Do You Know About the Specified Injury Benefit?

Do You Know About the Specified Injury Benefit?

We’ve been speaking with quite a few clients lately as part of their annual reviews and finding out that in the recent past they’ve had an injury or accident that resulted in a broken bone. “Oh yeah, I broke my ankle playing soccer” or “I broke my wrist skiing” and “I broke my collarbone in a fall” are some of the examples clients have shared with us recently.

When we tell clients they might be able to make a claim for this they don’t believe us. However, did you know that on most Income Protection policies that we advise on there is a benefit called Specified Injury?

What is Specified Injury?

It’s really simple – if you suffer from a fracture to a bone as listed in the policy document of your product provider then the waiting period will be waived to 0 days and you will be paid a multiple of your monthly Income Protection benefit depending on the fracture. Amazingly, you don’t have to stop work to make a successful claim!

Specified Injury Table

Each company is slightly different in their payment periods but on average you can expect the below depending on the break:

Make sure you check with us and/or check your product provider’s PDS for more info.

How to Qualify for a Claim

  1. Have fractured a bone that is listed in the above table since the policy was put into force and,
  2. Provide an x-ray report and any other supporting medical evidence along with a short claim form from the insurer.

 

Worked Example

Let’s say that you have fractured your ankle playing soccer. You’re still able to work but you’re hobbling about in a moon boot. No surgery is required and the fracture will heal on it’s own.

You have an Income Protection policy and your monthly benefit is $7,500 per month. Your waiting period is 90 days.

Based on the table above:

  • The waiting period is waived to 0 days
  • You will be paid 2 months x $7,500 upfront as a lump sum = $15,000.

 

Real Client Examples

  • A client who fell from a tree and broke his collarbone received $18,619
  • A client who broke their pelvis in a cycling accident received $17,051
  • A client who broke their wrist losing their balance on a ladder received $21,604
  • There are also statutes on when the break occurred as long as you held the policy prior to the incident – a client who broke their collarbone in a fall from a horse in 2011 made a successful claim in 2018, which resulted in a payout of $8,254.

 

Other things to Consider

  • Specified Injury option generally is not available on policies held in employer/retail super funds such as industry super fund. If you are a client of ours and have Income Protection it is likely you have this benefit, even if you have a policy through your SMSF or paid via super rollover.
  • Specified Injury only applies on policies with a 90 day waiting period or less

 

Have you broken a bone since your Income Protection was put into force? Not sure if you qualify for a claim? Want to discuss further? Call our office on 02 9633 5530 and we can have a chat.

Sacha Loutkovsky
sacha.l@orionfg.com.au
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