Claiming a disablement benefit

Transcription

1 Rio Tinto Staff Superannuation Fund Claiming a disablement benefit This fact sheet outlines how to make a claim for a disablement benefit and answers some commonly asked questions. This fact sheet only applies to members employed by Rio Tinto and its associated entities. Important note The benefits described in this fact sheet are only relevant to: Employee Members of the Accumulation Division who have disablement insurance cover in the Rio Tinto Fund; and Defined Benefit Division Members who have disablement benefit entitlements in the Rio Tinto Fund, and who qualify for a total and permanent disablement (TPD) or an ill health (if applicable)* benefit as defined in the Fund s Trust Deed. * An ill health benefit only applies to members who joined the Fund before 1 January 2014 and have not opted-out of ill health insurance cover after this date. Different disablement insurance cover applies to eligible Personal Member of the Accumulation Division. If you are a Personal Member please call the Fund Member Helpline on for assistance. What is a disablement benefit? A disablement benefit is the amount payable from the Rio Tinto Staff Superannuation Fund ( Rio Tinto Fund or Fund ) if the Trustee determines that a Member ceased employment with a Rio Tinto or associated employer due to ill health (if applicable) or TPD. For Employee Members of the Accumulation Division, generally, the benefit consists of: the Member s account balance in the Fund (i.e. their accumulated contributions and investment earnings less any fees, costs and levies); and (if eligible for insurance cover) any insurance benefit that the Member was entitled to at the date they ceased employment, which depends on their chosen level of cover (Basic, Medium or Top), their age and base salary at this date. # For Defined Benefit (DB) Division Members the disablement benefit is generally based on a multiple of base salary. Can I submit a disablement benefit claim? You can submit a disablement benefit claim to the Fund if you: were a Member of the Fund and employed by Rio Tinto or an associated employer when you ceased active work; had TPD and/or ill health (if applicable) insurance cover or disablement benefits in the Fund at the date you ceased work, and you ceased work due to illness or injury. How do I initiate a claim? You can make a claim by contacting the Fund Member Helpline on or by writing to the Fund at GPO Box 4303, Melbourne VIC The claim will be assigned to a Case Manager who can advise the requirements that will enable the Trustee to determine your eligibility for a disablement benefit in accordance with the rules and definitions in the Trust Deed. Initially you will be required to complete a Member Statement and provide details regarding: your occupation, work history and education the illness or injury that caused you to cease work the medical practitioners and specialists treating you currently and other details such as when you terminated employment or ceased work what treatment you are or were receiving which type of disablement benefit (TPD or ill health, if applicable) you wish to apply for. Once you have completed the Member Statement, this document, along with any other supporting medical information you wish to provide, can be forwarded to the Case Manager. If you need any assistance in completing the Member Statement, the Case Manager will be able to assist. # Employee Members of the Accumulation Division cease to be eligible for insurance cover once they turn age 65. Such cover may be subject to special restrictions, conditions or terms applicable to a Member s insurance cover in the Fund. Website: Fund Member Helpline:

2 Your Employer will also be required to complete an Employer Statement for the purposes of the claim. Once they have completed this document, they will forward it to the Case Manager as part of the claim process. What happens after the Member Statement and Employer Statement have been received by the Fund? Your Case Manager will confirm with you when both the Member Statement and Employer Statement have been received. When the Member Statement is received, the Case Manager will review the information provided and will request from your treating doctors and/or specialists whatever further medical reports and other evidence it considers are necessary in order for the Trustee of the Fund to be able to make a properly informed decision as to whether you satisfy a relevant disablement definition and meet the other applicable criteria to qualify for a TPD or ill health (if applicable) benefit under the Trust Deed as a result of your medical condition. In some instances, you may need to undergo an independent medical examination, at the Fund s expense, to help in the assessment of the claim. The extent of the medical information required will depend on the nature and complexity of the injury or illness. You will be notified by the Case Manager if additional medical evidence or other information is required. Please note that where a Member supplies medical reports from their treating doctors or specialists with their initial claim documentation, if it is not within the Fund s specific guidelines, a supplementary report from the same treating doctor or specialist may need to be requested. The guidelines require that any medical report must address whether the Member satisfies the specific Fund definition of TPD or ill health (if applicable) and why. Once sufficient medical evidence has been obtained the claim will be referred to the Trustee s Claims Committee for consideration and determination. The Claims Committee meets regularly to ensure all claims are considered as promptly as possible. You may also be requested to review all the obtained medical evidence for your disablement benefit claim prior to your claim being considered by the Claims Committee. In this case, you will be provided with an opportunity to submit further medical evidence or information in support of your claim prior to the claim being considered. This process is known as procedural fairness. Important definitions Employee Members means those who are employed by Rio Tinto or an associated employer and whose compulsory employer superannuation is paid to the Fund. Total and permanent disablement means, in relation to an Employee Member having been absent from the employ of the Employer as a result of permanent incapacity for six consecutive months (or for such shorter period as in the circumstances the Trustee considers appropriate). Permanent incapacity means that, in the opinion of the Trustee, the Member s ill health (whether physical or mental) makes it unlikely that the Member will engage in gainful employment for which the Member is reasonably qualified by education, training or experience. Ill health means, in relation to a Rio Tinto Employee Member, physical or mental ill health (not amounting to total and permanent disablement) caused through illness, infirmity or accident which, in the opinion of the Trustee after consideration of medical evidence, any statement from the Employer and such other matters as the Trustee thinks fit, renders the Member unable to perform: (a) their normal duties for the Employer before they ceased normal active employment with the Employer; and (b) the duties of any other position with the Employer for which the Employer considers them to be reasonably suited and which is offered to them by the Employer, such duties being as determined and advised to the Trustee by the Employer. Ill health means, in relation to a QAL Employee Member, physical or mental ill health (not amounting to total and permanent disablement) caused through illness, bodily injury, disease or infirmity and not incurred or inflicted for the purpose of obtaining a benefit from the Fund which in the opinion of the Trustee renders the Member unable to perform: (a) their normal duties for the Employer before they ceased normal active employment with the Employer; and (b) the duties of any other position with the Employer for which the Member is suited by reason of education, training or experience, such duties being as determined by QAL. Importantly, if an ill health benefit is determined to be payable, it will be subject to preservation requirements imposed by superannuation law. This means some or all of the benefit may have to remain in the Fund (or another complying superannuation fund if rolled over) until you permanently retire from the workforce after your preservation age or meet another condition of release under superannuation law. 2 Website: Fund Member Helpline:

3 My doctor says I m disabled why is medical evidence required? For the Trustee to approve payment of a disablement benefit under the Trust Deed, it must be satisfied that, while a Member of the Fund: you met the definition of either TPD or ill health (if applicable); and you met all the other applicable criteria to qualify for a TPD or ill health (if applicable) benefit under the Trust Deed (for example, that you ceased to be in employment with your Employer because of, or by reason of, your disablement). Medical guidelines are provided to any medical practitioners and specialists that a report is requested from. These guidelines ensure that when completing the medical report, your treating doctor or specialist is stating their opinion as to whether you satisfy the specific Fund definition of TPD or ill health (if applicable) and why. If you do not satisfy the relevant definition and other criteria for a TPD or ill health (if applicable) benefit, based on the terms of the Trust Deed, a disablement benefit cannot be paid to you from the Fund. Typical claim process Notify the Fund that you wish to lodge a disablement claim Claim forms will be issued to Member and Employer Once claim forms are received from both Member and Employer, additional evidence will be obtained so there is sufficient material for the claim to be properly considered Trustee s delegate, usually the Trustee s Claims Committee, will consider the claim and make a decision Decision will be advised to Member by Fund administrator Approved claims will be paid Note: ill health benefits (if applicable) are subject to preservation requirements under superannuation law (explained on the next page) meaning that some or all of the benefit may not be immediately payable to you in cash If the claim is declined the decision and complaint process will be advised by the Case Manager Who pays for the medical reports and any medical examinations? Once your claim has been lodged with the Fund, the cost of obtaining any further medical evidence or an independent medical examination (including any reasonable travel cost associated with attending any scheduled medical appointments) is covered by the Fund. How long will the claim process take? Each case is different. Finalising a claim can be a complex process and delays may be experienced when obtaining medical reports from doctors or in arranging medical appointments, so it may be several months before the Trustee is able to make a final decision. Your Case Manager will regularly follow up all parties required to provide information to support your claim to ensure any delays are minimised. They will also provide updates to you on a regular basis. Who do I contact if I have questions during the process? Once you have lodged your claim, you will be provided with a dedicated claims phone number for assistance with any queries you may have in relation to the process or the status of the claim. How can I help progress my claim? You can help progress your claim by submitting your properly completed claim form as soon as practicable after ceasing employment with your Employer. The Member Statement should be completed as comprehensively as possible, with all questions fully answered and with current contact details of all your treating medical practitioners and specialists. This will help expedite the initial claim assessment. If the Case Manager subsequently advises you that an additional medical report(s) have been requested from your treating doctor(s) or specialist(s), you may wish to contact them and ask that they respond to this request as soon as possible. You may also want to ensure that if your treating doctor or specialist intends to prepare a report for you for the purposes of a claim, but you have not yet lodged the claim with the Fund, that the report is completed in accordance with the Fund s medical guidelines. What is the Claims Committee s role? The Claims Committee s role is to consider a Member s disablement claim and determine, based on all the evidence obtained, whether you satisfy a relevant disablement definition and meet the other applicable criteria to qualify for a TPD or ill health (if applicable) benefit under the Trust Deed as a result of your disablement. 3 Website: Fund Member Helpline:

4 The Claims Committee will firstly consider the claim under the TPD definition, and if in their opinion the Member does not meet this definition, then they will consider if the Member meets the ill health (if applicable) definition. How will I know the outcome of my claim? If your claim is approved, the Fund s administrator will write to you to outline your available options with respect to the payment of your benefit and include any documentation which needs to be completed. If your claim has been declined or deferred, the Case Manager will advise you of the decision in writing and include details of the Fund s internal complaint and review processes. If my claim is approved, what is the benefit I will receive? If you are an Employee Member of the Accumulation Division, the Fund benefit payable in the event of TPD generally consists of your account balance plus an insured amount (if you are under age 65). The insured amount of your TPD benefit is calculated based on your selected level of cover (Basic, Medium, Top) and your age at the date you ceased employment due to your disablement. It is paid as a lump sum and is not subject to preservation requirements under superannuation law, meaning it can be paid to you in cash. The ill health benefit (if applicable) for Employee Members of the Accumulation Division generally also consists of your account balance plus an insured amount (if you are under age 65), with the insured amount generally being half that of your TPD insured amount. Note that a Member s insurance cover in the Fund may be subject to special restrictions, conditions or terms. Importantly, an ill health benefit (if applicable) is subject to preservation requirements under superannuation law. This means some or all of the benefit may have to remain in the Fund (or another complying superannuation fund if rolled over) until you permanently retire from the workforce after your preservation age or meet another condition of release under superannuation law. The Australian Taxation Office website provides information about these considerations and what criteria must be met. The benefit payable to a Defined Benefit Division Member on disablement is generally based on a formula (typically based on a multiple of base salary) and is subject to the same preservation conditions as for Accumulation Division Members. If I take a retrenchment or redundancy package, am I still able to make a disablement claim? A key consideration in assessing a TPD or ill health (if applicable) claim is whether or not the illness or injury was present at the time you ceased active employment. Under the Trust Deed, a Member s entitlement for a TPD or ill health (if applicable) benefit generally requires the Trustee to be satisfied that you ceased to be in employment with your Employer because of, or by reason of, your disablement. Providing that it is determined that you ceased work due to your illness or injury, receiving a retrenchment or redundancy package will generally not affect your ability to make a claim. Of course, a benefit will only be paid provided your illness or injury meets one of the disablement definitions under the Trust Deed (TPD or ill health). What if I am not happy with the outcome and want to lodge a complaint? If you are not satisfied with the Trustee s decision regarding your claim, you can lodge a complaint via the Fund s internal complaints procedure. A complaint to the Trustee should include the reason for your complaint and include any additional medical evidence or other information that you consider relevant to your disablement benefit claim. The Trustee s internal complaints process seeks to ensure that all complaints received by the Trustee are properly considered and dealt with within 90 days. On the written request of a Member, the Trustee may be required by superannuation law to give the Member written reasons for its decision in relation to their complaint and/or written reasons as to why no decision has been made in relation their complaint within 90 days. If you are still not satisfied with the outcome after this process, you may be able to lodge a complaint with the Superannuation Complaints Tribunal (SCT). The SCT is an independent body set up by the Federal Government to assist in resolving certain superannuation complaints and can be contact on The SCT can only help you resolve your complaint if you have first sought to resolve the matter through the Fund s internal complaints procedure. 4 Website: Fund Member Helpline:

5 More information For any further information about the disablement benefit claim process, before lodging a claim, please contact: Fund Member Helpline: Inside Australia: (8.30am to 7.00pm EST, Monday to Friday) Outside Australia: (8.30am to 7.00pm EST, Monday to Friday) Your regional Superannuation Specialist (Rio Tinto Employees only) Superannuation Specialists Region Contact number address Simon Tennant Victoria Tasmania Queensland (QAL only) (03) simon.tennant@riotinto.com Dean Gorey Western Australia (08) dean.gorey@riotinto.com Darren Beresford Queensland (except QAL) New South Wales Northern Territory (07) darren.beresford@riotinto.com Important note None of the information in this fact sheet takes into account your personal objectives, financial situation or needs. This information is not intended to influence you to make a decision about what to do in relation to your superannuation benefits. Before acting on this information, you should consider the appropriateness of it with regard to your personal objectives, financial situation and needs. You should also consult a licensed or appropriately authorised financial adviser. You should also read and consider the current Fund Product Disclosure Statement relevant to your membership which is available by calling the Fund Member Helpline on Issued by: Rio Tinto Staff Fund Pty Limited (ABN ), Australian Financial Services (AFS) Licence No , as Trustee of the Rio Tinto Staff Superannuation Fund (ABN ). MySuper authorisation Website: Fund Member Helpline: RT445