Making a trauma insurance claim in New Zealand is simpler than it might seem. Start by checking your policy to see if your condition is covered, then let your insurer know as soon as possible. From there, you’ll fill out a claim form, provide medical evidence, and your insurer will assess everything against your policy. If accepted, you’ll receive a lump-sum payment to use however you need. If declined, you can ask for a review or take it to an independent disputes service.
Every policy is different. The list of conditions, how they’re defined, and any waiting or survival periods are set out in your policy documents.
Step 1 - Check what your policy covers
The first step is to take a look at your policy wording. This will tell you:
- which conditions and procedures are covered,
- how the insurer defines them (the wording can be quite specific), and
- if there are any waiting times or survival periods that apply.
Not sure if your condition fits? That’s normal. Trauma cover can be technical, so if you’re uncertain, get in touch with your insurer — they’ll explain whether it looks like your situation could qualify.
Step 2 - Let your insurer know
Once you think you might have a claim, the next step is simply to let your insurer know. Most will accept notice over the phone, online, or by email. From there, they’ll guide you through what’s needed and send you the forms to get started.
The earlier you reach out, the smoother things usually go.
Step 3 - Collect the paperwork
To assess a claim, insurers usually ask for:
- your policy number and proof of ID,
- a completed trauma claim form,
- medical notes and reports from your doctor or specialist,
- copies of test results or hospital records, and
- your consent for them to access medical information if required.
It can feel like a lot of paperwork, but providing clear and complete information up front helps avoid back-and-forth later.
Step 4 - Fill in and send off your claim
Once you’ve got the forms and documents together, you can submit your claim. Take your time filling in the details, and make sure dates and names line up with the medical records you’re attaching.
Most insurers will confirm they’ve received your claim and outline what happens next.
Step 5 - The assessment stage
After you’ve submitted everything, the insurer will:
- check your policy is active and premiums are up to date,
- review the medical evidence against the policy definitions, and
- ask for further reports or tests if more detail is needed.
Some claims are straightforward and paid quickly. Others take a bit longer, depending on how complex the medical information is. Throughout the process, you should get updates so you know where things stand.
Why some claims get delayed or declined
It’s not fun to think about, but claims can be delayed or even turned down. Common reasons include:
- the condition doesn’t match the specific wording in the policy,
- medical evidence is incomplete or missing,
- waiting or survival periods haven’t been met,
- unpaid premiums mean the policy lapsed, or
- important health details weren’t disclosed when the policy was taken out.
If something like this happens, your insurer will explain why, and you’ll have the option to ask questions or challenge the decision.
If your claim is accepted
Good news - if your claim is approved, you’ll receive a lump-sum payment. This money is yours to use however you see fit. Some people put it towards the mortgage, others cover treatment costs, and many simply use it to ease financial stress while they focus on recovery.
Depending on your policy, the cover may end after the payout, or you may still have some benefits left (for example, partial or multiple-claim options). Check your documents to be sure.
If your claim is declined
If things don’t go your way, you don’t have to stop there. You can:
- Ask for the decision to be reviewed through your insurer’s complaints process.
- If it’s still unresolved, take your case to the independent dispute resolution service your insurer belongs to (every insurer in NZ must be a member of one).
It’s free to use, and their details should be in your policy or on your insurer’s website.
Tips to keep things moving smoothly
- Keep records - save copies of medical notes, reports, and claim forms.
- Stay organised - include a simple cover note listing what you’ve attached.
- Ask your doctor for clarity - a clear, dated letter that uses the medical terms in your policy can really help.
- Note your calls - write down dates, names, and key details when you talk to your insurer.
- Use your adviser if you have one - advisers can often support you through the claim process.
Making a trauma insurance claim might feel overwhelming, especially if you’re already dealing with health challenges. But the process is there to support you. By checking your policy, contacting your insurer early, and having your paperwork ready, you’ll make the journey as smooth as possible.
Every insurer in New Zealand has slightly different processes, and every policy has its own rules. When in doubt, lean on your insurer or adviser for help - they’re there to guide you.
Disclaimer: Please note that the content provided in this article is intended as an overview and as general information only. While care is taken to ensure accuracy and reliability, the information provided is subject to continuous change and may not reflect current development or address your situation. Before making any decisions based on the information provided in this article, please use your discretion and seek independent guidance.
