When is an incident a claim, or when is it not a claim – that is the question…

blog-imgIn my role as an insurance adviser, it is very common to meet people who have had an event that could lead to a claim and payout on their insurance cover – but who have never claimed as they were not sure or did not know what their cover actually provided.

Having insurance is one thing – but making it work for you and actually being able to make a claim is something completely different. A number of years ago I bought an existing book of clients and came across an interesting situation that did eventually lead to a successful claim.

But… If my client had not had an advisor who was invested in him, he would most probably have missed out on $138,673…  Not an insignificant amount!!

When you take out insurance your main thoughts are about what would happen if you became ill or had an accident. Not necessarily what type of insurance you have – most people take their adviser’s recommendation. And then forget everything except making the payment each month.

‘I have insurance’ I hear you say…  But my question to you is ‘when was your personal or business risk management protocol last reviewed?’ Most people I speak with cannot remember and some don’t remember who their broker or adviser is. It is an essential part of an adviser’s role to stay in contact, review your cover and ensure it is relevant to your present situation. And that can change – people get married, they buy property, move to new jobs or have an addition to the family. All of this would have an impact on your cover.

But more importantly – what would happen at claim time? Let’s go back to my client who almost missed out on a claim pay out.

Let’s call him Dave – Dave called his insurance company and asked for some information – from the answer he received he did not think he had a claim. (This was more about misunderstanding what he was told). It was quite by accident that I found out he had been in contact with the insurance company and so I called him directly. After the third attempt, I managed to have a conversation with him and he said ‘I have made a complete recovery, so am not entitled to make a claim’. Really, I thought. So I delved a little further.

It transpired he had had prostate cancer at Gleeson Level 8 – pretty serious. That in itself was sufficient reason for a claim to be lodged. Let alone the time he had off work and the ensuing treatments. I helped him to complete the claim application, and lodged it on his behalf. I followed up 24 hours later and was told by the insurer that yes, indeed he did have a claim.

When that was later confirmed in writing I called Dave. There was complete silence when I told him that $138,673 was going to be in his account overnight. Then some emotion followed by profuse thanks. This money came at a time when he was financially stretched and so was very gratefully received.

Dave was fortunate – he had an adviser who was actively involved with him as a customer and who followed up to ensure that his claim was paid as soon as possible. This was also a relatively easy process.

Another client I had needed to make a claim – she has Parkinsons – and it took months for us to get the information, the medical notes, the specialist appointment etc before we could complete the claim application process – and fortunately, her claim was also successful. However, without an adviser, she would really have struggled to make this happen at all and it was some 5 months before her claim was approved.

Is your adviser or broker actively involved in your risk management programme? Do they regularly review your cover and ensure it is sufficient? If you had a situation whereby you wanted to make a claim, are you certain that this would be handled on your behalf? In fact, if your insurance is with a bank – knowing how staff in banks move around – who would champion your case and ensure your claim was managed efficiently?

We take out insurance for certainty, however my experience leads me to believe that most people do not have certainty around their insurances – they do not know who their adviser is or even if their cover would work for them at time of claim. Perhaps the most important aspect of why we have insurance.

To be sure, gain certainty and know your cover is relevant to your situation today, give me a call and we can make a time to have a chat around your concerns. Unfortunately we never know what is around the corner, so don’t delay, contact me now.


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