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Income Protection Claim Form (AIA New Zealand), page 1

Complex · 69/100Form Complexity Index

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What this form asks for

The AI fills all of it, from your answers or your documents.

The Income Protection Claim Form is an insurer claim document (for AIA New Zealand, including ASB-distributed policies) that the Life Assured and Policy Owner(s) complete to request payment of income protection benefits after stopping work due to illness or injury. It collects key information such as diagnosis and treatment, dates you ceased work and were medically certified, job duties and capacity, other compensation (e.g., ACC, sick leave, WINZ), and bank details for benefit payments. It also includes consent/authority for AIA to obtain medical and financial information from providers and a declaration that the information supplied is complete and accurate, which is important for claim validity. Today, this form can be filled out quickly and accurately using AI-powered services like Instafill.ai, which can also convert non-fillable PDF versions into interactive fillable forms.

Fillable fields201

Pages6

Sections64

Form Complexity IndexComplex, 69/100

The AI checks your answers before you download

17 checks built for this form, so a wrong date or a missing answer is caught before anyone else sees it.

Policy Number presence and allowed format

Validates that the Policy Number is provided and matches the insurer’s expected pattern (e.g., alphanumeric length, no illegal characters, no leading/trailing spaces). This is critical to correctly match the claim to the correct contract and avoid misrouting or delays. If validation fails, the submission should be blocked or routed to manual review with a clear error requesting a corrected policy number.

Life Assured full legal name completeness and character rules

Checks that the Life Assured Full Name is present, contains at least given name and surname, and uses reasonable characters (letters, spaces, hyphens, apostrophes) without numeric-only or placeholder values (e.g., 'N/A', 'Test'). Accurate identity details are required for policy matching and downstream medical/financial requests. If invalid, prompt the user to correct the name and prevent submission until fixed.

Date of birth is a valid calendar date and indicates eligible age

Validates that the day/month/year fields form a real date (including leap-year handling) and that the date is not in the future. It should also check the Life Assured is within plausible/allowed bounds (e.g., not under 16 and not over 110, or per product rules). If validation fails, the form should reject the DOB and request correction to prevent identity and eligibility errors.

Claim timeline dates are valid and logically ordered

Ensures the key claim dates (first medical assistance, totally ceased work, medically certified to cease work, expected return dates) are valid dates and follow a logical sequence. For example, first medical assistance should not be after the declaration date, and expected return to full duties should not be earlier than expected return to light/part-time duties (if both provided). If inconsistencies are found, flag the specific fields and require correction or an explanatory note before acceptance.

Required medical narrative fields are completed with sufficient detail

Checks that Description of Illness/Injury, Diagnosis Given, and Symptoms Preventing Work are not blank and are not trivial placeholders (e.g., 'see attached', 'unknown') unless attachments are explicitly supported. These fields are essential for triage, determining medical evidence needs, and assessing functional impairment. If validation fails, require the claimant to add meaningful detail or provide structured alternatives.

Previous similar illness/injury conditional details

Validates that if the claimant indicates they have suffered the same or similar illness/injury, the 'Previous Similar Illness or Injury Details' field is completed with substantive information (dates, nature, treatment, outcomes). This is important for assessing pre-existing conditions and continuity of symptoms. If the details are missing when required, block submission or route to manual follow-up.

And 11 more checks

Hospital stay entries are internally consistent
ACC claim selection is mutually exclusive and conditionally complete
GP contact details completeness and format validation
Specialist details validation when provided
Job duties and time percentage totals are valid
Usual weekly work hours are numeric and within plausible bounds
Job availability conditional explanation
Loss of income fields are consistent and amounts are valid currency
Other compensation rows: Yes/No exclusivity and required details when Yes
Benefit payment bank account structure (NZ format) and required fields
Declarations and signatures: required names and signature dates not in the future

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How to Fill Out Income Protection Claim Form Online for Free in 2026

What the AI walks you through.

Go to Instafill.ai and upload the Income Protection Claim Form PDF (or select it from the form library if available).
Enter the Life Assured’s personal and policy details (policy number, full name, date of birth, address, phone numbers, and email).
Provide off-work and medical information (dates of first medical assistance, total cessation of work, medical certification date, illness/injury description, diagnosis, symptoms, investigations, treatment, medications, hospital stays, and expected return-to-work dates).
Add ACC and provider details as applicable (ACC claim status/number and case manager; current GP and specialist contact details).
Complete job and financial sections (occupation, duties and time split, hours worked, duties you can/can’t do, employer/self-employment entities, loss of income details, and any other compensation or income sources).
Review and complete payment and retirement-related details (bank account for benefit payments, IRD number/KiwiSaver details if relevant), then complete consent and declarations with required names, dates, and signatures for the Life Assured and Policy Owner(s).
Use Instafill.ai’s validation to check for missing fields and inconsistencies, then download the completed form and submit it to AIA/ASB via the instructed email/post/fax channel.

Common Mistakes in Completing Income Protection Claim Form

The ones the AI is built to catch.

Using inconsistent dates across key claim milestones

People often mix up the three critical dates: first sought medical assistance, totally ceased work, and medically certified to cease work (or they enter them in the wrong order). This creates red flags for the insurer and can delay assessment while they reconcile timelines with medical certificates and employer records. To avoid this, confirm each date from your GP certificate, employer leave records, and appointment notes before writing them in (day/month/year). AI-powered form filling tools like Instafill.ai can help by validating date formats and flagging timeline inconsistencies before submission.

Entering dates in the wrong format or in the wrong day/month/year boxes

This form splits many dates into separate day, month, and year fields, which leads to common errors like swapping day and month, using two-digit years, or writing the full date in one box. Incorrect date formatting can cause data entry errors in the insurer’s system and trigger follow-up requests. Always enter numeric values in the correct boxes (e.g., 05 / 02 / 2026) and use four-digit years. Instafill.ai can automatically format and place date components into the correct fields.

Providing vague medical descriptions instead of functional work limitations

Claimants often describe the illness/injury and diagnosis but don’t clearly explain the symptoms that prevent them from doing their specific job duties. This makes it hard to assess disability against occupational requirements and can lead to delays or requests for additional medical evidence. Avoid this by linking symptoms to tasks (e.g., “cannot stand >10 minutes, cannot lift 5kg, cannot concentrate for more than 20 minutes”) and matching them to your duty list. Instafill.ai can prompt for missing functional details and help ensure the narrative aligns with the job-duty section.

Leaving ‘previous similar illness/injury’ incomplete or answering ‘No’ when history exists

Many people either skip the “same or similar illness/injury” details or under-disclose prior episodes because they think it’s irrelevant or fear it will harm the claim. Incomplete history can be treated as non-disclosure and may lead to delays, additional medical file requests, or claim disputes. If you answer “Yes,” include dates, prior treatment providers, outcomes, and whether you fully recovered. Instafill.ai can help ensure you don’t miss required follow-up details when a conditional question is triggered.

Not listing investigations, treatment, and medications with enough specificity

A common mistake is writing “blood tests,” “physio,” or “painkillers” without dates, provider names, dosages, or frequency. This forces the insurer to chase clarifications from you or your clinicians, slowing the claim. Provide investigation types and approximate dates (e.g., MRI lumbar spine 12/01/2026), treatment frequency, and medication name + dose + how often taken. Instafill.ai can standardize medication entries and ensure key fields (dose/frequency) aren’t omitted.

Missing GP/specialist contact details or listing the wrong provider

People often enter their clinic name but omit the GP’s name, specialty, email, or phone/fax, or they list an old GP rather than the current treating doctor. Missing or incorrect provider details can prevent the insurer from obtaining timely medical reports and can stall the claim. Use the provider’s official practice contact details (not personal numbers) and include specialty for specialists. Instafill.ai can auto-complete and validate address/contact formats and reduce typos in emails and phone numbers.

ACC section errors (wrong selection, missing claim number, or no reason when not claiming)

For injuries, claimants frequently tick ACC “Yes/No” incorrectly, forget the ACC claim number, or fail to explain why ACC is not being claimed. This can create coverage coordination issues and lead to immediate follow-up questions. If it’s an injury, confirm whether an ACC claim exists and provide the claim number and case manager details; if not claiming, give a clear reason (e.g., not an accident, declined, outside scope). Instafill.ai can enforce conditional completeness so the ACC fields are filled when required.

Job duties and percentage breakdowns that don’t add up or don’t match the occupation

In the job section, people often provide a generic duty list, omit key tasks, or enter percentages that don’t total 100%. This weakens the link between medical restrictions and occupational incapacity and can lead to requests for employer verification. List duties as you actually performed them immediately prior to ceasing work and ensure the time percentages are realistic and total 100%. Instafill.ai can check that percentages sum correctly and help structure duties in a clear, consistent format.

Financial details incomplete for self-employment, entities, and profit share arrangements

Self-employed claimants commonly forget to tick the correct business type (contractor/sole proprietor/shareholder employee) or fail to list all entities (companies, partnerships, trusts) and profit share entitlements. Missing entity information can delay financial assessment and may require additional documentation (accounts, shareholder salary details, trust distributions). Avoid this by listing every entity you’re involved in, the legal names, and the exact profit share percentages, including any spouse/family member involvement and duties. Instafill.ai can guide entity entry consistently and reduce omissions across repeated “entity name” fields.

Incorrect or inconsistent ‘loss of income’ reporting (monthly amount vs explanation)

People often enter a monthly loss figure without explaining how the loss occurred, or they say there is no loss but don’t justify why (e.g., sick leave, business still paying drawings). Inconsistencies can trigger reassessment, requests for payslips/accounts, or confusion about benefit offsets. Provide a clear monthly amount and a matching explanation (replacement staff costs, reduced billable hours, employer stopped paying) or explain why there’s no loss (and what income continues). Instafill.ai can cross-check that the narrative aligns with the numeric fields and prompt for missing explanations.

Failing to disclose other compensation/income sources and missing start/end dates

Claimants frequently forget to tick “Yes” for sick leave, WINZ support, other insurance, or ACC payments, or they omit amounts and start/end dates. This can lead to overpayment issues, later recovery actions, or delays while the insurer verifies offsets. Carefully review each compensation row, tick accurately, and provide amounts plus start/end dates for anything received or expected. Instafill.ai can help by reminding you of common offset sources and validating that dates and amounts are provided when “Yes” is selected.

Frequently Asked Questions About Income Protection Claim Form

Is it really free for 7 days?

Yes. You pay $0 today. Cancel before Nov 18 and you are never charged. Keep it, and it is $19.99 a month for 5 fills of your Income Protection Claim Form.

Can I fill other forms too?

This plan is for your Income Protection Claim Form: your own AI agent fills it as often as 5 times a month. To fill other forms and upload your own, choose a Professional plan from your account.

How do I cancel?

From your account, in two clicks, any time. No email, no call.

How does the AI fill out Income Protection Claim Form?

You answer a few questions in plain words, or upload a document you already have. The AI reads what you give it and puts each answer into the right field of Income Protection Claim Form, on every page, in seconds. It checks the answers against the form's own rules, and you review and change anything before you download, print or sign.

What happens to my information?

It is encrypted in transit and at rest, and it is never used to train AI.

How complex is Income Protection Claim Form to fill out?

Income Protection Claim Form has a Form Complexity Index of 69 out of 100, in the complex tier: 201 fillable fields across 6 pages. Instafill.ai's AI fills it in under a minute, with every field there for you to review before you download.

What is the Income Protection Claim Form used for?

This form is used to claim income protection benefits when you can’t work due to an illness or injury. It provides AIA with the medical, work, and financial details needed to assess your claim and arrange payments if approved.

Who needs to complete and sign this form?

The Life Assured (the insured person) must complete the claim details, consent, and declaration sections. The Policy Owner(s) must also sign where requested, especially for benefit payment and the final declaration if they are different from the Life Assured.

What key information do I need before I start filling it out?

Have your policy number, personal contact details, key dates (first medical visit, stopped work date, medical certification date), GP and specialist contact details, and your bank account details ready. You’ll also need information about your job duties and any other income/compensation (e.g., ACC, sick leave, WINZ).

Which dates are most important in the ‘Off work details’ section, and how do I choose the right ones?

You’ll typically provide (1) the date you first sought medical assistance, (2) the date you totally ceased work, and (3) the date you were medically certified to cease work. Use the dates from your medical certificate and employment records; if they differ, enter each date exactly as documented.

How should I answer ‘What symptoms prevent you from working?’

Describe the specific symptoms and how they stop you doing your actual work tasks (e.g., “cannot stand longer than 10 minutes,” “cannot concentrate for more than 20 minutes,” “lifting causes severe pain”). Linking symptoms to your duties helps the insurer understand functional impact.

What if I’ve had the same or a similar illness/injury before?

Answer “Yes” and provide full details, such as when it happened, what treatment you received, and whether you fully recovered. Being complete is important because the declaration warns that missing relevant history may affect claim assessment.

Do I need to include hospital stays, investigations, treatment, and medications?

Yes—list any hospital admissions/discharges, tests (e.g., scans, blood tests), current treatment (e.g., physiotherapy, counselling), and all medications you’re taking. If you need more space, you can continue on a separate sheet as the form suggests.

What is ACC, and do I have to claim ACC if my condition is an injury?

ACC is New Zealand’s Accident Compensation Corporation, which may cover injuries. If your condition is an injury, indicate whether you are claiming ACC; if you are not, the form asks you to explain why.

How do I complete the ‘About your job’ duties and percentages section?

Break your role into main tasks and estimate the percentage of time spent on each so the total is about 100%. Be specific (e.g., “driving 40%, lifting/stocking 30%, admin 30%”) and then list which duties you can and cannot perform now.

What should I do if my job is not available for me to return to?

In the job availability question, explain why the role isn’t available (e.g., position filled, business closed, no suitable light duties). Include any relevant context from your employer if you have it.

I’m self-employed or involved in multiple entities—what does the form need from me?

You must indicate how you earn income (e.g., sole proprietor, contractor, shareholder employee) and list all entities you’re involved in. Include profit share entitlements and, if a spouse/family member receives profit share, describe their duties and hours to clarify business income arrangements.

Do I need to disclose other payments like sick leave, WINZ, or other insurance?

Yes—tick whether you are receiving or will claim ACC, other insurance benefits, sick leave, WINZ payments, or other compensation, and provide amounts and dates. If you tick “Yes,” you’ll also need to provide the organisation and contact person details.

Where do I put my bank account details for benefit payments?

Enter the account name and the bank/branch/account number/suffix in the benefit payment section. Make sure the account can receive payments and matches the Policy Owner details if required by your policy setup.

What am I agreeing to in the Consent and Declaration sections?

You are authorising AIA to request and receive relevant medical, financial, and employment information from listed sources (e.g., doctors, employers, ACC, banks) to assess your claim. You are also declaring that the information you provided is true and complete, and acknowledging that non-disclosure may affect the claim.

Can AI help me fill out this Income Protection Claim Form, and what if the PDF isn’t fillable?

Yes—tools like Instafill.ai can use AI to auto-fill form fields accurately from the information you provide, saving time and reducing missed fields. If your PDF is flat/non-fillable, Instafill.ai can convert it into an interactive fillable form and then help you complete it online.

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