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HOW TO MAKE A CLAIM – CLAIMS PROCESS

Step 1:

Contact our colleagues at n2n Claims Solutions (n2n) on 1800 999 626.

n2n will complete a claims registry and send you a claims pack.

You can also download our claim form here.

Step 2:

Arrange for all sections of the paperwork to be completed – Member Statement, Doctor Statement, Employer Statement. Then gather all supporting documents and lodge your claim.

Step 3:

n2n Claims assesses and actions your claim.

Step 4:

n2n Claims will make a decision about your claim, and will call you.

This initial assessment will be completed within 5 days.

 

POTENTIAL DECLINED CLAIMS PROCESS

Step 1:

If n2n Claims believe that a claim may be declined, they will send you a Procedural Fairness letter, and may also send you a request for further information. n2n advises that you have 7 days to contact n2n to advise that you will provide the information requested, and 28 days to provide that information.

Step 2:

You must contact n2n within 7 days to advise that you will provide any requested further information, and must provide that information within 28 days.

Step 3:

Once n2n receives the further information, they will complete an assessment of this information within 5 days. The case manager will submit a recommendation to management. If accepted, the claim will go through the acceptance process.

Step 4:

You will receive either an acceptance letter or a decline letter, and will be advised of the steps of appeal, to consider if you feel appropriate.

'Income' – What’s Included & What’s Not

‘Income’ means the average weekly income before personal deductions and income tax, excluding any reimbursement allowances (such as travel, accommodation, laundry, tool and meal), actually paid to the Insured Person which was earned from personal exertion from their usual employment with the Insured, during the 52 week period immediately preceding the last pay period prior to the Disablement for an Injury or Sickness resulting in payment of Benefits covered by the Policy.

If an Insured Person has had less than 52 weeks of Continuous Cover, their income will be averaged over the period of Continuous Cover.

‘Income’ excludes:

– Reimbursement of expenses
– Long services leave (paid but not taken)
– Any other non-regular income

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