Did you know that many New Zealanders are entitled to claim under their insurance policies and don’t even realise it?

One of the most commonly overlooked benefits is the Accidental Injury clause (also known as a Specific Injury benefit) found in many mortgage or income protection policies – or available as a stand-alone benefit. 

Because these clauses are often buried deep in policy wordings, many people either forget they have this cover or are unaware of what it means. As a result, thousands of Kiwis miss out on claiming when they are perfectly entitled to.

What is an Accidental Injury / Specific Injury Clause?

This is a built-in benefit or optional add-on in many mortgage and income protection policies. It pays out a lump sum if you suffer from a specific injury caused by an accident and as defined by your policy, regardless of whether you are off work or incur major medical costs.

It is a separate benefit from covers like trauma cover or income protection, and the payout is usually automatic once the injury is diagnosed and verified. Typically, there are also no offsets or wait periods and you can choose how to use the money, whether it be to assist with day-to-day bills or recovery costs (or perhaps to purchase a new bike and or holiday once you’ve recovered!).

What Types of Injuries Are Covered?

Each insurer’s list varies, but common injuries that trigger a payout include:

• Fractures (legs, arms, collarbone, ribs, pelvis, skull and more)
• Any injury that the life assured had surgery on under general anaesthetic
• Severe burns
• Loss of sight in one eye

It is worth noting that you do not need to be permanently disabled to qualify. Many everyday injuries may be covered, even if you recover quickly.

When Can You Make a Claim?

You can typically claim when:

• The injury meets the definition outlined in your policy.
• The injury was caused by an accident (not an illness or gradual deterioration).
• You submit medical evidence (such as X-rays or specialist reports) to support your claim.

How Does This Work With ACC?

Many people assume that if they receive cover from ACC, they cannot also claim on their insurance policy – but this is not true.

ACC covers medical treatment and loss of income, whereas the Accidental Injury / Specific Injury benefit in your insurance policy is a separate, lump sum payment.

In most cases, claiming from ACC does not affect your ability to also claim under this insurance clause. You can usually claim both, provided your injury meets the policy definitions.

This is another reason why it is so important to know what cover you have – otherwise, you may miss out on valuable financial support.

Why Do So Many People Miss Out?

The biggest reason is lack of awareness, when people take out cover, there are a lot of options discussed, and they may simply have forgotten what they have covered, We regularly see clients who have broken a leg or arm previously and didn’t know they could claim.

Real Example – A Claim Missed for Three Years

In fact, one of our team recently conducted a review of a client’s insurances and discovered exactly this. During a conversation, the client casually mentioned a broken bone they had suffered three years ago. They had no idea that this injury would have allowed them to make a claim under their insurance policy, and had never notified their adviser or insurer.

Because this came up during the adviser’s complimentary review, we were able to step in, support the client through the claims process, and secure the payout they were entitled to – even though the accident had occurred three years earlier.

It is a great reminder that keeping your adviser updated and having regular reviews can make a real financial difference

What Should You Do?

• Know what you’re covered for: Many mortgage and income protection policies include accidental injury benefits, but they’re often buried in the fine print. A quick review can uncover what’s sitting in your policy.
• Understand what triggers a claim: Fractures, dislocations, burns, and tendon tears are commonly covered – even if you’ve recovered quickly or claimed through ACC.
• Don’t assume it’s too late: Claims can sometimes be made years after an injury occurred, especially if you weren’t aware you were entitled to a payout at the time.
• Keep your adviser informed:  Not sure what cover you have? Keep your adviser updated if you suffer an accident or injury. They can quickly check your policies and identify any potential claims you may have missed.

Book Your Free Insurance Review

If you’d like to check what cover you have in place – or if you’d like to explore adding this cover to your existing policy – we invite you to book a free insurance review with one of our advisers by clicking here.

Plus, an added bonus, for every review completed, you’ll receive five entries into the draw to win a month’s free mortgage repayments on us!

The content of this article should not be taken as financial advice, or a recommendation of any financial product. These insights are based on current economic commentary, market pricing for interest rates, and our personal opinion. Threefold is not liable or responsible for any information, omissions, or errors present.