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      What is trauma insurance?

      Trauma insurance, also known as critical illness insurance, provides a lump sum payment if you’re diagnosed with a serious health condition like a heart attack or stroke. This payment can help cover medical expenses, rehabilitation, income replacement, or even pay off debts.

      Most insurers offer trauma insurance, which you can purchase as a standalone policy or bundle with life insurance. As of 1 July 2014, trauma insurance is no longer available through superannuation — but you can still make a claim if you had it included in your super before this date.

      Importantly, you don’t have to be off work to make a trauma insurance claim. But if your condition does affect your work capacity, you could also receive weekly income protection payments. And if you’re permanently unable to work, you might have a TPD claim, too.

      Speak to us today for expert advice on your trauma insurance claim. Our lawyers will review your policy and explain exactly what you’re entitled to — completely free of charge.

      What does trauma insurance cover?

      We’ve spent over 25 years helping Australians get the trauma insurance payouts they deserve. While each policy is slightly different, these are some of the most common conditions trauma insurance covers:

      • Cancer: including breast cancer, lung cancer, and prostate cancer.
      • Brain injuries: resulting from accidents or certain medical conditions.
      • Heart conditions: such as heart attack, coronary artery bypass surgery, and heart failure.
      • Stroke: including ischemic or haemorrhagic stroke.
      • Major organ failure: such as kidney failure or liver disease. This also includes having a major organ replaced.
      • Neurological disorders: including conditions like Multiple Sclerosis (M.S.), Alzheimer’s or Parkinson’s disease.
      • Other conditions: some policies let you claim for other conditions if you become so disabled that you can’t manage your everyday activities on your own.

      This is by no means a complete list — many more conditions could entitle you to a trauma insurance benefit. To find out exactly what you’re covered for, check the terms of your policy. Alternatively, just give us a ring. Our specialist insurance lawyers can investigate your policy and explain whether your particular condition is covered.

      Am I eligible to make a trauma insurance claim?

      Unfortunately, making a trauma insurance claim is rarely as simple as having a policy and filing a claim. There are many factors that could impact your eligibility to claim. These include:

      • The terms of your policy: your trauma insurance policy outlines the specific conditions covered and the requirements for making a claim. To make a successful claim, you’ll need to show that your condition fits each of your policy’s terms exactly.
      • Medical evidence: to support your claim, you’ll need to provide medical evidence, such as reports from your doctor. This evidence should not only prove your diagnosis, but also show how your condition meets your policy terms.
      • Exclusions and limitations: check if your policy has any exclusions or limitations that may affect your eligibility for a claim. Some policies might not cover pre-existing conditions, or they might have restrictions on certain types of conditions.
      • Waiting period: trauma insurance policies typically have a waiting period you’ll need to serve before starting a claim. This varies between policies but is generally around 90 days.

      How much does a trauma insurance claim cost?

      The exact cost of your claim depends on many factors, like the complexity of your case and how long it takes to resolve. But no matter your situation, one thing stays the same — you’re always protected by our No Win No Fee guarantee. This means:

      • No financial risk: you don’t pay a thing unless we win your claim.
      • No upfront costs: we cover all the expenses, including expert evidence, legal fees, and administrative costs. If your claim doesn’t succeed, you’ll never see a bill from us.
      • Fixed fees: we give you a clear and exact breakdown of our fees upfront. There are no hidden charges or surprises.
      • 30-day risk-free trial: try our services with a 30-day free trial. If you decide to cancel during this time, you won’t owe us anything.
      Find out more about our fees

      Do time limits apply?

      Time limits for trauma insurance claims can vary by policy. Some don’t specify a deadline, while others include a ‘prejudice clause’, meaning you need to file your claim within a certain time to avoid losing your benefits.

      If your trauma insurance claim has been denied, you can appeal the decision. However, strict time limits apply, so it’s crucial to get legal advice before starting. Over the years, we’ve helped hundreds of clients successfully appeal their denied claims.

      The claims process

      While each case is unique, your claim will likely go through the following steps:

      In your free consultation, you’ll talk to one of our lawyers about your situation and how your condition is affecting your life. If you decide to move forward, the same lawyer will likely manage your claim from start to finish, ensuring a smooth process and the best outcome for you.

      To give you the best advice, we’ll thoroughly review the details of your trauma insurance policy. Your lawyer will also gather all the necessary documents for your case, including your medical treatment records. This entire process is completely free, and there’s no pressure to proceed with your claim afterwards.

      Your lawyer will go through your policy with you, explaining what you’re entitled to and the best way forward. They’ll also let you know if there are other claims you could pursue, like workers compensation or Total and Permanent Disability.

      Your lawyer will gather all the necessary evidence to confirm that your condition is covered by your policy, including medical reports, test results, and any other relevant documents. They’ll then fine-tune your case, preparing detailed legal submissions, filling out your claim forms, and submitting everything to your insurance company.

      The insurer will review the medical evidence you’ve submitted and may request additional documents or clarification from your healthcare providers. We’ll manage all their requests and push back on any unnecessary ones, ensuring your claim moves forward as quickly as possible.

      Once the insurer has reviewed your claim, they’ll make a decision. With our thorough preparation and 98% success rate, we’re confident your claim will be approved. Just let us know how you’d like to receive your lump sum payout, and we’ll ensure you get your money right away.

      If your claim is denied, the insurer must provide an explanation. In that case, we’ll start working on your appeal right away — filling out the necessary paperwork and gathering fresh evidence. Our experienced lawyers know exactly how to handle appeals and the best strategy to get your denied claim approved.

      Meet the team

      Our team use their extensive experience to increase your chances of success. We’ve won many awards for our work, including ‘Compensation Law Firm of the Year 2020 GBM Global Awards.’

      Daniella Dababneh
      Senior Associate
      • English, Arabic
      • Superannuation, TPD, Life Insurance
      View full bio
      Leon Monaco
      Managing Partner
      • English
      • Workers Compensation, Motor Vehicle Accidents, Public Liability, Medical Negligence
      View full bio
      Kathryn Morcos
      Solicitor
      • English
      • Family Provision Claims, Public Liability, Motor Vehicle Accidents
      View full bio
      Meet more of the team

      Frequently asked questions

      Most Australian insurers do not cover critical illness for mental health conditions like anxiety, depression and PTSD. However, if you’re temporarily unable to work because of a mental health condition, you could have an income protection claim.

      Additionally, if your condition leaves you permanently unable to work, you could receive a substantial lump sum payout through a TPD claim. Most people automatically have TPD insurance through their super policy, so you’re probably eligible without even knowing it.

      If you’re dealing with a mental health condition, reach out to us today. During your free consultation, we’ll take the time to understand your situation and offer expert advice on getting the support you need.

      Most trauma insurance claims take around six months to complete from the lodgement date. However, if your claim is more complex, it could take up to 12 months for the insurer to make a decision.

      The time it takes depends on three key factors:

      • The size of your lump sum payout.
      • Your policy terms.
      • How well your claim is prepared.

      The amount of compensation

      Insurers often try to avoid paying large settlements by using delay tactics, such as asking for additional medical tests or more information. While some of these requests are legitimate, others are just stalling tactics. An experienced lawyer can help you identify which requests are necessary and which ones are simply meant to slow down your claim, ensuring your case moves forward as efficiently as possible.

      Your policy terms

      Every trauma insurance policy is unique, and some policies are very specific about the types of conditions they cover. This may include certain types of cancers, heart attacks, or strokes.

      For instance, your policy might only cover advanced stages of cancer, meaning you’ll need to provide clear medical proof that your diagnosis meets this criteria. If there’s any ambiguity in how your condition fits within the policy, it may take longer to gather the necessary evidence and get approval for your claim.

      After you file your claim, the insurer may ask you to undergo rehab or other treatment. It’s important to know whether this is a fair request based on your policy. If you’re not sure, an experienced trauma insurance lawyer can take a look at your policy and help make sure you’re being treated fairly.

      How well your claim is prepared

      To speed up the process, we recommend having a specialist lawyer handle your trauma insurance claim. When claims aren’t prepared properly, insurers can delay them for years.

      A lawyer can also challenge any unnecessary requests made by the insurer. In our experience, insurers often use these tactics to drag things out. We know exactly what you’re entitled to under your policy and will make sure your insurer doesn’t overstep its bounds. If delays continue, we’ll take action by sending official warnings and, if needed, referring the matter to the Tribunal or Ombudsman.

      If you’re severely ill, chances are you’re in a difficult financial position — especially if you’ve got medical bills piling up or you’re unable to work. We understand how frustrating it can be waiting for your trauma insurance claim to be resolved. That’s why, throughout the process, we’ll keep you updated and do everything we can to speed things up.

      In our experience, here are some reasons why your claim might be taking longer than expected:

      Wait period

      Before you can lodge a trauma insurance claim, you typically need to serve a designated wait period. This is usually about 90 days but differs depending on your policy. Once this period is over, you can begin your claim.

      Delay tactics

      Insurers often use delay tactics to discourage unrepresented claimants from pursuing their entitlements. Having a dedicated lawyer can help you overcome these tactics, ensuring your claim is processed more efficiently.

      Unexpected circumstances

      In some cases, there are ‘unexpected circumstances’ that can delay your claim. Insurers generally have 6 to 12 months to make a decision, but if something out of the ordinary causes a delay, your insurer must issue an ‘unexpected circumstances letter.’ This letter will explain the delay and outline the next steps. Your lawyer will guide you through this process and help you understand your rights.

      Requests for information

      Your insurer may request additional documentation to assess your claim, including:

      • Medicare and Pharmaceutical Benefits Scheme (PBS) history.
      • Tax and financial documents from the ATO.
      • Centrelink documents.
      • Medical records or reports from your healthcare providers.

      Gathering these documents can sometimes delay your claim. Your lawyer can help speed things up by pushing back on unnecessary requests and sourcing the right paperwork faster from the relevant organisations.

      Don’t accept a ‘no’ from your insurer. We offer a free second opinion and can help you challenge unfair decisions. With years of experience in overturning denied trauma insurance claims, we know how to fight for the outcome you deserve.

      Strict time limits may apply to disputing insurer decisions, so reach out to our lawyers today.

      Trauma insurance benefits are generally tax-free, so long as your policy is not held through your super fund.

      If your policy is held through super, you may need to pay tax depending on how the payment is structured and who it’s paid out to. But rest assured, we’ll fully explain any tax obligations before starting work on your claim — so you’ll know exactly how much you can expect to take home.

      Trauma insurance is different from health insurance in a few key ways. As we’ve discussed, trauma insurance provides a one-off, tax-free lump sum payment if you’re diagnosed with a particular condition, such as cancer, heart attack, or stroke.

      In contrast, health insurance typically covers the ongoing costs of medical treatment, like hospital stays, doctor visits, and surgeries. While health insurance helps with treatment and recovery, it doesn’t provide a lump sum to help with the financial impact of a serious illness.

      Yes, it’s possible to make multiple claims for the same condition. Your entitlements depend on factors like your location, injury severity, and how your condition affects your ability to work.

      As part of our service, we’ll assess all potential claims you could make. In our experience, many of our clients with trauma insurance claims also qualify for additional claims. Often, these extra claims are worth significantly more than your trauma insurance benefit alone. 

      Income protection claims

      If your condition temporarily prevents you from working, you may be eligible for income protection benefits. These can include:

      • Monthly payments covering up to 75% of your regular earnings, including superannuation.
      • Coverage for a defined period, which could range from a few years to until you reach retirement age.

      Total and Permanent Disability (TPD)

      If your condition permanently prevents you from working, you may qualify for a Total and Permanent Disability (TPD) claim. Unlike income protection, TPD offers a one-time lump sum designed to support you for life. Many superannuation plans include TPD coverage, so you could already have this insurance without realising it.

      Workers injury claims

      If your condition occurred at work or is work-related, you could be eligible for a workers compensation claim. You’ll receive weekly payments to cover lost income (up to 95% of pre-condition earnings), along with medical and rehabilitation costs. If the condition is permanent, you may also qualify for an additional lump sum. Plus, if employer negligence caused your condition, you might be entitled to a much larger lump sum through a common law damages claim.

      While you can make a claim on your own, it’s important to know that trauma insurance is a complex area of law. Without solid legal advice, you might not get the full benefits you’re entitled to.

      A specialist lawyer can help with every part of your case, including:

      Delays

      Insurers often try to brush off unrepresented claimants, using tactics to reject or delay claims. A skilled insurance lawyer knows how to handle these tactics and get your claim moving faster.

      Medical evidence

      Recently, courts have ruled that insurers can use their own experts to challenge evidence from claimants. For example, they might insist on using their own medical professionals for tests, rather than relying on the evidence from your doctors. In our experience, this often increases the likelihood of your claim being rejected. But don’t worry — your lawyer is there to challenge the insurer’s claims and ensure you have the strongest possible case.

      Policy interpretation

      Like any contract, your trauma insurance policy is open to interpretation. A lawyer experienced in insurance law will dig into the details and prepare your case to meet your policy’s specific definitions.

      No Win No Fee

      With our No Win No Fee guarantee, your initial consultation is free, and you don’t pay anything unless we win. We’ll even cover the upfront costs for medical assessments or expert reports, so you’re never a cent out of pocket.

      Get free legal advice

      Find out if you have a claim today.

      Make an enquiryCall 1300 769 665
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      What our clients say

      When you walk through our doors, our top priority is to help you as much as we can. This commitment is shown in over 200 5-star reviews.

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      Monaco made the process easy for me, I wouldn't have succeeded on my own.

      My experience with Monaco has been very good. Having commenced my TPD super claim myself, I soon was overwhelmed by the requirements. Although my claim was pretty small compared to others which make headlines, Monaco offered their services on a no win no fee basis.

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      They took care of every detail, supporting me every step of the way.

      The team at Monaco Solicitors are outstanding. I was broken and had no capacity to lodge a claim. My toxic employer had me believe I was worthless. My medical expenses were adding up and I could not access treatment due to the cost. Daniella Dababneh and her team stepped in and nurtured me through the complicated process of lodging my TPD claim.

      Google Posted by Aldo Virzi
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      Today, after only 8 weeks, I got the best news: my claim was successful!

      Today I received the best call of my life. It’s finally here, and I couldn’t be happier! I was referred to Monaco solicitors by my sister in law after sustaining work injuries. From the moment I contacted them the whole process was easy and I was always well informed.

      Google Posted by Cherie Mundkowski
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      Monaco's help reduced a 12-month process to just a few months.

      My father originally found Monaco online for super claims,. They had discussed with him in great detail the processes and had been kind and very helpful a few years ago. When needing help with my mothers super claim I knew I could trust Monaco again.

      Google Posted by Carlee Ward
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      Thank you for accomplishing so much in such a short time.

      Great communication, empathy and understanding. My case worker Daniella was a saint, understanding and patient and always passing on any updates in record time.

      Google Posted by Danial Anderson
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      Good result! We had a complicated claim but they got the job done.

      My brothers and I had a complicated claim. I found Ben Ralph to be very helpful, himself and Sally Sutton worked hard for just over a year to get through our claim. They achieved a good result and got the monies paid to myself and my brothers.

      Google Posted by Sarah Pagel
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      I knew it from the very first phone call: I had found a compassionate law firm.

      Monaco Solicitors, I have no hesitation in recommending Daniella Dababneh and her team. After I suffered a serious workplace accident, I was in need of legal help.

      Google Posted by Scott Holden
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      They helped me juggle my injury claim and my mum's full-time care.

      I highly recommend Monaco Solicitors. I was claiming PI through my superannuation for workplace injuries. They were doing a no win no fee which was great as I am a carer for my mum and don’t earn much.

      Google Posted by Ellen Smith
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      Monaco helped me get much more compensation than I expected.

      Monaco Lawyers helped me to receive compensation for an ongoing injury I sustained after I was simply driving home from work and was driven into head on by an incompetent and negligent driver who I believe was texting at the time of the accident.

      Google Posted by Debby McDonald
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      I can't recommend Monaco enough for their help in securing my future financially.

      Monaco Solicitor’s helped me get the best outcome financially for my future after work place injuries left me unable to return to work, my WPI claim was handled by Medea, Jo and Chantel for the main part and although stressful for me at times they always reassured me and kept me up to date throughout the whole process.

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      How we can help you

      Insurance claims can be complex, and getting the compensation you deserve isn’t always as simple as making a claim. To secure your benefits fast — and in full — you need expert legal support.

      Voted ‘Compensation Law Firm of the Year 2020’, we’ve got the experience to protect your entitlements and secure every dollar you’re owed. As part of our comprehensive service, we’ll also find your additional claims, including workers compensation, common law damages and Total and Permanent Disability. Often, these claims are worth significantly more than your trauma insurance benefit alone.

      Speak to us today for free legal advice on your trauma insurance claim. Find out everything you’re entitled to and how to get maximum compensation for your condition.

      Speak to one of our friendly lawyers

      Email us 1300 769 665

      Millions won for our clients

      View more case results

      $1.2 million

      Trauma Insurance Claims
      Total and Permanent Disability

      Pieta’s claim was rejected by her insurer. We got the decision overturned.

      When Pieta was diagnosed with breast cancer, she attempted to claim a TPD benefit through her superannuation. Her insurer rejected Pieta’s claim. Pieta then came to us....

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      $1 million

      Trauma Insurance Claims
      Total and Permanent Disability

      Mario wins large TPD payout for psychological condition despite strict policy definition

      After Mario stopped working due to psychological illness, his insurer attempted to deny his Total and Permanent Disability (TPD) claim, arguing that he could eventually return to...

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      $1 million

      Trauma Insurance Claims
      Total and Permanent Disability

      Aaron tried to claim under a strict insurance policy. Our extra evidence secured his win.

      When Aaron suffered a serious psychological injury, he attempted to claim a TPD benefit through his super fund. His policy, however, was very strict. At first glance,...

      Read more

      $700,000

      Trauma Insurance Claims
      Total and Permanent Disability

      Juliette secures $700k in just 4 weeks — despite claims her skills were transferrable

      Juliette, 44, had to stop working as a regional supervisor due to severe psychiatric and physical illnesses. She suffered from numerous conditions, including short bowel syndrome, an...

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      $525,000

      Trauma Insurance Claims
      Total and Permanent Disability

      13 years after his claim was rejected, we helped Jim overturn his insurer’s decision.

      In 2006, Jim suffered a deep psychological injury. When he tried to claim a TPD benefit through his super fund, his application was rejected. 13 years later,...

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      $500,000

      Trauma Insurance Claims
      Total and Permanent Disability

      Expert evidence secures Travis’ TPD payout despite insurer claiming he could return to work

      Travis suffered from severe Post-Traumatic Stress Disorder (PTSD) that left him unable to work. He was just 35 years old when he came to us for help...

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      $460,000

      Trauma Insurance Claims
      Total and Permanent Disability

      Sally wins TPD payout despite insurer’s claims of incomplete treatment

      At just 42, Sally, a registered nurse, was forced to stop work due to a severe mental health condition. When her insurer claimed she needed to exhaust...

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      $310,000

      Total and Permanent Disability

      John was bullied to the point of depression. Doctors and insurers insisted he could work again – but we proved them wrong.

      After enduring persistent workplace bulling, John developed depression and anxiety. When trying to claim a TPD benefit, he hit a roadblock. John’s policy required him to prove...

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      $280,000

      Trauma Insurance Claims
      Total and Permanent Disability

      After a workplace accident, Alex’s TPD insurer insisted he could return to work. We found a loophole.

      When a workplace accident left Alex unable to work, he lodged at TPD claim himself. At this same time, we were assisting Alex with his Workers’ Compensation...

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      $180,000

      Trauma Insurance Claims
      Total and Permanent Disability

      Sarah struggled to get medical support for her claim. Our network of experts helped win her case.

      Sarah, a nurse, suffered chronic pain as a result of her Fibromyalgia and Complex Regional Pain Syndrome. Unfortunately, due to the lack of medical testing and disagreements...

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      $100,000

      Trauma Insurance Claims
      Total and Permanent Disability

      Tony’s insurer claimed his injuries didn’t qualify as TPD. Our lawyers proved them wrong.

      Tony has struggled with lifelong psychological injuries. When later diagnosed with physical injuries as well, Tony tried to claim a TPD benefit through his superannuation. He discovered...

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      We have the experience you can count on

      98%
      SUCCESS RATE
      25
      YEARS EXPERIENCE
      8,967
      CLAIMS WON
      $650m
      COMPENSATION PAYOUTS

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      Darren got a response within an hour. “Monaco took the stress out of everything.”

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