Salary continuance insurance claim workflow
Salary continuance claims turn on three things — the TPD vs income protection definition, the waiting and benefit periods, and the medical evidence. The insurer's own claim form asks narrow questions; a claimant who completes it without advice often undersells the restrictions, leading to an avoidable decline.
This is an 8-step workflow for a salary continuance or income protection claim, including superannuation-linked cover. It runs from policy review through evidence gathering, claim lodgement, decision review, and AFCA escalation.
Before you start
- Signed costs agreement and conflict check
- Copy of policy schedule and PDS
- Client instructions on occupation, duties, and incapacity
- Treating practitioner contact details
The workflow
Locate every salary continuance policy
Identify group policies through each superannuation fund, any employer-provided standalone cover, and any personal policies. Request policy schedules, PDS, and any variation endorsements.
Read the disability definition carefully
Read the disability definition for each policy — own occupation, any occupation, duties-based — and identify the waiting period, benefit period, and offsets (super contributions, Centrelink, workers' comp).
Gather medical and occupational evidence
Gather treating practitioner reports, specialist reports, hospital records, and an occupational statement describing the duties actually performed. Tailor reports to the specific policy definition.
Complete the claim forms with care
Complete the claim and employer statement forms, ensuring the description of duties matches the policy definition. Do not compress or understate ongoing restrictions.
Track the claim against the Insurance Code timeframes
Track the insurer against the Life Insurance Code of Practice timeframes — acknowledgment, decision, and updates — and issue progress letters where timeframes slip.
Respond to medical and surveillance requests
Advise the client on IME attendance and surveillance, preserve the client's rights under the policy, and respond to any surveillance material relied on to decline.
Review a decline or partial decision
On decline, request the insurer's reasons in writing, obtain the claims file under privacy laws, and prepare an Internal Dispute Resolution response addressing each reason.
Escalate to AFCA or court
If IDR fails, lodge an AFCA complaint within statutory timeframes or issue proceedings for breach of contract and statutory duty of utmost good faith under the Insurance Contracts Act.
What you will have at the end
Either a paid claim with ongoing monthly benefit through the benefit period, or an AFCA determination or court outcome addressing a disputed decline.
Common issues
- Claimant completes forms before legal advice, undercutting future claim
- Offsets miscalculated, reducing the monthly payment
- Multiple policies (super-linked and standalone) not identified
- IME report accepted without review or challenge
- AFCA time limits missed after IDR decline
Run this workflow on a real matter
Quillio maps duties against each policy definition, prepares the claim statement and IDR response, and drafts the AFCA complaint. See /practice-areas/employment-lawyers or start a free trial at /free-trial.
General guide only — not legal advice. Income protection, TPD, and super-linked policies overlap; obtain specialist advice before lodging.
Try this workflow with Quillio.
Quillio can run this workflow on a real matter, with citations to current AU authority on every step. The free trial requires no credit card.
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