What is Accident Only Insurance?

Navigating insurance options when you have a complex health history or high-risk job can feel overwhelming, but you don't need to remain unprotected.

The basic premise is simple: Accident Only insurance acts as your 'Plan B,' securing your financial stability if an unexpected accident suddenly wipes out your ability to earn an income.

Accident Only Insurances

The Plan B for when you're not eligible for Plan A.

• Accidents change everything. They can suddenly wipe out your ability to earn an income, endanger your family's stability, and alter your confidence for the future.

If you don't qualify for comprehensive insurance cover due to health or occupation, Accident Only Insurance is the next best option to reduce your risks. It is designed to protect you from the financial effects of accidental death, disability, or loss of income that an accident can create.

Sometimes the next best thing becomes the best thing available.

When Plan A isn't an option for you

Living with a complex health diagnosis or holding down a high-risk occupation and not qualifying for traditional insurance cover is all about living with uncertainty.

• Many people, for various reasons, do not qualify for a full and comprehensive policy to protect themselves and their families.

This specific type of Accident Only cover acts as a 'Plan B' financial cushion, if you're unable to get standard sickand and accident personal insurance.

Who is this relevant for?

This solution is especially relevant for people who are usually declined standard cover, including those with:

• Complex medical history: Conditions like leukemia or genetic kidney disease.
• Recent medical procedures: Where long-term outcomes aren't known yet (eg: recent gastric banding, organ transplants, or recent mental health support).
• Difficult to manage conditions: Such as Dysplastic Nevus Syndrome, where the risk of melanoma makes standard cover commercially uninsurable.
• High-risk occupations: Such as Crane Drivers, Tree Loppers, or frontline Emergency Services Workers.

It Covers you where most Accidents happen (24/7)

What you may not know is that most accidents usually take place in and around the home while people are going about their everyday tasks. A weekend of DIY, cleaning roof gutters on a shaky ladder, or even a slip while taking out the wheelie bins, can end in an accident.

While you may recover physically, this insurance ensures you can recover financially by helping pay the bills while you rehabilitate.

The 3 Types of Accident Only Cover

Just because you cannot get comprehensive cover doesn't mean you can't have protection. These are the three main types of accident-only covers available:

1. Accident Income Protection (AIP)

This pays up to 75% of your income per month (and can reimburse your employer’s super contributions) if you are working and become totally or partially disabled as a result of an accident.

It provides an ongoing monthly payment so you can continue to pay the mortgage and meet family living expenses while you recover.

2. Accident Total & Permanent Disability (ATPD)

This pays a lump sum benefit if you are totally and permanently disabled as a result of an accident and unlikely to ever work again.

There are different definitions of cover available, including 'any occupation' or the higher grade 'own occupation' category.

3. Accidental Death (AD)

This pays a lump sum of money to your beneficiaries if you pass away from an unexpected and unintentional accident.

Frequently Asked Questions

What counts as an 'Accident'?

It is vital to understand that 'accident means accident'. If a pre-existing condition caused the event, it is usually not covered.

• Example: If you have pre-existing glaucoma and slip because you couldn't see the stairs, this may not be considered an accident.
• Example: If a pre-existing knee injury causes your leg to give way and you fall, this may not be considered an accident.

Can I pay for this through Superannuation?

Yes. All of these Accident Only Insurance solutions can be paid from a superannuation fund if you choose. Accidental Income Protection can even cover your employer's super contributions while you are on claim.

Why shouldn't I just buy this online?

These policies are not suitable for a 'DIY' approach or simplified online comparison services. Because they are designed for people with specific risks or medical exclusions, you need professional advice to ensure the policy definitions match your specific needs.

How we can help

We help people living with complex health histories and recent health conditions get the cover they need. We understand that living with a complex diagnosis or a high-risk job is about managing uncertainty, and we are here to help you manage that.

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The $642,000 Question Your Family Isn't Asking

Why the biggest threat to your dual-income mortgage isn't interest rates: it's the conversation you're avoiding.

For millions of Australian couples buying property, getting ahead and building their wealth, the financial structure of family life can sometimes feel like a house of cards. You’ve done everything right: secured two incomes, bought a property, you probaly have a double income mortgage, and you're managing the daily juggle.

Yet, underneath this success (and your growing wealth) there’s often a constant, low-grade hum of financial anxiety. No one dares take their foot off the income accelerator - because it's the stable household income that drives the plans for wealth.

This pressure is a shared national experience. With the average Australian mortgage climbing to $642,000, and a staggering 28.4% of mortgage holders deemed 'At Risk' of stress, the feeling of being stretched thin is the new normal.

This high-debt environment makes the dual-income structure, which accounts for 60% of all home loans, both a necessity and a profound vulnerability. The entire financial model rests on the assumption that both incomes will continue, uninterrupted.

But what if one of them stops?

This is the unspoken gamble. The catastrophic ‘what if’ that gets pushed aside in the daily rush of work, school runs, and budget pressures. The very financial stress that makes this safety net so critical is also what makes it psychologically harder to confront.

The Real Reason We Don't Talk About It

If you've avoided this topic up until now, you are not alone. The barrier isn't just about affordability; it’s about human psychology and how we’re often hardwired to avoid hard conversations.

Our brains are hardwired with mental shortcuts and ‘cognitive biases’ that make beginning this conversation feel incredibly difficult. We tell ourselves three distracting lies from

• The "it won't happen to me" syndrome aka Optimism Bias ‘even though O see financial hardships around me”
• The focus on the present at the expenses of the future aka Present Bias where we which makes us prioritise the immediate, tangible reward of paying for groceries today over the abstract, future benefit of a safety net.
• The “but if I never claim on an insurance policy isn't paying the premiums for all those years a loss?” aka Loss Aversion Bias where we try to convince ourselves the pain of a perceived loss feels more powerful than the uncertain ‘gain’ of future security

Pack all this together for a busy family and you get the dangerous phenomenon: ‘The Plan Your Spouse Thinks You Already Have in Place’.

Pro Tip: Learn more about how Optimism Bias in Learning How to Stay Rich

In the silent, mutual avoidance of a tough conversation, partners often make a dangerous assumption. One person may believe the other has it ‘handled’. This false sense of security is often propped up by the Great Superannuation Misconception.

Many Australians just assume their default super fund cover is ‘the plan’. But we all have questions we secretly don’t want to know the answer to. The reality is default levels of insurance in super are often dangerously low, typically around $250,000 to $300,000. This amount is glaringly insufficient to clear an average mortgage of $642,000, let alone cover a family's ongoing living expenses.

This gap between perception and reality often triggers the low level of financial anxiety that seems to never leave family life.

How to Start the ‘What If’ Conversation

The path to financial security is about being able to face the future with confidence. Breaking the silence is the most critical step.

But you must be strategic. Ambushing your partner with a hard questions after a long day at work will likely fail. Instead, relationship and financial experts suggest a more deliberate approach.

1. Schedule a Financial Date Night

Set aside a specific, calm time, free from distractions. This signals the importance of the topic and allows both of you to be in a productive mindset, rather than a reactive one.

2. Start with Shared Goals, Not Fears

Begin the conversation by focusing on your shared dreams and values. This frames the discussion around teamwork and shared purpose.

Try saying: "I was thinking about our future. All the things we're working for - this house, giving the kids a great education, our retirement - are so important to me. I want to make sure we protect that, no matter what happens."

3. Reframe the Purpose

This is not ‘death insurance’; it is ‘goal protection insurance’. It is the tool that guarantees your shared dreams can be realised, even if the unthinkable happens. The conversation is not about planning for death; it is about planning for life to continue for the survivors.

4. Use ‘I Feel’ Statements to Avoid Blame

This discussion can be emotionally loaded. Use "I feel" statements to express your anxiety without it sounding like an accusation.

• Instead of: "You never think about this, and we're totally exposed."
• Try: "I feel anxious that we're working so hard for this house, but we might not have a proper safety net if something happened to one of us. It would give me so much peace of mind to look at it together".

5. Ask a Simple, Open-Ended Question

Sometimes, a simple prompt is all it takes to get started.

• Try asking: "If one of us was suddenly unable to work for six months due to an illness, what would our financial plan look like? How would we cover the mortgage?"

Your Next Steps: From Conversation to Solution

Once the conversation is open, the path to a solution becomes clear and manageable. It is about moving from anxiety to empowered action.

Step 1: Conduct a Reality Check

Your first action is to log in to your superannuation accounts. Find the exact dollar amount of your default Life and Total and Permanent Disability (TPD) cover. Write it down. Then, compare that number to your mortgage and your family's annual living expenses. For most, this simple act reveals the gap in stark, unavoidable terms.

Step 2: Understand the Four Pillars of Protection

A true safety net is not one product, but a suite of four tools designed to work together.

• Life insurance: Provides a lump sum to clear debts and fund the future if you die or become terminally ill.
• Total & Permanent Disability insurance (aka TPD): Provides a lump sum if you suffer a career-ending illness or injury.
• Trauma (Critical Illness) insurance: Pays a lump sum on diagnosis of a serious condition like cancer or a heart attack, giving you financial breathing room to recover.
• Income Protection insurance: Protects your income stream, paying a monthly benefit if you're temporarily unable to work.

Step 3: Seek Professional Guidance

This is where most people get stuck. The world of insurance is complex, and 'Complexity Avoidance' (another sneaky cognitive bias we all have) is a key reason families give up and do nothing. A specialist financial adviser like Sapience Financial is a helpful family guide.

Our role is to navigate this complexity for you, tailor a strategy to your specific budget, and act as a neutral third party to help you and your partner make a rational decision.

Crucially, an adviser becomes your family's advocate at claim time. This is a critical, often-overlooked value. Data shows that advised policies (the ones supported by financial advisers) have extremely high payout rates - over 95% for Income Protection and 97% for Life Cover - because an expert has ensured the plan is appropriate from the start and is there to manage the complex claims process.

The true cost of this Plan B is not the monthly premium. It is the 'devastatingly public and deeply personal' grief of losing a home for a decision that was simply postponed.

Don't let the unspoken gamble dictate your family's future. The conversation is the first, most powerful step to protecting everything you have built.

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• managing the mortgage
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• Income Protection Insurance

What is Severity Based Insurance (SBI)?

Why spend your life contributing to an insurance policy that pays out once, when life is a series of events to be navigated while you live?

Severity Based insurance (SBI) is a higher-grade alternative to the traditional 'all or nothing approach' to traditional separated Life, Crisis/Trauma and TPD insurances. Unlike most traditional life insurance policies, a SBI policy combines traditional Life, Total & Permanent Disability and Trauma Insurance products into one simple alternative, designed to last you a lifetime, not only for a single claimable event. Unlike many policies, a SBI policy is designed to allow multiple claims over the lifetime of the policy based on the severity of the health event – the more serious the condition, the greater the benefit.

Because medical and pharmaceutical breakthroughs have made groundbreaking advances in health, today most people who get sick or injured can have an expectation of recovery - if they just get that additional support from their insurance company early when they initially need it.

• These medical advances provided the motivation for the creation of an equally advanced insurance product – fairer and faster – the new Severity Based assessment process that aims to pay claims sooner and in proportion to the need, as assessed by an external medical standard.

Using an expectation of recovery, it makes claim payments based on the level of impairment a person might suffer.  This means claim payments can be made sooner for partial claims and money can be made available for early treatment and rehabilitation. This is different from the traditional TPD and Crisis insurance products that are known more for a black-and-white approach - where people might have an early cancer diagnosis but have to wait until it develops into a more serious condition before they might qualify to make a claim on a Crisis policy.

How is Severity Based Insurance different from traditional Crisis/Trauma and Income Protection insurance policies?

Most traditional life insurance policies are designed for one event in a lifetime – with limited parameters for making a claim.

• With advancements in modern medicine, people are much more likely to survive a serious illness. However, as a result, they’re more likely to suffer a recurrence or secondary illness. And as we live longer, we’re more exposed to illnesses in later life.
• SBI covers more medical conditions – and pays claims earlier, according to severity, as assessed by an external medical standard. And, you can keep claiming on any remaining cover if needed.

How does the Severity Based Insurance approach (SBI) work?

• SBI works on the classification of the health condition a person may face, not the type of occupation they may hold.

SBI follows an independent medical 'level of impairment' test to avoid the old subjective standard of 'in the opinion of a doctor, are you likely to return to work ever?'.

This new medical approach to assessing the level of impairment when assessing a claim means;

• the ability to make multiple claims,
• a higher likelihood of claim payments for partial conditions and disabilities and
• early diagnosis claims.

A big benefit to a person making a claim

Taking a medical approach to assessing a person's degree of physical and health impairment removes the fear of insurance company Doctor Shopping for a more commercially favourable medical opinion at the time of claim and increases transparency to match the ways Centrelink disability assessments are conducted.

What are the major differences between traditional TPD and Crisis insurance products?

Earlier claim payments

• A key feature of SBI is the ability for people to access the financial benefits of the coverage during the initial onsets and lower thresholds of Crisis Health Events.
• In practical terms, this means people are more likely to receive a claim payment for less severe health events which can still have significant financial consequences.

Payments for conditions not covered by traditional Crisis policies

• An example of this may be Myelodysplastic Syndrome and other cancers that often are an initial indication of a more serious condition pending.
• While traditional crisis and trauma policies cannot pay if their definition of cancer does not extend to this syndrome, SBI often can pay a claim under a disability assessment model rather than a definition-only model.

For the most serious conditions, SBI is designed to pay out the full sum insured, giving the peace of mind that your client is covered.

Pro Insight: In reviewing the claims history of severity-based insurance claims, approximately 24% of SBI claims made would not have been paid under the traditional Crisis or TPD claims products.

So what's covered?

A Whole Body System Approach

SBI usually classifies the body in terms of body systems rather than the black-and-white sickness or injury approach where you might be sick but not sick enough to claim.

Crisis Health Events

• SBI Crisis Health Events are usually divided into five major categories with higher benefit payments made for more severe conditions.
• Death and Total and Permanent  Disability (TPD) is classed as the highest severity and all others on a lesser percentage basis.

An example of this body system approach and its underlying conditions can be better explained below by looking at the range of Crisis Health Events that can be claimed for.

Who should consider using Severity Based Insurance?

There are two types of TPD insurance policies to consider:

• Traditional insurance - it takes a contractual definition of impairment of being unable to continue to work in either your Own Occupation or Any Occupation, and
• Severity-Based Insurance (SBI) - takes a medical definition of impairment of being unable to continue to work.

When comparing apples and oranges we have challenges but simply said;

• SBI policies pay out on medically defined levels of impairment, up to the capped amount the policy has been set at
• Traditional policies pay out upon meeting a definition specified in the contract issued by the insurer, usually the full capped policy amount. (see the second sample at $1,000k)

How are the two different types of policies assessed at claim time?

The Traditional insurance policy uses one of two assessment definitions.

• Own Occupation definition of impairment (where they pay if you cannot perform your own occupation -or something substantially similar you are educated for), and
• Any Occupation definition of impairment (on a claim, if they can retrain you to a lesser job they will try).

There is a third definition of cover reserved for the lower grade policies (often provided by a super fund) called Modified Definition TPD and this is usually coupled with a payment structure similar to a drip feed pension, rather than a single lump sum payment from the Traditional version designed to allow you to make a significant lifestyle adjustment if required.

Take Aways

Severity Based life Insurance products are widely available throughout Asia, Africa, Europe, and North America and are recognised as being an innovative insurance product more aligned to the evolving nature of modern medicine and health.

How we can help

Severity Based Insurance cover is an alternative to traditional Crisis and TPD cover and provides greater flexibility as part of protecting your business and your family, from the business.

Contact us for a confidential chat about your needs.

Related: Types of Personal Insurance products we work with

Different types of risk protection insurances, provide protection for different life risks.

• Life & Terminal Illness - the basis of all protection strategies
• Income Protection - safeguarding your ability to continue to earn your income
• Total & Permanent Disability (TPD) - protecting against the long-term financial consequences of disability
• Crisis & Trauma Recovery - protecting against specified serious medical conditions (more a 'when' you need to claim than an 'if')
• Severity Based Insurance - designed to pay small claims sooner (Life, Crisis & TPD insurances in one)

• life insurance
• total & permanent disability (TPD)
• crisis & trauma recovery insurance
• severity based insurance
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