Glossary

Weasel Words

[Assessor]

What they say it means

A person who evaluates the quality of a person or thing.

What it actually means

This is the person employed by the insurance company to review your claim and determine whether you satisfy the policy definitions.

[Benefit]

What they say it means

Something that helps you, whether in the form of health insurance provided by an employer, welfare given by the government to those in need, or the benefit of the doubt extended to you by a friend.

What it actually means

This is the level of insurance cover you have at the date you became unable to work due to illness or injury. The financial amount will depend on your age and the insurer

[Claim]

What they say it means

State or assert that something is the case, typically without providing evidence or proof. Formally request or demand; say that one owns or has earned (something).

What it actually means

A claim is the request you make for compensation from your insurer if you suffer a loss that is covered by your insurance policy.

[Death claim]

What they say it means

A death claim is a request to grant the life insurance benefits due under the policy to the designated beneficiaries after the death of the insured.

What it actually means

This is a one-off lump sum payment made to your next of kin or estate in the event of your death. If your claim is accepted, your next of kin are also able to access your Superannuation balance.

[Default cover]

What they say it means

Minimum insurance cover for Death and Total and Permanent Disability (TPD) insurance

What it actually means

This is insurance cover, usually provided through your Super Fund automatically, without you needing to request it. The cover amount will depend on your age and the Super Fund your employer contributes to.

[Duty of disclosure]

What they say it means

Duty of disclosure requires all parties to a family law dispute to provide to each other party all information relevant to an issue in the case. This includes information recorded in a paper document or stored by some other means such as a computer storage device and also includes documents that the other parties may not know about.

What it actually means

When changing your insurance cover or making a claim, you have to provide all information which is relevant to your application. Failure to do so can lead to your cover being cancelled or claim rejected.

[Eligibility]

What they say it means

The state of having the right to do or obtain something through satisfaction of the appropriate conditions

What it actually means

This refers to the policy definitions you need to meet prior to your claim being accepted

[Financial hardship]

What they say it means

Financial hardship is difficulty in paying the repayments on your loans and debts when they are due.

What it actually means

When making a claim, this refers to your inability to meet your financial commitments due to your loss of income. If you are suffering financial hardship, the Insurer must consider your circumstances to determine whether an ex-gratia payment can be made.

[Income Protection]

What they say it means

Income Protection is exactly that – it replaces your income if you can’t work due to sickness or injury.

What it actually means

This is insurance to cover your loss of your usual income as a result of illness or injury. Most policies pay monthly and will cover you for 2 years, however some may be 5 years or until you reach 65 years of age.

[Liability]

What they say it means

The state of being legally responsible for something. A person or thing whose presence or behaviour is likely to put one at a disadvantage.

What it actually means

This refers to the Insurer who will be assessing and paying your claim. As Super Funds will occasionally change Insurers, certain policy terms need to be met to determine which Insurer looks after your claim.

[Over insurance]

What they say it means

Insurance effected upon property where an insured has bought so much coverage that it exceeds the actual cash value of the risk or property insured.

What it actually means

If you opt to increase your insurance cover, this refers to an amount requested which is above your eligible amount. For example, you may request $5,000 Income protection cover per month, however only earn $4,000 from your employment and therefore have over-insured yourself.

[Partial disability]

What they say it means

Partial disability is defined as any type of disability in which the workers is unable to perform at full physical capacity. This is usually due to an on the job injury or due to illness. 

What it actually means

This refers to you being able to do some, but not all, of the duties of your usual occupation as a result of illness or injury. If you are partially disabled, you may choose to return to work on restricted duties and the insurer will pay a reduced benefit based on your earnings.

[Permanent Incapacity]

What they say it means

Permanent incapacity, in relation to a member, means ill health (whether physical or mental), where the trustee is reasonably satisfied that the member is unlikely, because of the ill health, to engage in gainful employment for which the member is reasonably qualified by education, training or experience.

What it actually means

If you are unable to return to work in a role within your previous education, training or experience but don’t have insurance cover, you can apply to access your Superannuation blance through a Permanent Incapacity claim.

[Policy Exclusion]

What they say it means

An exclusion is a policy provision that eliminates coverage for some type of risk. Exclusions narrow the scope of coverage provided by the insuring agreement.

What it actually means

Policy exclusions are specific events that the Insurer won’t pay a claim for. Common exclusions are intentional self-inflicted injuries, uncomplicated pregnancy/childbirth and service in the armed forces.

[Pre-existing condition]

What they say it means

A pre-existing condition is a medical condition that started before a person’s health benefits went into effect.

What it actually means

This refers to a medical condition you were either diagnosed with or suffered from symptoms of prior to obtaining insurance cover. If you make a claim for a condition which is pre-existing, there will likely be additional policy terms to satisfy

[Reinsurance]

What they say it means

Reinsurance is insurance that an insurance company purchases from another insurance company to insulate itself (at least in part) from the risk of a major claims event. With reinsurance, the company passes on (“cedes”) some part of its own insurance liabilities to the other insurance company.

What it actually means

Reinsurance is insurance for insurance companies. This is a method used by insurers to spread their risk and ultimately, the amount of money they pay out.

[Specific events]

What they say it means

Particular things that happen or take place, especially one of importance.

What it actually means

Some policies include additional cover for specific events, for example heart attacks, cancer, loss of eyesight/limbs or stroke

[Terminal Illness claim]

What they say it means

Terminal Illness insurance benefit is the amount of money payable to you if it’s medically determined that you have less than 24 months (Rest Super members) or less than 12 months to live (Rest Corporate and Acumen) 

What it actually means

This is a one-off lump sum payment made to you if you have been diagnosed with a condition which is considered to be terminal. Insurers require confirmation from 2 doctors that your life expectancy is less than either 12 or 24 months.

[Total and Permanent Disability]

What they say it means

A permanent injury or illness can make it difficult or impossible to return work. TPD  insurance can provide a financial safety net to help support you and your family, and pay for medical and rehabilitation costs.

What it actually means

This is a one-off lump sum payment made to you if you are unable to reasonably return to work in a role within your previous education, training or experience.

[Underwriting]

What they say it means

Sign and accept liability under (an insurance policy), thus guaranteeing payment in case loss or damage occurs.

What it actually means

If you opt to increase your insurance cover, this refers to the process of the Insurer reviewing your application and medical history disclosed to determine whether your increase will be accepted, whether some exclusions will be offered or if your request is rejected.

[Waiting Period]

What they say it means

A waiting period is the amount of time you have to wait before you can start to claim on your health insurance. 

What it actually means

This is the period stipulated in your policy that you need to satisfy before your claim and be accepted. Common Income Protection waiting periods are 14, 30, 60 & 90 days. Total & Permanent Disablement are usually between 3 & 6 months