By Tony Smilevski · Updated 11 October 2026
Key points
- Each insurer sets its own claim process; for example, ClearView's PDS asks you to notify it as soon as reasonably possible,[1] and Acenda's PDS asks for notice as soon as practicable, preferably within 30 days of the event, with completed forms preferably within 90 days of the disability beginning.[2]
- APRA and ASIC industry-wide figures (all channels combined, 12 months to 31 December 2025) show the share of claims in the first 0-2 week band and the estimated average duration: death 76% and 1.0 months, TPD 22% and 3.8 months, trauma 56% and 1.4 months, income protection 52% and 1.4 months. These figures are not about any one insurer or claim and don't predict how long a claim will take.[3]
- TAL's PDS says claims will not be paid if the criteria and requirements aren't met or an exclusion applies,[4] and OnePath's PDS says withholding information it reasonably requires will delay a claim and could result in a declined claim.[5]
- Acenda's PDS says that for insurance in super it will not pay a benefit unless the trustee can immediately release it under a condition of release, except for insurance that started before 1 July 2014.[6]
- ClearView's PDS says AFCA's service is "free to consumers", that time limits may apply, and that AFCA will likely refer a person back to the insurer if the insurer hasn't been contacted first.[7]
These are general reasons taken from PDSs, not a prediction about any claim.
A life insurance claim starts when you tell the insurer about an event that may be covered, such as a death, a disability, an illness or an injury. The insurer then asks for forms and evidence, assesses the claim against the policy terms and tells you its decision.
How does the life insurance claim process work?
Each insurer sets its own process. Examples:
- Tell the insurer. ClearView's PDS asks you to notify it as soon as reasonably possible if you believe you may be eligible for a claim.[1] OnePath's PDS asks you to tell it about a claim as soon as practicable, and says a claim "may be reduced, or refused, but only to the extent our liability under the policy is prejudiced as a result of the delay."[5] Acenda's PDS asks you to notify it as soon as practicable, preferably within 30 days of the event, and to return completed forms preferably within 90 days of the disability beginning.[2]
- Provide evidence. TAL's PDS says you may be asked for a completed claim form, a signed authority to collect medical, occupational and financial information, proof of the event, proof of payment for a reimbursement claim and proof of age (unless previously provided). For death claims it also asks for proof of probate and a death certificate.[8] Zurich's PDS says you are responsible for the standard supporting documents and may need to pay for some, such as a medical report. It pays for medical examinations it reasonably requires.[9][10] Acenda's PDS says proof or information you're asked to provide is at your cost, but it pays for an examination, assessment or interview by a person it appoints.[2]
- The insurer assesses the claim. TAL's PDS says its assessment involves determining whether the claim meets all relevant policy terms and conditions. It may include investigating whether the duty to take reasonable care not to make a misrepresentation was complied with when the policy was applied for.[8]
How the insurers compare
What each insurer's PDS says about telling it and providing evidence:
- Insurer: ClearView — Telling the insurer: Notify as soon as reasonably possible if you may be eligible for a claim.[1]; Evidence and conditions: You must provide the information it reasonably needs to establish your entitlement.[1]
- Insurer: OnePath — Telling the insurer: Tell it as soon as practicable; it commits to reach out within 24 hours.[5]; Evidence and conditions: A claim may be reduced or refused only to the extent the delay prejudices its liability.[5]
- Insurer: Acenda — Telling the insurer: As soon as practicable, preferably within 30 days of the event; forms preferably within 90 days of the disability beginning.[2]; Evidence and conditions: You pay for proof you provide; Acenda pays for an examination, assessment or interview it appoints.[2]
- Insurer: TAL — Telling the insurer: May ask for a claim form, signed authority to collect information, and proof of the event and age; death claims also need probate and a death certificate.[8]; Evidence and conditions: The event must occur while the cover is in force.[8]
- Insurer: Zurich — Telling the insurer: You supply the standard supporting documents and may pay for some, such as a medical report.[9][10]; Evidence and conditions: Zurich pays for medical examinations it reasonably requires.[9][10]
Where do I get a life insurance claim form?
From the insurer, once you tell it about the claim. TAL's PDS says that once it is notified, it provides the forms and explains its requirements and next steps.[8] Zurich's PDS says you can access a claim form on its website or ask for one to be sent.[9]
How long does a life insurance claim take?
It depends on the cover type and how quickly evidence arrives. OnePath's PDS commits to a first response: within 24 hours of being informed by your financial adviser or receiving your call, it will reach out and say what it needs to assess the claim.[5] TAL's PDS says it has adopted the Life Insurance Code of Practice, which "sets out timeframes for insurers to respond to claims".[11]
APRA and ASIC also publish industry-wide processing times.[3] For the 12 months to 31 December 2025 (all channels combined), the first band (0-2 weeks) and the estimated average duration were:
- Death: 76% in 0-2 weeks; 1.0 months.[3]
- TPD (total and permanent disability): 22% in 0-2 weeks; 3.8 months.[3]
- Trauma: 56% in 0-2 weeks; 1.4 months.[3]
- Income protection (APRA shows it as DII, disability income insurance): 52% in 0-2 weeks; 1.4 months.[3]
These figures are not about any one insurer or claim, and they don't predict how long a claim will take. The full statistics are on APRA's website.
How do I claim TPD insurance, including through super?
A TPD claim involves telling the insurer, completing its forms and providing medical evidence that you meet the policy's TPD definition. If the cover is held in super, the fund's trustee is involved too. Our TPD insurance guide explains the definitions.
Through super, the trustee of the fund is involved:
- Acenda's PDS says that for insurance in super the trustee is the policy owner.[12] It says the trustee releases benefits to you if super law permits. For TPD, the related condition is permanent incapacity, which it describes as the trustee being reasonably satisfied that ill health makes it unlikely you will engage in gainful employment for which you are reasonably qualified. It also says that for insurance in super it will not pay a benefit unless the trustee can immediately release it under a condition of release, except for insurance that started before 1 July 2014.[6]
- Zurich's PDS says a benefit payable under a policy held in super is paid to the trustee, who may need to conduct further assessment.[10]
Our life insurance in super guide has more.
How do I claim income protection?
Acenda's PDS says income protection pays a monthly benefit if you are totally or partially disabled for longer than the waiting period while insured.[13]
Zurich's PDS lists evidence for income protection claims, including: medical evidence that supports the condition; evidence of absence from work; details of your occupation and employment arrangements; financial evidence, including other insurance cover; pre-claim earnings, monthly earnings and ongoing income; payments received while on claim; and, if it asks, tax returns and other proof of income.[14] Our income protection guide has more on waiting periods.
How do I claim on trauma insurance?
Zurich's PDS says trauma claims must be supported by confirmatory investigations, including clinical, radiological, histological and laboratory evidence.[9] Some cover has a survival period. TAL's PDS says that if its critical illness insurance is not attached or linked to life insurance, no benefit is paid unless the person survives the event for at least 14 days.[15] See our trauma insurance guide.
Why are life insurance claims declined or delayed?
These are general reasons taken from PDSs. They are not a prediction about any claim.
- The policy terms aren't met. TAL's PDS says "claims will not be paid if the criteria and requirements to make a claim are not met, or an exclusion applies".[4] Acenda's PDS says all its insurances have specific definitions that must be satisfied before a benefit is payable.[16] Acenda's income protection, for example, pays only if you are disabled for longer than the waiting period.[13]
- The duty to take reasonable care. TAL's PDS says that if the duty to take reasonable care not to make a misrepresentation isn't met, cover could be avoided or its terms changed, which may also result in a claim being declined or a benefit being reduced. It adds that the insurer may investigate whether information given was true, for example when a claim is made.[17] Our pre-existing conditions guide covers health history at application.
- Missing information. OnePath's PDS says that if you withhold information it reasonably requires to assess a claim, this will delay the claim and could result in a declined claim.[5]
- The cover wasn't in force. TAL's PDS says an event giving rise to a claim must occur while the cover is in force. It also says it is important to keep paying premiums while a claim is assessed, unless it tells you otherwise, so cover isn't cancelled. It says people in financial hardship can call it to discuss options.[8]
How often are life insurance claims paid?
APRA and ASIC publish industry-wide claims statistics.[3] For individual cover they report two channels, which APRA's glossary defines like this:
- Advised: "the sale of individual insurance, with the provision of personal advice".[18]
- Non-advised: "the sale of individual insurance, without the provision of personal advice. This includes where no advice or general advice is provided."[18]
For the 12 months to 31 December 2025, the claims admittance rate (shown as "% admitted") was:[3]
- Death: Individual Advised 97%; Individual Non-Advised 92%.[3]
- TPD: Individual Advised 82%; Individual Non-Advised 69%.[3]
- Trauma: Individual Advised 88%; Individual Non-Advised 84%.[3]
- Income protection (shown as DII, disability income insurance): Individual Advised 94%; Individual Non-Advised 86%.[3]
These are industry-wide results. They are not about any one insurer, product, business or claim, and they don't predict the result of a claim.
What if I disagree with a claim decision?
Complaints usually start with the insurer. ClearView's PDS says AFCA will likely refer you back to the insurer if you haven't contacted it first.[7] It also says it will endeavour to reach a fair resolution if you don't agree with a decision.[1]
If you're not satisfied, or the insurer hasn't dealt with your complaint in its stated timeframe, you can contact the Australian Financial Complaints Authority (AFCA). ClearView's PDS says AFCA's service is "free to consumers" and that time limits may apply.[7] AFCA's contact details are 1800 931 678 (free of charge), www.afca.org.au and info@afca.org.au.[19]
If your concern is about our service, email think@tonyinsurance.com.au. We handle it and notify our licensee. See our Financial Services Guide.
Do I need a lawyer for my claim?
We can't give legal help, so we can't tell you whether you need a lawyer. That depends on your own circumstances, and this page doesn't take them into account.
If you disagree with a decision, the insurer's complaints process and then AFCA are available, and AFCA's service is "free to consumers".[7] A lawyer can give legal help that we can't. Our claims support, described next, is not legal help.
How does Tony Insurance help with claims?
We offer a claim management service. The claims fee applies only to this service and is agreed upfront:
- The first 2 hours of claim support are free.[20] That time covers the initial claim assessment.
- After that, we may charge an hourly rate of up to $400 including GST. We may discuss a fixed-fee option.[20]
- Before work starts, a written agreement sets a maximum estimated fee, which is reduced if fewer hours are needed.
- The fee is only payable if the claim succeeds. There is no charge if it is unsuccessful.
- Extra expenses, such as medical reports or legal fees, may be itemised and invoiced separately.
Claims we've helped with
- TPD claim, 2026. The client's GP and specialist each had to address the policy's own TPD definition. We got the insurer's requirements list, explained what each doctor needed to cover, and coordinated the super trustee's sign-off.[21]
- Trauma claim on linked cover, 2026. Life and TPD cover reduced by the amount paid, because the covers were linked. We lodged the claim and updated the policy records.[21]
- TPD claim under a super policy, 2025. A financial planning benefit wasn't available afterwards, because the cover was owned through super without the insurer's flexible linking option. Ownership and linking can change which benefits apply.[21]
- Income protection inside super, 2026. Tax was withheld from the benefit payments. We collected the forms and tracked the regular medical updates the insurer asked for.[21]
Every claim is assessed by the insurer on its own policy terms; these cases don't predict the outcome of any other claim.
What clients say about our claims help
Rated 5.0 from 50 Google reviews.[22] Excerpts:
"What impressed me most was their transparency and responsiveness during a recent claim process; I felt supported and respected throughout." — M W, Google review
"Tony's dedication and perseverance have truly made a difference. We could not have done this on our own!" — M & C D, Google review
Reviews reflect individual experiences. Outcomes vary.
Questions to ask before you choose
- What evidence does the insurer need, and who pays for each report?
- How long has the insurer said each step will take?
- Is the cover held in super? What does the trustee need to be satisfied of before releasing a benefit?
- If the claim isn't accepted, will the insurer give its reasons in writing, and how do I complain?
Read the insurer's PDS and TMD before deciding. You can find them in our PDS and TMD library. We deal with 11 Australian life insurers. For general information about anything in this guide, book a time with Tony or call 0433 22 77 11.
Sources
- [1] ClearView ClearChoice Combined PDS (Aug 2026), PDF page 33.
- [2] Acenda Insurance and Acenda Insurance (Super) PDS (Apr 2026), PDF page 59.
- [3] APRA and ASIC, Life insurance claims and disputes statistics, 12 months to 31 December 2025 (published 29 April 2026).
- [4] TAL Accelerated Protection Combined PDS and Policy Document (Dec 2025), PDF page 6.
- [5] OnePath OneCare PDS (Mar 2026), PDF page 21.
- [6] Acenda Insurance and Acenda Insurance (Super) PDS (Apr 2026), PDF page 60.
- [7] ClearView ClearChoice Combined PDS (Aug 2026), PDF page 38.
- [8] TAL Accelerated Protection Combined PDS and Policy Document (Dec 2025), PDF page 36.
- [9] Zurich Wealth Protection PDS and policy conditions (Nov 2025), PDF page 90.
- [10] Zurich Wealth Protection PDS and policy conditions (Nov 2025), PDF page 92.
- [11] TAL Accelerated Protection Combined PDS and Policy Document (Dec 2025), PDF page 2.
- [12] Acenda Insurance and Acenda Insurance (Super) PDS (Apr 2026), PDF page 12.
- [13] Acenda Insurance and Acenda Insurance (Super) PDS (Apr 2026), PDF page 42.
- [14] Zurich Wealth Protection PDS and policy conditions (Nov 2025), PDF page 91.
- [15] TAL Accelerated Protection Combined PDS and Policy Document (Dec 2025), PDF page 25.
- [16] Acenda Insurance and Acenda Insurance (Super) PDS (Apr 2026), PDF page 17.
- [17] TAL Accelerated Protection Combined PDS and Policy Document (Dec 2025), PDF page 5.
- [18] APRA, Life Insurance Claims and Disputes Statistics - Explanatory Notes and Glossary (retrieved 30 September 2026).
- [19] Sustainable Life Solutions Financial Services Guide Part One (April 2025).
- [20] Tony Insurance Financial Services Guide Part Two (October 2023).
- [21] Tony Insurance claim files, de-identified (2025–2026).
- [22] Tony Insurance Google reviews (retrieved 30 September 2026).
Just so you know, Tony Insurance operates under Sustainable Life Solutions (AFSL 536966) and can only give general advice about life insurance. That means we'll tell you what you need to know for you to make a good decision, but we can't give you specific advice or recommendations. It also means that everything on our website is only general information and isn't specific to you.
Toni Smilevski, Authorised Representative 343156 of Sustainable Life Solutions Pty Ltd (AFSL 536966)