Originally published 1 October 2019
You may have gathered from our previous communications this year we have been making a concerted effort to play our part in helping raise awareness about financial risk management and what all consumers need to know about life insurance products and making a successful insurance claim. We are pleased to report that our communications are having a positive effect. For example, our communications in April and July, highlighting the impending implementation of the Federal Government’s reforms to insurance in superannuation generated a couple of dozen follow up phone calls from clients.
These, in turn, led to the insurance within super policies of six clients being reinstated, including one policy providing cover well in excess of $4m. The loss of this cover could have had dire implications for that client’s long-term financial security. We’ve also talked about how at AFRM we always put your (our client’s) needs first; about how our advisers always take the time to ‘dig a little deeper’ to ensure we understand your individual circumstances to tailor the best possible solution to mitigate your financial risks; and we have also urged you to take the time to really understand the terms and conditions of insurance products you have. Following up on that last point, there’s some basic things all consumers need to know about the financial risk advice process itself; why getting advice can protect your best long-term interests and the factors that should be considered when filing an insurance claim. So, in this communication we are providing you with a range of information resources to fulfil these needs. Even if you already know this stuff, why not share it with family and friends in case they don’t? The Financial Risk Advice Process With thanks to Clearview Wealth Limited, we have developed the following brief videos that explain the advice process. Simply click on each link:
Additional information on advice While we recognise that many of our clients already have a financial adviser, for those of you who do not have an existing adviser relationship in place, The Australian Securities and Investments Commission’s Moneysmart website provides useful information on:
Why is it so important to have an AFRM adviser manage your claim? At AFRM, our job is to assist you in your time of need and to actively manage your claims for you. We are with our clients from start to finish. We ensure you have the best definitions in your policies, which we know will stand up at claim time. AFRM advisers are experts when it comes to claims. We know the process and what is required to ensure the best claim outcome. We have relationships with many of the wide range of retail insurers in the market. Due to the volume of claims under our care, we know the people we will be dealing with when we manage a claim for our clients. We know that they have a willingness to treat our clients fairly and to do what is right. As it is likely you’ll be experiencing a time of distress, we take on the hard work for you by managing the entire process including filling in forms and liaising with doctors and insurers as necessary. If you wonder what kind of support we could give you if you ever need to make a claim, please take the time to read the following Case Study which illustrates how our extensive knowledge of insurance products and expertise in claims management can achieve outcomes our clients never dreamed possible. Until next time, live your life well!
Sincerely,
Nicholas Hatherly
Managing Director AFRM
Case Study
“When I told him we’d got him a positive result, Bill had to just sit down and cry.”
This case study comes from AFRM’s Canberra-based Financial Risk Analyst, Justin Beeforth, and it illustrates how our advisers always “go the extra mile” to help our clients in any way we can.
This story is about Bill [name changed to protect client privacy] who has been a client of AFRM since 2007. Bill is another person referred to us by someone who thought we could help.
Justin took over looking after Bill’s best interests in September 2018, following the retirement of former AFRM Director, Mark Hoskin.
After Bill called to advise AFRM that he had been again diagnosed with cancer, Justin visited Bill at his home to talk through his situation and to see how he might be able to help.
Bill suffers from a form of B-cell lymphoma that has resulted in him having to file claims on his income protection insurance in response to three separate bouts of cancer over the past decade; from May 2009 to December 2011, from July 2013 to January 2016 and from August 2018 to the present.
Through that period Bill has endured numerous bouts of chemotherapy and has developed a range of varied and complex symptoms that have ‒ in short ‒ made his life hell.
Compounding the disability caused by his symptoms, Bill lost his wife to cancer in 2015 which led to the onset of depression.
Bill is now a frail 67-year-old whose business is failing because he is simply unable to continue to work.
While Bill and Justin were talking, Bill said the insurance companies he had been dealing with seemed to be confused about what “disability” is versus a bout of cancer. Justin promised to fix that issue.
Bill held optimal income protection cover from a major insurer and claimed on it each time he was diagnosed.
Following the chemotherapy treatment for the second bout of cancer, Justin said Bill was “left pretty banged up” by the time he went into remission in Jan 2016.
At the time, his insurer ceased paying out on his income protection insurance on the grounds that Bill had ‘gone into remission’ and could return to work.
This was despite the fact that Bill was still very incapacitated and not in a fit state to resume working.
Not satisfied with the insurer’s ruling, Justin organised for Bill’s GP to draft a letter detailing Bill’s medical conditions and symptoms since January 2016 that were ongoing and persistent, irrespective of the cancer remission.
The doctor’s March 2019, letter recorded that Bill had seen him for treatment some 54 times since February 2016, with an average of two to three visits per month.
Among the raft of debilitating symptoms listed by his doctor were severe insomnia caused by serious chronic pain, lethargy and other impairments of motor function that left him incapable of working more than four hours per week, at best.
Bill’s GP concludes:
“In my opinion he remained incapable of sustaining any sort of paid employment throughout this period and remains totally disabled with no prospect of recovery.”
Armed with this new medical report, Justin was able to persuade the insurer to agree to a conference call between the insurer’s Chief Medical Officer and Bill’s haematologist in early April.
On the agenda, was a determination of which symptoms were related to Bill’s cancer treatment ‘hangover.’ The haematologist supported the argument that all of Bill’s ongoing issues stemmed from the impact that the cancer treatment had had on his body.
This was critical because his policy terms allow for the continuing payment of a benefit until the age of 70 for disability as a result of a traumatic condition. The call ultimately resulted in a determination that Bill’s ongoing condition is a continuation of the cancer claim that he had been on when his payments had been terminated in 2016, rather than a new claim.
On 17 April 2019, Justin got a call from the insurer confirming they were going to be providing Bill with back pay going all the way back to when they had ceased making payments on his income protection policy back in 2016.
Justin said: “They called to let me know that they’re going to backpay him approximately $8,000 a month (monthly benefit of $7,400 plus premium refund of $600) for the last 31 months. That’s about $248,000.”
“When I told him we’d got him a positive result, Bill had to just sit down and cry.”
When asked how it feels to go into bat for a client and ultimately achieve that kind of a result, Justin’s response was short and sweet:
“It feels amazing mate, there’s nothing like it.”
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