The short answer
Most claims in New Zealand are paid. The ones that are not usually fail for one of four reasons: non-disclosure at application, a policy definition not being met, an exclusion that was on the policy all along, or the claim falling within a waiting period.
Every one of those four is decided at the moment you buy, not the moment you claim.
Last reviewed 2026-07-30
What the process actually looks like
Notify
Tell the insurer or your adviser as soon as you reasonably can. Some policies have notification timeframes. Early notification also starts the clock on income protection, where payments run in arrears.
Claim forms and consent
You complete a claim form; you sign an authority letting the insurer obtain medical records. Your doctor or specialist completes a section. This stage is where most of the elapsed time goes.
Assessment
The insurer checks the event against the policy definition, checks your original application against your medical history, and may request further specialist evidence or an independent assessment.
Decision and payment
Accepted, declined, or accepted in part. Income protection then moves to ongoing review — you will be asked periodically to confirm you remain unable to work.
The four reasons claims fail
1. Non-disclosure
The most common. Something material was not disclosed at application — often genuinely forgotten rather than hidden. Insurers pull full medical records at claim time, so a consultation you had eight years ago and did not mention will surface. The fix is entirely at the application stage: over-disclose, and let the underwriter decide what matters.
2. The definition was not met
Especially on trauma cover. Every policy pays "on cancer" — they do not all pay on the same cancer. Severity thresholds, troponin levels for heart attacks, evidence of permanent deficit for strokes. A diagnosis that feels catastrophic can still fall outside a definition. This is why the wording, not the price, is the product.
3. An exclusion applied
The back exclusion on your income protection, the cardiovascular exclusion on your health cover. These were disclosed when the policy was issued — but often skimmed. Knowing your own exclusions is worth ten minutes with your policy schedule today.
4. Timing
Within an initial waiting period, or a condition that first appeared before cover started. See waiting periods.
Whether a claim gets paid is mostly decided the day you apply.
What this means for how you buy
The practical conclusion is uncomfortable for the "compare and click" model: the things that determine whether you get paid are all decided before you ever claim, and none of them appear on a price comparison.
- Disclose thoroughly, in writing, and keep a copy of what you disclosed.
- Read the definitions for the conditions you are most likely to face, not all fifty.
- Know your exclusions by name.
- Keep your policy schedule somewhere your partner can find it. A surprising number of claims are delayed because nobody knew the policy existed.
If a claim is declined
- Ask for the decline reason in writing, citing the specific policy clause.
- Check the clause against your policy document yourself.
- Ask your adviser to challenge it — this is a large part of what advisers are for.
- Use the insurer's internal complaints process.
- Escalate free of charge to the insurer's external dispute resolution scheme (IFSO, FSCL or similar). Every licensed NZ financial service provider must belong to one, and it costs you nothing.
Common follow-up questions
How long does a claim take in New Zealand?
It varies widely by cover type and complexity. A straightforward life claim with a clear cause can be quick; an income protection or trauma claim requiring specialist evidence takes considerably longer, because the pace is set by how fast medical records and specialist reports arrive. Notifying early is the main thing within your control.
Will claiming push my premium up?
Not on an individual guaranteed-renewable policy — the insurer cannot single you out for a rate increase because you claimed. Health insurance is annually renewable and priced by age band and overall claims experience, so it moves for everyone rather than for you specifically.
Who do I claim to if I bought through an adviser?
Contact your adviser first. Part of what commission pays for is having someone who knows what was disclosed, what the wording says, and how to push back on a decline. If your adviser is not helping, you can always go directly to the insurer.
Keep reading
This page is general information about how insurance works in New Zealand. It is not regulated financial advice and it does not take your situation into account. For advice about your own cover, talk to a licensed financial adviser.