Maria LonglandClaims Specialist & Business Owner - Risk Assist Claims ManagementQuite often I come across people who have been admitted to hospital or confined to bed rest which can be due to a number of reasons; hospitalised due to injury/illness or for investigations, slipped or ruptured disc in your back, severe fracture, complications in late pregnancy, The list is endless, but you get my point,
If you have been admitted to hospital for a few days or confined to bed by your doctor, then you may have a claim... Under some income protection insurance policies insurers will pay you a benefit if you are confided to bed rest for more than 3 consecutive days during your waiting period. The Nursing Care Benefit (the title and terms of the benefit may change between insurance companies) will pay you a benefit amount equal to 1/30th of the monthly Total Disability Benefit for each consecutive day of confinement. There are conditions to be aware of including the insurers definition of confined to bed, but generally this means you would require a doctors certification, stating that you are required to stay in bed under the full-time care of a registered nurse. The nurse cannot be you, your spouse, parent, child, sibling or business partner of yours or the Insured Person. This benefit option is only available to policies held outside of superannuation and in some cases may require you to have a 'plus' contract. Check your policy schedule for information on your particular cover or contact your Adviser/Insurance Company for clarification. If you require any further information on how we can help you make a claim under your income protection policy, then call Risk Assist Claims Management on 1300 644 980. ![]() Maria Longland, Claims Specialist/Business Owner, Risk Assist Claims Management
Being able to assist clients in successful claims is always a joy, no more so than at this time of year. I wanted to share my story of one such claim… My client who had undergone surgery in June of 2015, yes 18 months ago! was referred to me by a Risk Advisor when looking at reviewing his cover. During this review the client confirmed that he had undergone back surgery however at the time he did not make a claim, as his previous Advisor had informed him that they could request claim forms but as he was only off work for a few weeks, it would not be worth him making a claim! SERIOUSLY! The client was off work for 8 weeks, with a 30 day wait period. I was able to lodge a ‘Pay & Close” claim with his insurance company, OnePath, who were flexible in my request to waive the financial requirements for the indemnity policy and even paid an additional $1,671.00 in ‘No Claim Benefit’ which resulted in a payout of nearly $7,000 within less than a week of lodgment. I would like to say a BIG thank you to all the claims staff who worked throughout the Christmas/New Year period to ensure clients claims, like mine, are dealt with smoothly and efficiently. Next time you are reviewing or renewing cover for new and existing clients, don’t forget to check if they are able to make a claim for an injury or illness they have experienced since their policy was last reviewed/renewed. Quite often the client is unaware of their ability to claim or they just find the whole process too difficult. If this is the case, why not contact me and I would be more than happy to assist them in lodging a claim for any potential benefits that they may be entitled to…. Call me on 1300 644 980. ASIC has announced the findings of its industry-wide life insurance review, saying there are “significant shortcomings” in a number of areas in claims handling.
In March, ifa reported that ASIC would conduct a wide investigation into claims handling following the CommInsure scandal. In an announcement today, ASIC said it has found “a clear need for public reporting on life insurance claims outcomes at an industry and individual insurer level”. While the review did not find evidence of cross-industry misconduct, it did identify issues of concern in relation to higher claims denial rates and claims handling procedures. For instance, there were higher claims denial rates in relation to insurance policies sold direct to consumers with no financial advice, compared to policies sold through advisers and group insurance policies, ASIC said. The rates of declined claims were highest for total and permanent disability cover (average declined claim rate of 16 per cent) and trauma cover (average declined claim rate of 14 per cent). There was also a “considerable variation” in declined claims among insurers, with TPD denial rates being as high as 37 per cent and trauma up to 25 per cent for some types of cover. The most common types of life insurance disputes were about the evidence insurers require when assessing claims (including surveillance), and delays in claims handling, the review found. In an effort to improve claims handling standards, ASIC has established with APRA a new public reporting requirement for life insurance industry claims data and claims outcomes. “To improve public trust, there is a clear need for better quality, more transparent and more consistent data on life insurance claims,” ASIC said. “ASIC and APRA will work with insurers and other stakeholders over 2017 to establish a consistent public reporting regime for claims data and claims outcomes, including claims handling timeframes and dispute levels across all policy types. Data will be made available on an industry and individual insurer basis.” The six-month review examined 15 insurers covering more than 90 per cent of the market. It analysed three years' of data on the four major life insurance policy types: term life cover, TPD, trauma, and income protection. |
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November 2017
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