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Policy Owner
You
How to Make a Life Insurance Claim
Short Answer
Simply put, it's an agreement between you and an insurer that if something happens to you, a lump sum of money is paid to your beneficiaries (your partner, kids or dependants) in the event you pass away or are diagnosed with a terminal illness. It's a way to protect those who depend on you financially, covering things like the mortgage, your children's education costs, and everyday living expenses.
You'll also hear "life insurance" used as a catch-all for a few different covers, TPD, trauma and income protection. They each do a slightly different job, and we'll get to all of them below.
Life insurance is one of those things most Aussies don't think much about, until something changes. Buying a home, starting a family, or realising that other people depend on your income has a way of bringing the question into focus.
The good news is it doesn't need to be complicated. Below, we'll break down how it works, what it covers, and how to work out whether you need it.
What is life insurance?
Life insurance is an agreement between you and an insurer.
Claim
approved
Pays
premium
2
Insurer
Insurance Company
Claim
approved
3
Beneficiary
Your Family / Loved Ones
Owns the policy and pays premiums.
Provides the insurance cover.
Receives the benefit if a claim is paid.
When an approved claim is paid, where that money lands depends on how your policy is held.
Outside super, you can usually nominate your beneficiaries directly on the policy.
Inside super, it goes to your fund first and the trustee pays your nominated beneficiaries.
Why do Australians consider life insurance?
People rarely look into cover out of nowhere.
It's usually triggered by a moment when the stakes suddenly feel real:
It's usually triggered by a moment when the stakes suddenly feel real:
Starting a family
Once a partner or child depends on your income, the cost of that income disappearing becomes a genuine concern.
Buying a home
A mortgage is a large, long-term commitment that doesn't pause if something happens to you.
Protecting your income
For many people, their ability to earn is their family's financial foundation, and the one most worth protecting.
Going self-employed or contracting
Employees have sick leave and often some cover through work. Sole traders, contractors and business owners generally have neither, and that gap tends to become obvious fast.
Reviewing super cover
Many Australians have some default life and TPD cover through their super fund without ever having chosen it. It's a genuinely useful safety net but the amounts are often modest, the definitions are usually broader-brush than a retail policy, and cover can be reduced or switched off without you noticing.
If any of those sound familiar, you're in good company, they're the most common reasons Aussies start exploring cover.
What types of life insurance are there?
"Life insurance" is often used as a catch-all, but it actually covers a few different products, each designed for a different kind of risk.
Life cover (also called death cover)
Pays a lump sum if you pass away or are diagnosed with a terminal illness. It's the cover most people picture, and it's commonly used to help clear a mortgage or support a family.
TPD insurance (Total and Permanent Disability)
Pays a lump sum if you become permanently unable to work due to illness or injury. It can help with rehabilitation, debts, and ongoing living costs when income stops for good.
Trauma insurance (also called critical illness cover)
Pays a lump sum if you're diagnosed with a specified serious condition, such as cancer, heart attack, or stroke, to help with treatment and recovery costs.
Income protection
Pays regular monthly payments, rather than a lump sum, if you can't work for a period due to illness or injury. It's designed to replace part of your income while you recover.
Many Australians end up comparing more than one of these together, since a single product rarely covers every financial risk.
How does life insurance work?
It's pretty straightforward:
YOU APPLY
❯❯
YOU GET ASSESSED
❯❯
❯❯
IF A COVERED EVENT OCCURS
❯❯
HOW CAN YOU GET LIFE INSURANCE?
What is Underwriting?
Underwriting is the process an insurer goes through to assess your health, occupation, income and lifestyle before offering you cover. It usually means answering a set of medical and occupational questions, and sometimes providing medical evidence.
Why underwriting matters to you?
When the assessment happens upfront, you know what you're covered for before you ever need to claim. Any exclusions, extra costs or special terms are put in writing at the start, rather than being worked out at claim time when your family is least equipped to deal with a surprise.
Generally in Australia, there are three main ways people purchase cover.
The main difference between them is when that underwriting assessment happens.
RETAIL COVERArranged through an adviser or insurance specialist, and fully underwritten upfront. You choose the cover, the definitions are generally the most comprehensive, and it can be held inside or outside super. Once you're on the books, the insurer can't single you out to re-price or cancel your policy if your health changes.
Trade-off: the application takes longer, because the assessment is done properly at the start.
DIRECT COVERThe kind you see advertised on TV or online, set up over the phone or through a website. Little or no medical underwriting upfront, so it's quick to arrange.
Trade-off: less flexibility, lower maximum cover, and broad pre-existing condition exclusions. Not much is assessed upfront, so what you're actually covered for can only really become clear at claim time.
GROUP COVER THROUGH SUPERDefault cover that comes automatically through your super fund, usually up to a set amount with no medical questions. Premiums come out of your super balance instead of your take-home pay.
Trade-off: the fund picks the definitions, not you, and TPD is often assessed on whether you could do any job rather than your own. Cover can also be reduced or switched off without you noticing.
None of these is automatically right or wrong. Direct and super cover suit plenty of people, especially when simplicity matters most, and default cover is far better than none. The key is simply knowing which type you have, and what's actually been assessed upfront versus left until claim time.
We will walk through the full process, application, underwriting, premiums, and claims, in a dedicated guide.
Do you already have cover through super?
Here's something a lot of people don't realise: you may already have some life insurance through your superannuation fund. Many funds provide default cover, which can include life cover, TPD, and income protection, with premiums deducted from your super balance.
It can be a reasonable starting point, but default cover is based on population-wide averages rather than your personal situation, so the amount isn't always enough for a household with a mortgage or dependants.
Cover can also switch off without you knowing. Funds cancel insurance on accounts that have been inactive for 16 months, and new members under 25, or with balances under $6,000, generally don't get default cover unless they opt in. If you've changed jobs a few times and left old funds behind, cover you assumed was still there may not be.
It's worth checking what your fund actually provides before assuming you're covered.
What actually drives your price?
No two people pay the same, because premiums are priced to each individual. Your age, health, lifestyle and how much cover you take are all considered when premiums are calculated. Here's what insurers look at:
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Premium types & structures
Stepped premiums are recalculated each year based on your age. They start lower, which makes them easier to take on, but they rise every year and the increases accelerate as you get older.
Level premiums are calculated based on your age when the cover started. They cost more in the early years but are designed to be far more stable over the long term, which usually makes them cheaper overall if you hold the cover for a long time.
A common misunderstanding: level premiums are more stable, not fixed. Insurers can still change the underlying premium rates across a group of policies, and if your cover is indexed to inflation each year, your sum insured and therefore your premium will rise with it. Level premiums also typically convert to stepped at a set age, often 65 or 70.
Compare different insurers because pricing and policy terms vary.
What life insurance doesn't cover
No policy covers everything, and knowing the limits upfront is part of choosing well.
Every product has its own definitions, waiting periods and exclusions, and they're set out in the Product Disclosure Statement. It's worth reading the parts that apply to your situation.
Compare different insurers because pricing and policy terms vary.
Frequently Asked Questions
Compare life insurance options with confidence
Life insurance policies can differ significantly between insurers, in coverage definitions, exclusions, waiting periods, premium structures, and optional features. The right cover depends on your circumstances, your financial responsibilities, and what you're trying to protect.
Protect Buddy helps Australians compare life insurance options and understand available cover clearly, so you can explore policies with greater confidence, even if this is the first time you've looked into it.
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The information on this page is general advice only. It has been prepared without taking into account your objectives, financial situation or needs. Before acting on it, you should consider whether it's appropriate for you, and read the relevant Product Disclosure Statement and Target Market Determination before deciding whether to acquire a product. Protect Buddy is a Corporate Authorised Representative (CAR No. 1319120) of Nexa Life Solutions Pty Ltd (AFSL 563622).
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