Check to see if you can claim for delayed elective surgery

YourLIfeChoices by Andew Gigacz



The effects of the COVID pandemic on Australians and their health has been widespread and well documented. But on top of all the ‘front-of-mind’ effects – from loss of work to the direct impact of having contracted the virus – there are other issues that have generated little comment.


One of those, elective surgery, has been put in sharper focus this month, after the Victorian government announced that it had suspended most elective surgery to help the hospital system cope with the influx of patients with Omicron.


Elective surgery has been severely restricted in most Australian states and territories at various stages throughout the pandemic, leaving many patients frustrated, confused and, for those unable to work as a result, out of pocket.


The latest Australian Healthcare Index survey highlighted one of the major challenges facing Australian healthcare – a 31per cent increase in elective surgery waitlists.


However, many of those affected by the delays may be able to alleviate at least some of the financial stress, according to one industry expert.


Bruno Muraca, CEO of AFRM Claims Advocacy (ACA), says many patients may not be aware that their super fund likely has a personal insurance component, such as income protection, that members can use to advantage.

“Figures suggest that as many as 40 per cent of those with superannuation are unaware of what insurance is included in their super account, or if it incorporates an insurance component at all,” he says.


As the name suggests, ACA is a specialist in personal insurance claims and advocates on behalf of clients. “Our goal is to alleviate people’s financial stress when injured or ill,” says Mr Muraca.


He says many people may not be aware that, depending on the type of personal cover their super fund provides, they may be able to make a claim resulting from delayed postponed surgery.


“One 52-year-old, Paul, I am assisting at the moment has had hip surgery – originally scheduled for last December – delayed, leaving him unable to do his job as a bricklayer,” says Mr Muraca. “He was unaware if his superannuation plan incorporates an income protection component. It does, as many plans do, and we are now in the process of lodging a personal claim for 75 per cent of his regular income.”


There are four main types of personal insurance cover:

  • income protection, which pays 75 per cent of income in the case of illness or injury precluding you from working

  • trauma cover, for those diagnosed with a major illness

  • total and permanent disability (TPD), which pays out a lump sum to cover rehabilitation and living costs

  • life insurance, a lump sum payment to a nominated beneficiary in case of death.


Many industry super funds will include personal insurance that provides one or more of these cover types. Mr Muraca says that increased awareness of the services provided by companies such as ACA can only lead to better patient outcomes.


“We provide an alternative to lawyers by supporting our clients with their claim paperwork, representing them with their insurer and providing them peace of mind throughout the claims process.”

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