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Articles by Steve Munro - Guest Contributor

Guest Contributor

Do health and risk insurers actually pay out when you make a claim?


When most people think of insurance, they think about the cost. I guess it's because you see the premium evaporating from your bank account every month. More critically, in these present times, it's tough – what I call the "everything crisis" (the cost of living, healthcare, education, housing – you name it, it's a crisis). It sounds scary, right? The fact of the matter is, yes, times are tough.  

However, when the rubber hits the road, I’m certain you won’t be complaining about your insurance premiums. When the time comes to make a claim, I’ve never heard anybody moan that they have too much coverage. 

A recent case in point 
A client contacted me recently wanting to trim back his premiums. Yes, we talked through it, and I presented him with a few different options, but he never came back to me. 

Three months later, we received an email explaining that his wife had been diagnosed with cancer. Within a couple of minutes of receiving his email, he called me quietly to ask, "Hey, please tell me I didn’t reduce that cover!" (His wife wasn’t aware that he’d be talking to me about this.) He breathed a sigh of relief once I told him, "No, it’s still the same."

Claim payments – myth or reality?
Yes, insurance companies do pay claims, and they do so in a timely manner. Am I sure? Absolutely. 

If you have the correct policies in place with the right structure, then insurers are happy to pay. They expect to pay. They employ some of the smartest mathematicians in the country; it's part of their business. An insurance company's claims team is made up of incredibly skilled people, who are empathetic and make pragmatic and practical decisions for a given claim situation. I know you may be reading this in disbelief, as most people's opinion of insurers is that when you go to claim, they have the "computer says no" mentality. This is simply not true!

Recently, we have had a series of claims, all for breast cancer, and the clients were all in their early 40s. This came out of the blue for these clients who are pretty much in the prime of their lives. 

It may seem uncanny that we were hit with several claims with similar demographics – they all live within about 20-30 km of each other. No, there's no conspiracy here. You can go months without a single claim, and then within a few weeks, you can be inundated with a number of random, unrelated events. That's the nature of statistics. Unfortunately, someone has to be the statistic.

Our experience with the financial and medical aspects of these claims has been impressive. This is super important because once you find out you have such a diagnosis, it's critical to understand your position ASAP so that any unnecessary anxiety around finances or medical treatment can be nipped in the bud.

While the claim process can seem overwhelming, we act as the middleman – the support person who knows which questions to ask, what information is needed, and how the claim process works. During a time when specialists are providing you with a lot of information, we aim to make the claims process one less thing for you to worry about. From the day you advise us of symptoms or a definite diagnosis, we guide you through seeking prior approval for necessary medical tests and treatments, and starting your trauma claim.

Knowing when and how to make a claim
Some people believe that insurers make you jump through hoops by requesting extensive medical information and claim forms for assessment, but that's not true. When you know what they need, the process becomes straightforward. 

Clients have expressed concerns such as 'I didn’t think I was sick enough to claim as I don’t need that much time off work' or 'It is only in the early stages and hasn’t spread so it won’t be serious enough for a claim to be paid.' On many occasions we have proved such clients wrong, and they’ve ended up with payments that have made a significant positive difference to their situation. 

One of the benefits of trauma cover, for example, is that a claim payment isn’t dependent on your ability to work. Even if you don't see the condition as serious, you may still be eligible for a partial payment of your benefit. For instance, we had a client receive a partial payment when they were initially diagnosed with breast cancer before any treatment had commenced. This lump sum payment helped alleviate the initial stress of being off work and coming to terms with the diagnosis. Once treatment commenced and surgery and radiation were confirmed, the remaining sum insured was paid out as they had now met the criteria for a full claim payment. We also liaised directly with the radiation provider to organise preapproval for the health insurance side of things, ensuring that the client’s sole focus was on her treatment and recovery, rather than additional paperwork and chasing insurers.

The moral of the story here is that even if you are unsure or believe you won’t be eligible to make a claim, talk to your broker. You may be very pleasantly surprised. 

Summary
This article isn’t meant to be a scare tactic, but rather a reassurance that having the correct cover in place, a good broker, and the right insurer, sets you up for the best claims experience and gives you confidence that the support will be there when you need it the most.

To talk to us at Risk Direct about your insurance, fill out the form on our website, send us an email at [email protected], or phone us on 09 522 7933. There is no charge for you to have a discussion with us. 


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© Gilligan Rowe & Associates LP

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Disclaimer: This article is intended to provide only a summary of the issues associated with the topics covered. It does not purport to be comprehensive nor to provide specific advice. No person should act in reliance on any statement contained within this article without first obtaining specific professional advice. If you require any further information or advice on any matter covered within this article, please contact the author.
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