Sick or injured PSSap customers
PSSap customers may have access to lifePLUS cover insurance, including income protection and total and permanent disability benefits, and could claim their super if they are permanently incapacitated.
PSSap customers can apply for benefits where they are unable to perform their duties because of sickness or injury. There are usually two components to a payout:
- Insurance within PSSap—known as lifePLUS cover.
- The balance of their superannuation account within PSSap
LifePLUS cover
There are two types of lifePLUS cover available to eligible PSSap customers—lifePLUS auto and lifePLUS choice—and both include:
- Income Protection (IP) cover, supporting your employees financially if they can’t work due to sickness or injury.
- Total and Permanent Disablement (TPD) cover, covering your employees if they’re sick or injured and can’t return to work.
- Death cover, providing financial protection for dependants of your employees if they die.
Your employees in PSSap can generally choose to tailor the amount and type of insurance cover they hold under PSSap lifePLUS cover to meet their specific needs at a cost outlined on our website. Your employee may also choose to hold no insurance cover at all.
For more information about PSSap LifePLUS cover refer to the Insurance and your PSSap super booklet.
If your employee lodges an IP claim, you will receive a request to provide an employer statement. This means you should always be aware if an employee has lodged an IP claim through PSSap.
Supporting your employee though a claim
Do you have an employee on long-term sick leave? They may be eligible to make a claim.
If your employee is considering claiming, or would like more information on the claims process they can call us on 1300 725 171 and we’ll pair them with a dedicated case manager to support them through the entire process.
The case manager will work closely with your employee, with you, our insurer and rehabilitation providers (where applicable) to coordinate an approach to get them back to health and wellness.
For privacy reasons, we must generally have authority from your employee to discuss their specific insurance matters with you. Please ask your employee to sign our Third Party Authority form, it will allow us to provide you with any information needed on the insurance options available to your employee.
Income Protection and TPD Insurance claims in PSSap
| 2020-21 | 2021-22 | 2022-23 | |
|---|---|---|---|
| TPD claims assessed | 93 | 94 | 130 |
| IP claims assessed | 342 | 231 | 308 |
CSC has a 94.6% TPD and a 98.1% Income Protection claims acceptance rate as at 30 June 2023.
Accessing super upon an Invalidity retirement
Your employee may be eligible to access their super benefits from PSSap if they’re permanently incapacitated and retire on medical grounds in addition any insurance component that is being paid.
If your employee is under age 60 and will be medically retired—that is, they are unlikely to be engaged in gainful employment for which they are qualified for—because of ill health, either you or your employee must apply for an Invalidity Retirement Certificate (IRC).
If we issue an IRC, this will provide confirmation that your employee meets the definition of being permanently incapacitated and is able to access their super benefits.
We’re unable to issue an IRC to any employees over age 60. Instead, they can claim their super once they’ve ceased employment. Their benefit will be tax free regardless of how their employment ceases. Your employee simply needs to complete the Withdrawing your super form and send it to formsandapplications@pssap.com.au for processing.
Support and rehabilitation
Our aim is to help your employees ensure their financial security, for themselves and for their family even if they are unable to work because of sickness or injury. Rehab after sickness or injury comes in various designs, depending on your employees’ personal circumstances.
We have access to one of the largest and most experienced teams of rehab professionals in Australia. Our rehabilitation team works with you, your employee and relevant rehab program providers to find the best way to support your employee’s return to health.
Post-illness or injury rehab support can include:
- A tailored work-readiness program including fitness and coaching to make sure your employee is confident and ready to return to work after they’ve recovered.
- Workplace assessments to find out if there’s any equipment or personal support that will help your employee transition back to work and thrive when they’re there.
- Help to improve your employee’s skills and capabilities, making their return to work sustainable over the long term.
- Career guidance to explore other options, especially if they can’t return to their previous role.
If approved, rehabilitation expenses are limited to 6 months value of your employees’ monthly Income Protection benefit payment.
By working closely with employers we can deliver personalised rehab programs that support any existing programs or return to work goals you may be supporting your employee with.
Timing is everything
It’s important that PSSap customers contact us as early as possible about claiming on their insurance, even if they have an existing employment process or a compensation claim underway. We will help our customer to understand what insurance options are available to them, and guide them through the process of how and when to make a claim.
In terms of physical conditions, if the person is off work for:
20 Days
the chance of ever getting back to work is 70%.
45 Days
the chance of ever getting back to work is 50%.
70 Days
the chance of ever getting back to work is 35%.
So, if you have an employee on long-term sick leave please encourage them to call us on 1300 725 171 and we’ll pair them up with a dedicated case manager who will support and guide them through the claims process.
Common questions answered
CSC shares PSS Invalidity claim information with me for my impacted employees, why can’t you do the same with PSSap lifePLUS cover insurance claims?
The invalidity benefit associated with the PSS or CSS is an employment benefit funded by you as the APS employer, and is administered by CSC. Because this is a specific employment benefit that you as the employer fund, and that CSC administers on your behalf, CSC is allowed to provide relevant information on the administration of invalidity claims impacting your employees in PSS or CSS.
PSSap lifePLUS cover is very different to the PSS and CSS invalidity employment benefits. It is instead an insurance sub-policy where insurance premiums are deduced directly from the balance of your employees PSSap account, and is an insurance policy held by your employee in their name, under an overall Master Policy that CSC holds with our insurer AIA. It is not an employment benefit, nor is it in any way directly funded by you as the employer.
PSSap lifePLUS cover is similar to insurance other employees might hold through other, non-CSC, super funds. If you were to ask another super fund to share specific information about an insurance claim being made with them by one of your employees, they would very likely have the same answer as CSC—under privacy rules they would not be allowed to share such information with you without the explicit permission of your employee. The insurance policy, whether with CSC or another super fund, is a policy held by the employee in their name under an arrangement between the super fund and the insurer.
How do I know if my employee has PSSap lifePLUS cover Income Protection (IP) Insurance?
Whilst we cannot disclose details of the PSSap lifePLUS cover held by your employee for privacy reasons, if your employee makes a PSSap lifePLUS cover insurance claim, you will receive a request to complete an employer statement. This means that you should always be aware if an employee has lodged a PSSap lifePLUS cover IP claim.
If CSC was to provide you as the employer with information about an employee’s PSSap lifePLUS cover insurance cover, without the employee’s explicit permission, this may be in conflict with CSC’s privacy commitment.
How do I know if my employee has lodged a claim on their PSSap lifePLUS cover Income Protection (IP) Insurance?
When your employee lodges an IP claim, you will receive a request to you complete an employer statement. This means that you will always be aware if an employee has lodged a PSSap lifePLUS cover IP claim. For privacy reasons, we cannot share any specific information about this claim, such as if the claim was successful and whether the employee is now receiving an insurance benefit (and for how long will it be paid).
If CSC was to provide you as the employer with information about an employee’s PSSap lifePLUS cover insurance cover, without the employee’s explicit permission, this may be in conflict with CSC’s privacy commitment.
I’d like to commence the invalidity retirement certificate (IRC) process for an employee so I can cease their employment. Is approval of the IRC impacted if my employee has submitted a PSSap lifePLUS cover Income Protection (IP) or TPD insurance claim?
No. When you commence the IRC process for an employee in PSSap, we’ll let your employee know that you as the employer have lodged an IRC application, and we’ll begin the IRC assessment process. Even if a customer is making an IP or TPD claim you can still complete the IRC process, so long as the employee meets the standard IRC criteria.
If a customer is making an IP claim, the IP claim process will continue no matter the status of the IRC process, so long as the customer’s health event causing the IP claim occurred prior to the IRC process commencing. Once an IP benefit is approved, the customer will continue to receive this benefit (for up to five years, dependant on their cover details) for as long as they meet the terms of the insurance policy (temporary disablement), no matter the status of the IRC process.
Note: At a certain point during the IP claim our insurer may make a decision that the employee is eligible for a TPD insurance claim. In this instance we’ll commence the IRC process, assuming the employee is willing to do so, and will engage you as part of this process.
My employee is off sick, I’d like to see what I can do to assist my employee to return to work and recover from their health issue. How can CSC assist me to do that if my employee has an PSSap lifePLUS cover IP or TPD claim in progress?
Where an employee is off work sick and receiving a PSSap lifePLUS cover Income Protection benefit, rest assured that if CSC’s insurer AIA assesses that your employee is at the point where a return to work (or a graduated return to work) program may be appropriate, they will contact you to try and arrange such a return. They will also discuss how they can support the employees return to work with you.
Research shows1 that the rehabilitation programs customers have access to through their PSSap lifePLUS cover Income Protection cover (if held) may assist an employee’s return to work. Returning to work in nearly all cases is the best way to maximise an employee’s long-term physical and psychological health.
1 The Royal Australasian College of Physicians, Australasian Faculty of Occupational and Environmental Medicine Position Statement on Realising the Health Benefits of Work, Sydney 2010
Will the medical information provided by the employer’s medical experts as part of the IRC process be used as part of the assessment of a PSSap lifePLUS cover insurance claim?
No, our insurer will not use the medical information provided as part of the IRC process as evidence for their lifePLUS cover claim. When assessing a claim, AIA will always seek evidence from the customer’s treating doctor/specialist. AIA may also seek evidence from relevant independent medical experts (as recommended by AIA’s Chief Medical Offer).
When an employee lodges a PSSap lifePLUS cover insurance claim, will CSC request relevant evidence from the employer as part of the insurance claim process?
Yes. At the point when an employee lodges a PSSap lifePLUS cover insurance claim, the primary evidence items that are requested from employers, as a part of the employer statement includes:
- pay/leave information
- monthly pay slips or a months’ worth of pay slips
- any return to work (where attempted) documentation
- occupation history and training.
This is the employer’s opportunity to provide relevant information about your employee. This also means that you will always be aware of a PSSap lifePLUS cover IP claim which has been lodged by an employee.