an Invalidity retirement claim on your behalf.

How to apply

  1. Let your employer know you’d like to claim

    They’ll arrange a medical examination with one of our approved medical practitioners.

  2. Attend a medical examination

    After you’ve attended your medical examination, your employer will receive a completed Medical examination report for Invalidity retirement form (SM2) from the medical practitioner.

    If the medical practitioner thinks you are or may become totally and permanently incapacitated, your employer will send the completed documents and relevant supporting medical evidence to us to review.

  3. We’ll assess the medical practitioner’s report

    If we need to, we’ll refer you claim to an independent invalidity assessment panel for assessment.

    And if you are or are likely to become totally and permanently incapacitated, we may pay pre-assessment payments to help support you until you receive our final decision.

  4. We’ll advise you of our decision

    • If your claim is approved: We’ll finalise your claim and pay your benefit.
    • If your claim is declined: We’ll give you the opportunity to provide more information to support your claim. If your claim remains declined, we do not pay a benefit.

  5. If you disagree with the decision

    If you disagree with a decision about your invalidity benefit claim, you can appeal the decision. You have 30 days from the date you receive a decision to submit your request. Download our Appeal rights factsheet for more information and, if you’d like to, complete an Application for reconsideration of a decision.

    If you have a complaint about decisions made by CSC or the Reconsiderations Committee, you can complain to the Australian Financial Complaints Authority within 28 days.

 

 

Invalidity benefit claims—preserved members

How to apply

  1. Call us before you complete any paperwork

    We’ll talk you through what’s involved and start the claims process with you.

    Call 1300 000 377

  2. Complete the paperwork and lodge your claim

    Work with your dedicated case manager and medical practitioner to complete and submit the Application for approval of early access to preserved superannuation benefits on medical grounds form.

    Send your completed application form and supporting evidence to us.

  3. We’ll assess your application and advise you of our decision

    • If your claim is approved: We’ll finalise your claim and pay your benefit.
    • If your claim is declined: We’ll give you the opportunity to provide more information to support your claim. If your claim remains declined, we do not pay a benefit.

  4. If you disagree with the decision

    If you disagree with a decision about your invalidity benefit claim, you can appeal the decision. You have 30 days from the date you receive a decision to submit your request. Download our Appeal rights factsheet for more information and, if you’d like to, complete an Application for reconsideration of a decision.

    If you have a complaint about decisions made by CSC or the Reconsiderations Committee, you can complain to the Australian Financial Complaints Authority within 28 days.

 

 

ADIC claims

How to apply

  1. Call us before you complete any paperwork

    We’ll talk you through what’s involved and start the claims process with you.

    Call 1300 000 377

  2. Complete the paperwork and we’ll lodge your claim

    Work with your:

    • dedicated case manager to complete the insurer’s claim form; and
    • medical practitioner to complete the Medical Attendant’s statement.

    When you’re done, we’ll lodge the claim for you and keep you updated on the progress (every 20 business days).

  3. Wait while the insurer assesses your claim

    During this process, they may need more information or ask you to take a medical examination. Generally, we’ll be the contact between you and the insurer, but there may be times when they contact you directly.

    The insurer will decide if they are going to accept or decline your claim. They’ll let us know how they reached their decision, then it’s over to us.

    While the insurer assesses your ADIC claim, we’ll work with you to finalise your Invalidity retirement. It’s likely that we’ll make a decision about your super benefits before your insurance claim is finalised.

  4. If your claim is accepted, we’ll let you know

    We’ll finalise your claim and pay your benefit. If your PSS Invalidity retirement benefit has already been paid, we’ll adjust your pension to include your ADIC benefit.

  5. If your claim is declined, we’ll review the decision independently

    We’re legally obliged to (and of course we want to) act in your best interest, so we’ll always review the insurer’s claim decision. During this review, we’ll assess whether we agree with the insurer’s decision.

    We’ll give you the opportunity to provide more information to support your claim. If your claim remains declined, we do not pay an ADIC benefit.

    • If we don’t agree with the decision to decline, we’ll ask the insurer to reconsider your claim or to arrange more medical evidence. The claim will go back through the assessment process and your case manager will keep you up to speed with what’s going on.
    • If we agree with the decision to decline, we’ll write to let you know why it was declined and why we agree.

    Your case manager will also let you know how to request a review and how to lodge a formal complaint.

    If you do this, and you’re not satisfied with how we manage your formal complaint (or you don’t get our response within 90 days of submitting your complaint), you may contact the Australian Financial Complaints Authority on 1800 931 678 or via info@afca.org.au or at afca.org.au.

 

 

Death benefit claims

Apply for a PSS Death benefit if you’re a dependant (surviving spouse or eligible children) of a PSS customer who has died.

How to apply

  1. Call us before you complete any paperwork

    After we verify you, we’ll talk you through what’s involved.

    Call 1300 000 377

  2. We'll give you a form to complete

    As a potential beneficiary, a case manager will provide you with the form(s) to complete. The claim may involve Invalidity benefits, Death benefits and super benefits.

  3. Sit tight as we assess your claim and make a decision about beneficiaries

    We’ll determine who’s eligible to receive any benefits that are payable.

    Everyone has 28 days to object to the decision

    If potential beneficiaries or other interested parties object to our decision, we’ll request evidence from them to support the objection. The evidence goes to the Reconsiderations Committee that decides if the objection changes the original decision.

  4. If you disagree with the decision

    If you disagree with a decision about the Death benefit claim, you can appeal the decision. You have 30 days from the date you receive a decision to submit your request for reconsideration. Download our Appeal rights factsheet for more information and, if you’d like to, complete an Application for reconsideration of a decision.

    If you have a complaint about decisions made by CSC or the Reconsiderations Committee, you can complain to the Australian Financial Complaints Authority within 28 days.

  5. We'll pay beneficiaries

    We’ll distribute the Death benefit (and any invalidity or super balance if applicable) to the beneficiaries. Beneficiaries should seek advice about whether there are any tax obligations they need to meet. See your financial adviser or visit the Australian Tax Office website.

Income Protection claims Frequently Asked Questions

How long does the process take?

Generally, for Income Protection (IP) claims, you can expect a decision within two months of submitting all your claim forms. The Insurer will try to make a decision as quickly as possible, but will need all your completed forms for this—they may also require additional information from you during their assessment.

You can help this process by engaging with your medical practitioner and employer, and ensuring they complete the required forms in a timely manner.

What is the waiting period?

Your waiting period is the number of days before you become eligible to claim. lifePLUS can have a waiting period of 30, 60, 90 or 120 days. Log into the CSC Navigator to see what waiting period applies to you.

Can I choose when my waiting period starts?

No. This period commences from the date you are first examined and certified by a medical practitioner as totally disabled in relation to a condition that gave rise to a claim, provided you had ceased working due to that condition.

When will I be paid?

If the insurer approves your IP claim, you will receive payments monthly in arrears after your waiting period ends. For example:

Malini was injured in March, and examined and certified by a medical practitioner as medically unfit for work from 1 April. This was followed by 90-day waiting period, meaning benefits were payable to Malini 90 days later, on 30 June. She’ll receive her first payment in July.

How will I be paid?

We’ll pay your monthly benefit payments directly to you, in addition to 15.4% contributions to your superannuation account.

How much will I be paid if my claim is accepted?

If you have a two-year maximum benefit period, you will be paid 75% of your pre-disability income or of your sum insured, whichever is the lesser of the two. The benefit is taxed before being paid to you, just as your employment income would have been taxed.

If you have a five-year maximum benefit period, you will be paid as above for the first two years, and 50% for the remainder of the benefit period. A stricter definition of disability will apply for years three to five of the benefit period—we will be in touch to explain this process to you at the end of the first two years. For a five--year benefit period, the benefit will be indexed each year by the lesser of the CPI and 5% per annum. This indexation will apply following 12 continuous payments of either a total or partial benefit.

For both two and five-year benefit periods, you will also receive 15.4% of your income (or sum insured as above) directly into your PSSap account, as long as you keep this account open.

You will need to notify the insurer if you close your PSSap account during the benefit period. The contribution will be re-directed to your new superannuation account. Any delay in notifying the insurer of the superannuation account change may result in a delay of the contribution being received. You will not receive this contribution and will be paid the direct benefit only.

Will my benefit be taxed?

Any amounts paid to you are generally taxed as normal income. The insurer withholds the relevant Pay As You Go (PAYG) tax before they pay your benefit to you. At the end of the financial year, you’ll receive a payment summary that you’ll need to submit with your tax return.

The super contribution payment of 15.4% is treated as a concessional contribution for tax purposes, and is taxed at 15%. This is the same as your employer-related contributions. While the 15.4% super contribution payment we make is not classed as a super guarantee payment like your regular employer contributions are, the amount still counts towards your concessional (before tax) contributions cap for super.

For more information on how benefits or concessional contributions are taxed, see the ATO website.

How does the insurer calculate my salary for benefit purposes?

The benefit is calculated on either your actual pre-disability income or your sum insured, whichever is the lesser of the two.

The insurer will seek information from your employer to determine your pre-disability income. You can find out more about the pre-disability income by reading the definition outlined in Insurance and your PSSap super.

When do benefit payments stop?

Payments do not necessarily continue for the full length of the benefit period.

Payments will cease during this time if;

  • you no longer meet the disability definition;
  • you reach age 67;
  • you die, or,
  • for fixed-term contract employees, the date your current contract term ends. If a Total And Permanent Disability (TPD) claim is paid, this will not impact your IP payments—they will continue, even if you finish work.

Can I return to work during the waiting period?

When you’re ready to go back to work, lifePLUS cover lets you check how fit and ready you are without resetting your waiting period.

Your waiting period is 90 days, and you can go back to work for up to 10 days during this time without restarting your waiting period—the waiting period will simply be extended by the total number of days you returned to work. If you go back to work for longer than 10 days during your waiting period, the 90 days restarts.

Will I be covered for pre-existing conditions?

If you have lifePLUS auto cover, limited cover applies for the first 12 months of cover commencement. Limited cover means you’re covered only for new claims that arise from illnesses or injuries that were not related to a condition that occurred before your cover started. Specifically, the new claim must be for:

  • an illness that first manifests itself on or after the date your cover most recently started; or
  • an injury that occurred on or after the date your cover most recently started.

Can I earn any income during the benefit period?

When you have an Income Protection claim you also may have a TPD claim and be getting payments from other sources.

If you do receive a TPD benefit, you’ll keep getting Income Protection benefit payments. It’s worth noting that PSSap Income Protection benefit payments will be reduced by any amount that’s paid or must be paid:

  • By workers’ compensation, transport accident compensation or similar legislation that applies to your illness or injury.
  • By your employer while you’re receiving your Income Protection benefit payments.
  • By another insurance company (including through another super arrangement) for Income Protection benefit payments.
  • By any entity that owes you sick leave entitlements.

Partial disability benefits

If you are able to undertake partial work at a reduced salary, the partial disability benefit will make up the difference between your pre-injury/illness salary and your reduced salary.

Will my benefits cease if I leave my employment by resignation, dismissal or invalidity retirement?

As long as you have ongoing medical evidence confirming your ongoing incapacity, benefits will continue to be paid if you leave employment.

Do I have to exhaust my leave?

You will need to check your employment contract about leave provisions, however it is not a requirement of the IP Policy that you take available leave before being eligible to claim.

 

 

Death benefit claims

Losing someone close to you is one of the hardest things that you might have to go through. We want to make the process of making a claim as simple as possible.

How to claim

  1. Call us before you complete any paperwork

    After we verify you, we’ll talk you through what’s involved.

    Call 1300 725 171

  2. We'll provide you with a form to complete

    As a potential beneficiary, a case manager will give you a form to complete (all beneficiaries will complete this form.)

    If there’s:

    • A valid binding beneficiary nomination in place, we’ll make payments to that beneficiary.
    • No binding nomination, we’ll work out who the customer’s dependants are or who the executor is.

  3. If the late customer had lifePLUS cover, the case manager will lodge a claim with the insurer

    If the insurance claim is approved, the benefit will be paid into the late customer’s PSSap account.

  4. We'll notify beneficiaries

    Everyone has 28 days to object to the decision

    If potential beneficiaries or other interested parties object to our decision, we’ll request evidence from them to support the objection. The evidence goes to the Reconsiderations Committee that decides if the objection changes the original decision.

    If anyone has complaints about decisions made by CSC or the Reconsiderations Committee, they can complain to the Australian Financial Complaints Authority at afca.org.au within 28 days.

  5. We'll pay beneficiaries

    We’ll distribute the super balance and any insurance benefit (if applicable and approved) to the beneficiaries. Beneficiaries should seek advice about whether there are any tax obligations they need to meet. See your financial adviser or visit the Australian Tax Office. 

 

 

When we can't pay benefits

Insurance always comes with some exceptions and restrictions.

There are some situations where we can't pay Income Protection or Death and TPD benefits because certain events are excluded from cover. 

We can't pay Income Protection benefits if disability is caused wholly or partly, or directly or indirectly by:

  • any intentional self-inflicted injury or attempted suicide or self-destruction while sane or insane;
  • uncomplicated pregnancy, childbirth or miscarriage;
  • war or act of war, whether declared or not;
  • active service in the armed forces or peacekeeping forces (whether armed or unarmed) of any country or territory or foreign or international organisation; or
  • participation in a combat or fighting force of any country or territory or foreign or international organisation.

We can't pay Death and TPD benefits if Death or TPD is caused wholly or partly, or directly or indirectly by:

  • active service in the armed forces or peacekeeping forces (whether armed or unarmed) of any country or territory or foreign or international organisation; or 
  • participation in a combat or fighting force of any country or territory or foreign or international organisation; or
  • any self-inflicted injury or suicide, whether sane or insane within 13 months from the date of any acceptance of underwritten cover.

 

 

How we protect your privacy

You trust us with very private information, particularly during the claims process. We’re committed to protecting your privacy in line with: