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We pay over 91% of OneCare claims

We pay over 91% of OneCare claims

At OnePath, it’s our business to pay claims – and we’re proud of how we operate. Here you can discover our claim rates and learn why we decline some claims.

You can also look at our claims rates compared to other major insurers in the industry via the claims comparison tool published by the Australian Securities & Investments Commission (ASIC), on their Moneysmart website – they are an independent government authority there to help you make confident decisions about your finances.

We pay over 91% of all claims on OneCare policies

We’ve paid over $962 million for calendar year 2020

Why we decline some claims

To provide a long-term, sustainable life insurance product to all our customers, naturally we have to
ensure that genuine claims are paid, and that illegitimate claims do not end up being paid for by our
honest customers.

  • The majority are related to claims being made that are not actually covered by the product
    terms and conditions
  • A minority have to do with a customer not having disclosed something when they bought the
    product that would have been critical to our decision to offer cover in the first place

Claims can be declined due to:

Being outside the policy terms or definitions

This means that a claim is made on something that is not actually covered in the customer’s policy, so naturally we can’t pay these claims.

Two things you can do to be confident about what you’re covered for:

  1. Be certain about what you’re covered for,
  2. Speak to your adviser to ensure you’re adequately covered for your needs.
Not complying with your duty to take reasonable care not to make a misrepresentation

When taking out a policy the person being insured has a legal duty to take reasonable care not to  make a misrepresentation to the insurer before the contract of insurance is entered into. Not complying with this duty means that an answer in the application may have been false or misleading, only partially true, or an answer does not fairly reflect the truth. There may be circumstances where we later investigate whether the information given to us was true. For example, we may do this when a claim is made.

Some examples could include things like a history of medical issues or an occurrence of specific illnesses or injuries, or inaccuracies in occupational or financial details. Some misrepresentations have a limited impact on underwriting, while others are more significant. Not all misrepresentations are equal, and they’re assessed differently at claim depending on the customer’s circumstances.

Learn more about how our claims team makes decisions and supports claimants in their time of need.

Policy exclusions

This means that a claim is made on an event which has been specifically excluded from the customer’s policy.

For example, if a customer came to us seeking to be protected with Income Secure cover and has a pre-existing condition like depression, we may agree to cover the customer for all events except for those related to their condition and include a premium loading. This 12% of claims are declined because a customer is claiming on an event which is not covered in their individual policy

Check your Policy Schedule for details on policy exclusions related to your policy (the schedule is attached to your Welcome or Renewal letters).

Being fraudulent

We want to pay all genuine claims.

Unfortunately sometimes we discover that some claimants mislead us to get paid out when they don’t have a legitimate reason to be. In the best interest of all our customers, we firmly decline these claims.

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Understanding claims
We pay over 91% of OneCare claims