'"Life Expectancy Under 24 Months": What It Means for Your Super Insurance Claim'
- May 16
- 8 min read
When a doctor tells you that your condition is terminal, the words that follow carry enormous weight. What those words mean in a legal and insurance context, however, is often quite different from how they feel in the room where you heard them.
Australian super funds and insurers use specific language to define who qualifies for a terminal illness benefit. The phrase at the centre of that definition is "likely to die within 24 months." Understanding what that phrase actually requires, and what it does not require, is critical to knowing whether you can access your life insurance benefit through super.
This guide explains the 24-month threshold, what your doctors need to certify, and why many people who are fully eligible miss out simply because the claim is not lodged correctly.
What Is the 24-Month Threshold?
Most Australian super funds define a terminal illness using language drawn from the Superannuation Industry Supervision Act. The standard definition requires that two registered medical practitioners certify that, despite receiving all reasonable medical treatment, you are likely to die within 24 months.
Some older super fund policies use a 12-month threshold instead. It is important to check your fund's Product Disclosure Statement to confirm which threshold applies to your policy before seeking certification from your doctors.
The 24-month threshold is a legal and clinical standard. It is not a prediction of the exact date of death. It is a professional medical judgment that, based on the nature of your condition and its expected progression, death within that timeframe is probable.
Over $1 billion in super insurance benefits goes unclaimed in Australia every year. Many terminal illness claimants who fully qualify never lodge a claim because they misunderstand what the 24-month threshold requires.
What "Likely" Actually Means
The word "likely" is the most important word in the terminal illness definition, and it is frequently misunderstood by both claimants and, sometimes, by the medical practitioners completing the certification.
"Likely" means probable. It does not mean certain. It does not mean imminent. It does not mean you have exhausted all treatment options or entered a palliative phase.
A person who is still receiving active chemotherapy can have a prognosis that meets the 24-month threshold. A person whose condition is being actively managed with immunotherapy or targeted therapy can still qualify. A person who has months of treatment ahead of them and whose outcome remains uncertain can still qualify, provided their specialist considers death within 24 months to be the more probable outcome given the nature of their condition.
The certification is a clinical judgment by qualified specialists. It is not a final sentence. It is a professional assessment of probability. And if two specialists assess that probability as meeting the threshold, the legal and insurance criteria are met.
Do You Qualify for a Terminal Illness Benefit?
To access your life insurance benefit early through super on the basis of a terminal illness, the following criteria generally apply:
Your super fund must hold an active life insurance policy in your name at the relevant time
Two registered medical practitioners must certify your prognosis, and at least one of them must be a specialist in the area relevant to your condition
Both practitioners must certify that, despite receiving all reasonable treatment, you are likely to die within 24 months (or 12 months under some older policies)
The certification must be made using your fund's prescribed forms, or equivalent documentation that satisfies your fund's requirements
The certifying practitioners do not need to be your treating doctors, though they often are. A GP can serve as one of the two practitioners in some cases, provided the second is a relevant specialist.
If you are unsure whether your situation meets these criteria, Better Claim provides a free eligibility review. We review your diagnosis, your fund's policy terms, and the certification requirements before any paperwork is lodged. Check your eligibility here
What Your Doctors Need to Certify
This is where many otherwise valid claims fail. The medical practitioners completing the certification forms need to address specific questions, not simply confirm a diagnosis.
The certification must establish:
The nature of the diagnosis and the treating practitioner's area of specialisation
That the patient has received, or has access to, all reasonable medical treatment for the condition
That despite that treatment, the practitioner is of the professional opinion that the patient is likely to die within 24 months (or 12 months, depending on the fund's policy)
What the certification does not require:
A specific date of death
Confirmation that treatment has ceased
A statement that no further treatment options exist
A determination that the patient is in palliative care
Many treating oncologists, neurologists, and other specialists are experienced with these forms. Others are not, and the wording they use can inadvertently fall short of what the insurer requires, creating delays that could have been avoided.
Better Claim works directly with your treating medical team to ensure that the certification addresses each element that your fund and insurer require. This is one of the most valuable parts of what we do, and it is included in our no-win, no-fee service.
What Your Super Fund Won't Tell You
Super funds are not required to explain the 24-month threshold to you. They are not required to tell you which of your doctors can certify the prognosis. They are not required to flag when a certification is incomplete before you submit it and they return it months later with a request for further information.
Here are the things your fund is unlikely to tell you without being asked:
The threshold used in your policy may be 12 months, not 24. Older policies often use the stricter standard.
You may hold life insurance across multiple super funds, including old accounts from previous employers. Each fund uses its own definition and its own certification forms.
If your super balance was transferred to the ATO as unclaimed super, the insurance cover does not transfer with it. The ATO lookup tool helps identify which fund originally held the balance. Your claim must be made against that original fund if it remains active and held insurance at the relevant time.
The timing of your certification matters. Certifications that are dated close to the time of your diagnosis tend to carry more weight than those obtained well after the prognosis was first established.
A second opinion from a different specialist can sometimes support a claim where the primary specialist's certification is borderline or incomplete.
50% of Australians do not know their super includes insurance cover. For terminal illness specifically, that awareness gap costs families enormously.
How the Certification and Claims Process Works
The process of accessing your life insurance benefit early through super involves more administrative precision than most people expect. Here is a realistic view of the steps involved:
Identify all super funds. You may hold life insurance across multiple funds. Better Claim identifies every fund in your name, including old or forgotten accounts.
Review each policy. Each fund's Product Disclosure Statement sets out the definition of terminal illness, the prognosis threshold, and the certification requirements that apply.
Coordinate with your treating specialists. Better Claim contacts your medical team and explains exactly what the certification must address. We provide or coordinate the correct forms for each fund.
Complete and certify the claim forms. In addition to the medical certification, you will need to complete the fund's claim form and provide supporting documentation. Required documents include certified copies of your medical reports and test results, a certified copy of a government-issued photo ID (passport or driver's licence), and the completed medical practitioner certificates.
Lodge the claim. Better Claim submits all documentation to each relevant insurer and manages the lodgement record.
Manage the assessment period. Insurers may request additional information. Better Claim handles all correspondence so you are not drawn into administrative back-and-forth while focusing on your health.
Receive the outcome. If approved, the insurer pays the benefit directly to you as a lump sum. Terminal illness benefits paid from superannuation are generally tax-free.
REALISTIC TIMEFRAMES
Simple claims with complete documentation: 4 to 8 weeks
Claims requiring additional medical evidence: 8 to 16 weeks
Complex or disputed claims: 3 to 6 months
Better Claim manages every step so you can focus on your health and your family.
Why Some Claims Are Delayed or Declined
The most common reasons that terminal illness claims are delayed or declined include:
Insufficient prognosis wording. If the certifying practitioner states that the patient "may" die within 24 months rather than that death is "likely," the insurer may decline the claim on the basis that the threshold is not met. Better Claim ensures the wording of each certification addresses this precisely.
Wrong specialist for the certification. The second certifier must be a specialist in the area relevant to the condition. A GP certifying a neurological condition without the required specialist co-certification will not satisfy the fund's requirements.
Incorrect or incomplete claim forms. Errors in personal details, unsigned sections, or missing attachments are common causes of delays. Better Claim reviews all forms before lodgement.
Lapsed insurance cover. In some cases, insurance cover may have lapsed due to low account balances or extended inactivity. Better Claim identifies this early and advises on available options.
Use of incorrect forms. Different funds use different certification forms. Submitting a generic medical letter instead of the fund's prescribed form often results in the claim being returned.
A declined claim is not the end of the process. Better Claim reviews declined outcomes and manages internal reviews and Australian Financial Complaints Authority (AFCA) appeals where they are warranted.
How Better Claim Can Help
Better Claim manages terminal illness and life insurance claims through superannuation on a no-win, no-fee basis. We specialise in the precision that these claims require and work directly with your medical team so you do not have to.
Our service covers:
Free initial eligibility review, including checking all super funds in your name
Review of your policy's specific definition and prognosis threshold
Direct coordination with your treating specialists for certification
Completion and lodgement of all claim forms and supporting documents
Ongoing claim management and insurer liaison
Review of declined outcomes and management of appeals where applicable
You pay nothing unless your claim succeeds. Our fee comes from your settlement only.
Frequently Asked Questions
Does "likely to die within 24 months" mean I have to be in palliative care?
No. You can be receiving active treatment, including chemotherapy, immunotherapy, surgery, or radiation, and still qualify. What matters is your specialist's professional assessment of the probable outcome, not the treatment phase you are in.
What if my doctor is reluctant to certify the prognosis?
Some practitioners are hesitant because they do not want to diminish a patient's hope or are unfamiliar with insurance certification requirements. Better Claim speaks with your medical team to explain the process and what the certification requires. In some cases, a second specialist opinion supports a claim where the primary practitioner is uncertain.
Can I apply if my fund uses a 12-month threshold rather than 24?
Yes, but the prognosis your doctors certify must meet the 12-month standard. Better Claim checks your fund's policy terms as part of the initial review and confirms which threshold applies before pursuing certification.
What if I outlive the prognosis period?
If you receive a terminal illness benefit and outlive the certified prognosis, you are generally not required to repay the benefit. The money remains yours.
How long does the certification process take?
It depends on your medical team's availability and the complexity of your condition. Better Claim coordinates directly with your specialists to obtain certification as efficiently as possible. Once all documents are in order, lodgement and assessment can proceed.
Does Better Claim charge upfront?
No. Better Claim works on a no-win, no-fee basis. There is no charge for the initial eligibility review or for any part of the claims process. Our fee is deducted from your settlement if your claim is successful.
Your Next Step
Understanding the 24-month threshold is the first step. Acting on it is the next one.
If you or a family member has received a terminal diagnosis, Better Claim can review your super fund coverage at no cost, explain exactly what the certification requires, and manage every part of the claim process from start to finish. You pay nothing unless your claim succeeds.
You have already been through enough. Let Better Claim handle the rest.
Resources
AFCA (Australian Financial Complaints Authority): Free dispute resolution if your terminal illness claim is delayed or denied
ASIC MoneySmart: Super and Insurance: Overview of life insurance and terminal illness benefits held through super
ATO: Early Access on Terminal Medical Condition: ATO guidance on the terminal illness condition of release
Palliative Care Australia: Support and information for people with terminal illness and their families
Disclaimer: The information in this article is general in nature and does not constitute legal or financial advice. Terminal illness benefit terms vary between super funds and insurers. Better Claim recommends seeking professional advice specific to your circumstances before making any decisions about your claim.
