Document ID: chunk:federal_register_of_legislation:F2018L01496:body:0:p18
Version: federal_register_of_legislation:F2018L01496
Segment Type: other
Provision Reference: 
Character Range: 46585–49354

occurred on the date it was sent. Communication by postal service is deemed to have occurred three business days after it was sent.
    The Claim Finalised Date for DII refers to the date that the claim is admitted, declined or withdrawn and not to the claim termination date (when any regular payments cease because the insured has recovered from disability, the end of the benefit period was reached, or the claimant has died).
    Where DII payments have commenced prior to a final claim decision being made (so-called goodwill payments), the claim should not be classified as Finalised. Such claims should only be classified as Finalised once a final claim decision has been made. If that claim decision is to decline the claim, the claim should be recorded as such, regardless of payments already made.
49.         'Undetermined Claim' refers to a Received Claim that has not been finalised or withdrawn at the end of the Reporting Period. Classification of a claim as Withdrawn, Finalised or Undetermined should be based on its status at the end of the Reporting Period. Any developments between the end of the Reporting Period and the date of the data submission should be excluded from the reporting form.
50.         'Claim Sum Insured' refers to the Sum Insured in respect of the Policy Contract and relevant Cover Type or benefit being claimed for. The full Sum Insured should be reported, ignoring any reduction, even where this is allowed for in the terms of the Policy Contract. The Claim Sum Insured should be gross of reinsurance.
51.         'Claim Amount Paid' refers to the actual amount paid gross of reinsurance. For DII, this is the regular monthly payment to the insured life, policyholder or nominated beneficiary. Where the Policy Contract allows for a reduction in the full Sum Insured (e.g. in the case of severity-based Trauma or Accidental Injury benefits, or for DII due to partial disability or a workers' compensation offset), this field should reflect such a reduction. In the event of varying DII payments during the Reporting Period, the average monthly payment amount should be reported.
    Any amounts paid from a superannuation account balance should not be included in the Claim Amount Paid. That is, only the insurance payout component should be included.
52.         It is possible that the same Claim Event is considered and assessed for multiple Policy Benefits under the same Cover Type or Product. Referring to the three categories defined in paragraph 29, claims in respect of those categories should be dealt with as follows:
(a)          Policy Benefits that can be added together, with the same claim conditions:
(i)            A single claim outcome should be reported, with the Claim Sum Insured and Claim Amount Paid