What to do if your super insurance claim is denied

Last updated on October 30th, 2025

Anyone who has had a super insurance claim denied knows it feels like being kicked when you’re down.

We make claims when we are at our most vulnerable, battling serious illness or injury, unable to work, or mourning the loss of a loved one.

Whether lodging a claim for total and permanent disability (TPD), death benefits or income protection, there is an expectation that this money will help ease the pain and distress.

More than eight million Australians have some level of insurance through their superannuation, though many are unaware of how much the cover is for, or under what conditions they can claim superannuation benefits.

About 70 percent of fund members only have insurance at the default amount, so you may be entitled to a lot less than you think if you are unable to work, for example.

 

 

Industry under fire for claims handling

A total of $1.7 billion in death benefits and $3 billion in TPD benefits were paid out in 2023-2024, according to the Association of Superannuation Funds Australia (ASFA).

However, the industry has come under criticism over delays and claim handling issues, with the Australian Securities and Investments Commission (ASIC) saying they had contributed to genuine suffering.

This comes after the financial watchdog launched proceedings against CBus late last year for allegedly failing to handle death and TPD claims efficiently, honestly and fairly after more than 10,000 claims took more than 90 days to process.

Super Consumers Australia (SCA) called for a review of insurance in super funds to determine whether Australians were getting what they paid for.

SCA chief executive Xavier O’Halloran was particularly critical of the way funds handled increasing mental health claims.

“They can drive down claims through complex claims processes and restrictive policies, or put up premiums,” he told Professional Planner. “Neither of these lead to good outcomes for consumers.”

 

 

Reasons for super claim rejection

While there are many different – and valid – reasons why a super fund might deny a claim, these are some of the more common:

• • Incomplete or inaccurate paperwork – Issues could include missing signatures, incomplete forms, outdated medical reports or employment history gaps.
  • Policy exclusions and eligibility criteria – The claim may fall outside the fund’s conditions for waiting periods, employment or contribution history. It could be denied if you haven’t been off work long enough, for example, or you’re not classed as “disabled” under the TPD terms.
  • Pre-existing conditions – If your fund can establish a history of the illness or disease before you took out insurance (or within the policy’s exclusion period), they may deny the claim.
  • Missed deadlines or lapsed cover – Your fund may require you to make ongoing contributions or maintain employment status. If your account lapsed, your cover ceased, or you didn’t lodge the claim within the required time, that can lead to a denial.
  • Policy status or fund changes – If the account has been inactive, you’ve changed jobs and your cover wasn’t rolled over correctly, or your fund merged and changed terms without your knowledge, you could also have your claim denied.

 

 

What to do if your claim is rejected

While a denied superannuation claim can be devastating, it is not the end of the road.

Review the decision carefully. Make sure the letter from the fund explains why the claim was denied. It should contain specific reasons, such as “your condition did not meet the definition of TPD under the policy” or “the medical evidence you provided was insufficient”.

The letter should indicate how long you have to appeal the decision. You generally have about 28 days to start an internal dispute, and up to two years to lodge a complaint with the Australian Financial Complaints Authority (AFCA).

Use the time wisely. Go back over the evidence you provided to see if there is anything you missed. Focus on the reason given for the rejection, such as incomplete forms or missing work history, and fill those gaps.

Check your super fund’s internal dispute resolution (IDR) process. If it’s not on their website, ask for it to be provided to you. Submit new or additional information, clearly addressing the reason for the denial, and ask them to reconsider.

If the response is unsatisfactory, consider making a formal complaint

 

 

Preparing for a super insurance claim

No one wants to make a claim on their super insurance. But it is in your best interests to be prepare for the worst case scenario. Spending some time now could save you, or your family, a lot of heartache in the future.

Make sure you understand your policy. Check your level of cover. See what definitions apply for TPD, income protection and death benefits. Determine any exclusions, such as the waiting period or pre-existing conditions.

Keep thorough records. Regularly update your medical files, maintain detailed employment records, such as changes in hours or duties. Save paperwork from your super fund about your insurance.

Stay on top of your super. Ensure your account is active, contributions are being made, and your insurance cover is still valid. Income protection eligibility, for example, changes with age, so don’t assume you are covered.

Address issues early. If you have a medical condition before cover started, or if you foresee you may need to claim, talk to your fund/insurer about how it may affect your eligibility. In some cases, you might be better to seek additional cover outside super separately.

Check in regularly. Check your fund’s website, your statements, and your member portal regularly to ensure the information is correct and up to date.

We’re here to help

Making a claim for super insurance is stressful enough. Having a super claim rejected can be devastating.

The longer a payout is delayed, the more difficult your circumstances can become.

If you believe your claim has been unreasonably rejected, make a complaint with us and we’ll help you handle it.