Most of our clients assume insurers are looking for a reason not to pay. I get why – it’s the story you hear. But in 2024, Australian life insurers paid out $13.3 billion in claims, and 95% of claims made were approved. That’s not a rounding error. That’s the industry doing what it’s supposed to do.
So far this year alone at Pride Advice we have lodged in excess of $10M in claims for clients ranging from Death and Terminal Illness, Cancer, TPD and Income Protection, and this figure is continually climbing.
The question that needs to be asked, isn’t will my claim be paid but, it’s how long will it take, and what can I do to avoid getting stuck in the process.
That’s what this article is about.
Most claims are approved
Most claims are paid for a simple reason: most people claim for something their policy is designed to cover, and the insurer can confirm it using the evidence they’re required to gather.
If insurance claims are usually paid, why do some take so long?
In my experience, delays typically come down to one of three things:
1) Evidence takes time to collect
The honest answer is that most delays aren’t the insurer dragging their feet – they’re waiting on evidence. Medical reports, specialist letters, employer income information, incident reports. That stuff takes time to gather, and if anything comes back incomplete or inconsistent, the clock resets. It’s frustrating, but it’s usually fixable.
2) You’re insured through super (there’s an extra step)
The second thing that slows claims down – and this catches a lot of people off guard – is when cover is held inside super. Most people don’t realise there are actually two parties involved: the insurer assessing the claim, and the super trustee processing the payment under superannuation rules.
3) “Admin gaps” (the avoidable stuff)
The third cause is the one I find most frustrating, because it’s almost entirely avoidable. Forms submitted with missing sections. Dates that don’t match across documents. Medical certificates held up because no one followed up with the GP. Business policies where the ownership structure changed two years ago but nobody updated the paperwork. None of these are complicated problems – they just require someone paying attention before the claim is lodged, not after.
How long should a claim take in Australia?
Under the Life Insurance Code of Practice, insurers aim to provide an initial decision within set timeframes (for income-related claims, generally within 2 months, and for most other claims within 6 months, depending on circumstances and evidence).
But here’s the practical reality:
- Simple claims with clean documentation can be decided quickly.
- Complex claims (TPD, contested medical definitions, multiple treating specialists, business policies with valuation questions, or cover via super with trustee processing) can take longer.
The goal isn’t to rush; the goal is to get everything right and in order in a calm, considered manner.
The “do it right the first time” approach
If you want the smoothest path, focus on these seven steps.
1) Lodge early (don’t wait until you’re desperate)
A common delay trigger is waiting until finances are already strained, then lodging under pressure. Even if you’re unsure, you can often start with a notification and get guidance on what evidence will be needed next.
2) Use one point of contact
When family members, employers, doctors, funds and insurers are all involved, confusion multiplies quickly. Having one person coordinating (your adviser, a nominated family member, or a claims contact) reduces delays.
3) Build a complete “claim pack” upfront
A strong claim pack usually includes:
- ID documents
- policy details / fund details (if super)
- claim forms fully completed
- medical certificates and treating doctor details
- income evidence if relevant (income protection / business cover)
- employer information where required
- bank details, authority forms, and contact details
4) Align the story (dates matter)
A surprisingly common cause of delay is inconsistent dates across forms.
Make sure the timeline is clear and consistent:
- symptoms / diagnosis date
- last day worked (if relevant)
- incident date (if accident)
- treatment timeline
- who your treating practitioners are
5) Sign authorities quickly
Claims often stall waiting for authority forms that allow release of medical or employer information. The faster these are completed, the faster evidence can be collected.
6) Stay responsive
Insurers may request clarification or extra information. A fast response can save weeks.
7) If it’s through super, treat it as a “two-lane process”
For super-held cover:
- confirm what the insurer needs and what the super trustee needs
- keep both moving
- make sure beneficiary documentation is correct (for death claims)
This is where advice support can really reduce friction.
Super trustee processing can add extra time because it’s an additional step beyond the insurer’s assessment.
The bottom line
Rest assured, most claims are approved. When claims become difficult, it’s often because the process is complex, documentation is incomplete, or super trustee steps add extra time.
If you ever need to claim (personally or through your business), the best outcome usually comes from:
- acting early
- being organised
- getting the “first submission” right
Pride Advice offer a bespoke claims management service that takes all the stress and worry away from you at claim time so you can focus on getting better. The team at Pride have over 20 years of claims management experience in both retail and group insurance claims.
If you feel that you may need to claim on your Life, TPD, Income Protection or Trauma policies please make a time to speak to one of our claims experts at Pride Advice.
FAQs: Insurance claims, approvals, and avoiding delays
What percentage of life insurance claims are paid in Australia?
Industry reporting indicates life insurers paid 95% of claims made in 2024, totalling $13.3 billion in benefits. The takeaway is that most claims are approved – the focus should be on lodging correctly and providing evidence promptly to keep things moving.
Why is my insurance claim taking so long?
Most delays come from evidence collection (medical, employer or third-party reports), difficulty contacting the claimant, or missing information. If the insurance is held through super, trustee processing can add extra time because it’s an additional step beyond the insurer’s assessment.
How long does an income protection claim take in Australia?
The gap is driven by compounding factors like the gender pay gap and time out of the workforce for caring responsibilities. WGEA reports a material gender pay gap, and research cited by WGEA/SMC highlights women retire with substantially less super than men.
How do I catch up on super after maternity leave?
Timeframes vary, but under the Life Insurance Code of Practice, insurers aim to provide an initial decision within set periods (income-related claims commonly within 2 months, depending on waiting periods and evidence). Practical tip: having income evidence and medical certificates ready early reduces delays.
How long does a TPD claim take in Australia?
TPD claims often take longer than simpler claim types because they can require extensive medical evidence and specialist opinions to confirm the policy definition is met. Claim duration also depends on responsiveness of doctors, employers, and any additional investigation required. If cover is inside super, add the trustee processing layer.
How long does a life insurance death claim take?
Straightforward death claims can be processed relatively quickly when documents are complete (death certificate, proof of identity, beneficiary information). Complexities arise when beneficiary arrangements are unclear, there are multiple potential beneficiaries, or additional trustee checks are required for super death benefits. ASIC has highlighted service and delay issues in some super death benefit processes.
What documents do I need for an insurance claim?
It depends on the policy type, but common items include: ID, claim forms, policy/fund details, medical certificates, treating doctor contact details, income evidence (if relevant), and signed authorities so insurers can request records. Delays often occur when documentation is incomplete or inconsistent.
How do I claim insurance through super?
Claims through super typically involve both the insurer’s assessment and the super trustee’s payment process. MoneySmart notes insurer claim times don’t include trustee processing time and total time can be longer. If it’s a death benefit, trustee processes and beneficiary rules often add complexity, and ASIC has called out delays in some trustee handling.
Does using an adviser help avoid claim delays?
Good coordination can help. The biggest delays are often administrative: missing information, unclear timelines, slow responses, and lack of coordination between doctors, employers, insurers and trustees. Having a single coordinator keeps evidence flowing and reduces back-and-forth.
Disclaimer: This article is general in nature and doesn’t take into account your objectives, financial situation, or needs. Consider whether it’s appropriate for you and seek personal advice before acting.