Each product has a different claim trigger
Medical insurance
The member usually checks benefit eligibility and obtains any required pre-approval before treatment. The insurer applies the medical policy’s benefits, limits and exclusions.
Income protection
The claimant supplies medical and earnings evidence. The insurer assesses incapacity, the waiting period, benefit calculation and any offsets under the policy.
Life, trauma or TPD
The claimant, family or representative supplies the claim form and relevant medical or legal evidence. The insured definition must be met.
Employer support
The employer helps the person find the right process and confirms requested employment information. It should not predict the insurer’s decision.
The insurer decides; the employer and Employee Lab support the process
- Identify the relevant group policy and claims contact
- Start the insurer’s product-specific claim process promptly
- Provide requested claim and employment evidence
- Respond to questions and keep a record of communications
- Receive the insurer’s decision and next-step information
Employee Lab can explain the process, help identify the correct contacts and support communication. It cannot guarantee acceptance, change policy wording or make the insurer’s claim decision.
Collect and share only what the process requires
Health information is sensitive. Keep it out of ordinary manager notes, broad email chains and general HR files where possible. Use the insurer’s claim channel and follow the employee’s authority and the employer’s privacy obligations.
The Office of the Privacy Commissioner says employers generally need consent to obtain ACC information about a person. The same cautious principle is useful operationally: do not assume employment gives unrestricted access to health details.
The FMA says insurers should identify and support consumers in vulnerable circumstances and explain the claim lifecycle and the roles of third parties. Tell the insurer or Employee Lab when the claimant needs accessible communication or additional support.
A question or decline should have a visible escalation path
Ask for the insurer’s reasoning and identify whether information is missing or disputed. Use the insurer’s complaints process before assuming the decision is final.
The FMA says consumers are entitled to fair treatment and can use their provider’s free, independent dispute-resolution scheme if an internal complaint remains unresolved. The correct scheme should be named in the provider’s disclosure information.
Continuation is policy-specific and time-sensitive
Do not promise that group cover automatically converts to an identical personal policy. Check when group cover ends, what products can continue, who qualifies, the application deadline and what premiums or terms will apply.
Fidelity Life currently says an eligible departing member may choose to continue cover privately when moving to new employment if they meet its stated age, occupation, residency, claims-status and 45-day application conditions.
Southern Cross tells members leaving a work scheme to contact it within 30 days to discuss retaining qualifying pre-existing or developed-condition cover. These examples show why the actual insurer and policy deadline must appear in the employer’s leaver process.
Make cover cessation and continuation a standard leaver task
- Record the employee’s final date and affected policy memberships
- Confirm the date each type of group cover ends
- Check the actual continuation eligibility and deadline
- Give the employee written insurer or adviser contact details
- Record that the information was supplied without recording health details
Continuation is the departing employee’s decision. The employer’s job is to provide accurate, timely information and complete the scheme administration required by the policy.