‘’Are they trying to get out of the claim?’’
This week we made a difference in someone’s life - we got to call them and tell them their Trauma Insurance claim would be paid.
For various reasons this claim did take a little longer than normal, one being the Christmas holidays but on several occasions this client asked me ‘’Are they trying to get out of the claim”.
In my experience of over 20 years in this industry I have never come across an insurance company who simply decided they did not want to pay a claim.
So, why did this client keep asking me this?
In our last call he told me he had been listening to the wrong people. His friends were telling him he would never get paid. They kept telling him ‘Insurance Companies always look for ways not to pay you’. Which is incorrect, and it added stress to this client’s life he didn’t need.
As much as we tried to reassure our client that we were just working through the process, I don’t think he ever really expected to get his claim paid.
Why do Insurance companies decline claims?
It’s quite simple, something which is material has not been disclosed on the proposal. Sometimes this is deliberate, but most of the time it is just a matter of something has been forgotten or it didn’t seem important.
When a claim is submitted to the Insurance Company they will request doctor’s notes. This is often the time where non-disclosure is picked up.
What is non-disclosure?
Non-disclosure is when either a medical condition or accident is not disclosed on the proposal. As the Insurance Company are unaware of the condition they do not have the opportunity to underwrite it. Therefore, loading's and exclusions which may have been applied to an insurance cover are not put in place.
What happens if non-disclosure is discovered?
As part of the claims process the client is re-underwritten as if it is a brand-new policy. If, the records show a non-disclosed medical condition or accident the Underwriter may cancel the cover from inception or put a retrospective loading or exclusion on the policy. They will also decide if the illness or accident is material to the claim.
We recently had a lady who suffered a brain tumor but when she had completed her proposal she didn’t disclose an ear operation. As part of the claim process the ear was excluded from the Trauma Cover but she was paid out a Trauma claim. It was decided although the ear was an issue it had no bearing on her brain tumour.
This client just forgot about her ear operation as it had been a few years ago. As hard as it is to believe you could forget something like this, it does happen more than you would think.
So, what is our part in all of this?
Our job is to help you complete your proposal and to ask as many questions as possible to help you remember your medical history. Sometimes, if we think things may be missed, we will suggest you get your medical information from your doctor or your ACC records.
We work on the theory, too much information is better than not enough. At times this means we can do lots of work and the new policy doesn’t proceed. But, we would rather our clients have an insurance policy in place that is going to pay them a claim than we get paid.
Your insurance claim is only as good as your broker and we pride ourselves on being good brokers.
If you think you may have non-disclosed on your insurance proposal or just want to have a coffee and a chat, then please give us a call on 0800 747 336 or email us on email@example.com
A Disclosure Document is available free on request.