What happens to my trauma insurance when I make a claim?

A full Trauma claim usually ends that policy; a partial claim reduces the remaining sum insured. Most panel insurers offer Reinstatement or Buy Back options that let you restore some cover after a paid claim, subject to a waiting period and condition-family restrictions.

The exact treatment depends on whether your claim was partial or full, and whether the Trauma cover was Stand Alone or Linked to other covers.

After a full (100%) Trauma claim

If you receive 100% of your sum insured for a major Critical Illness Event (such as invasive cancer or a severe heart attack), the Trauma cover usually terminates. You stop paying Trauma premiums for that policy.

If the Trauma cover was Linked or Attached to Life cover, the Linked Life cover is reduced by the Trauma amount paid. A Buy Back option (see below) lets you restore the reduced Life cover 12 months later, without further medical underwriting.

After a partial Trauma claim

If you receive a partial benefit (typically 10-25% of the sum insured for conditions such as carcinoma in situ, early-stage prostate cancer, or coronary artery angioplasty), the remaining Trauma cover continues at the reduced amount. Premiums may be recalculated.

Example: $400,000 Trauma cover with a $40,000 partial benefit paid for early-stage melanoma leaves $360,000 of cover for any future Critical Illness Event meeting the full or partial definition.

Reinstatement / Buy Back options across the panel

Most panel insurers offer one or more options to restore cover after a claim. Two common structures:

• Trauma Reinstatement Option: lets you restore Trauma cover after a claim (commonly 12 months after the claim) for future, unrelated Critical Illness Events. The reinstated cover excludes the same condition family that triggered the original claim.
• Life Cover Buy Back: where Trauma is Linked to Life cover, this restores the reduced Life cover sum insured after a Trauma claim.

| Insurer | Reinstatement / Buy Back evidence | PDS reference | |---------|----------------------------------|---------------| | AIA | Crisis Reinstatement (Section 8.7) restores Crisis Recovery after 12-month wait; Crisis Recovery Buy-back (Section 8.6) restores Life cover reduced by a Crisis claim | AIA Priority Protection PDS (9 November 2025), Sections 8.6 and 8.7 | | Zurich | Trauma reinstatement option; Life cover Buy-back reinstates death cover 12 months after a trauma claim | Zurich Wealth Protection PDS (1 November 2025) | | TAL | Critical Illness Reinstatement Option exercised within 30 days of the 12-month anniversary of the original claim; reinstated cover excludes the same Critical Illness Event family | TAL Accelerated Protection PDS (12 December 2024), Section 2.3.3 | | OnePath | Trauma reinstatement available; specific section in OneCare PDS | OnePath OneCare PDS (1 October 2025) | | ClearView | ClearChoice Trauma reinstatement after a claim, subject to PDS conditions | ClearView ClearChoice PDS (13 May 2024, Update 5 June 2025) | | NEOS | Critical Illness Cover Reinstatement Benefit; reinstated cover excludes the original event and certain related conditions; specific restriction on early stage prostate cancer and melanoma in situ | NEOS Protection PDS (6 December 2024) | | Encompass | Critical Illness Reinstatement Option (only available where Critical Illness Cover is structured a particular way) | Encompass Protection PDS (26 September 2025) | | Acenda | Critical Illness Reinstatement Option per Critical Illness insurance section | Acenda Insurance PDS (27 September 2025) | | Futura | Critical Illness Cover Reinstatement Option; reinstated cover excludes same-condition family; survival period applies | Futura Protection PDS (1 October 2025) |

Key restriction: same-condition-family exclusion

Every panel reinstatement option excludes the same condition family that triggered the original claim.

• If a cancer claim was paid, the reinstated cover does not pay for any future cancer event
• If a heart attack was claimed, the reinstated cover does not pay for any future heart condition
• If a stroke was claimed, the reinstated cover does not pay for any future cerebrovascular event

Do not present reinstatement as "new cover" without this restriction. Its value lies in protecting against unrelated future Critical Illness Events.

Why reinstatement matters

Obtaining new Trauma cover after a serious diagnosis is typically prohibitive. New underwriting will assess the prior diagnosis as a pre-existing condition and may decline outright, apply a permanent exclusion, or impose a heavy premium loading.

The reinstatement option locks in continued cover at the original underwritten terms. For most claimants, exercising the reinstatement is the only practical path back to Trauma cover after a claim.

Linked Life cover after a Trauma claim

When Trauma was Linked to Life cover, a $250,000 Trauma claim on a $500,000 Linked Life cover reduces the remaining Life cover to $250,000. The Buy Back option restores the reduced Life cover 12 months after the Trauma claim (or 14 days in Zurich's Trauma option variant), without further medical underwriting. Premiums after Buy Back reflect the original Linked structure.

• Zurich offers both a 14-day accelerated Trauma option (Reinstates death cover 14 days after a trauma claim; Zurich Wealth Protection PDS (1 November 2025)) and a 12-month standard Buy-back
• TAL Death Buy-Back: 12-month wait, exercise within 30 days (TAL Accelerated Protection PDS (12 December 2024), Section 2.3)
• AIA Crisis Recovery Buy-back: minimum sum $10,000 (AIA Priority Protection PDS (9 November 2025), Section 8.6)

Stand Alone Trauma after a full claim

With Stand Alone Trauma (not Linked to any other cover), a full claim ends the Trauma policy. The Reinstatement option, if exercised within the specified window, opens a new Trauma cover for unrelated future events. Without Reinstatement, the policyholder is no longer covered for Trauma.

Practical guidance

• Confirm before claim time which reinstatement and buy back options your specific policy carries
• Exercise within the window: most options have a 30-day or 90-day window after the eligibility date passes
• Discuss with your adviser whether to take the Buy Back now or to apply for new cover; the Buy Back is usually superior because it does not require new underwriting

This is general information, not personal advice. Specific outcomes depend on the insurer, the structure, and the PDS terms in force at the time of claim.