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Hewison Private Wealth - Insights
Hewison Insights

All you need to know about making a personal insurance claim.

Marcus English
Insurance Adviser - Risk & Insurance
14 Apr 2022

What to expect from your insurance team at Hewison Private Wealth when the unexpected happens?

Insurance claims are a side of the equation we hope never come into fruition. While we spend plenty of time helping clients understand where they are financially exposed and the appropriate wealth protection arrangements in place, the fact is that we hope it all remains in the background, purely there for peace of mind.

The majority of us are fortunate enough to chip away at our goals over time, but sadly for some, the personal insurance policies we have put in place can quickly become the ‘life support’ of a financial position.

The message I give our clients is clear. We hope claims assistance is never required, but if it comes to that, it certainly forms part of our value proposition and it is an area where we strive to add value and support, during what is already an emotionally stressful time for the individual and/or family. Dealing directly with an insurance company is not always easy, so ideally we aim to make it as smooth as possible by holding the clients hand every step of the way.

So, what can one expect during this process? The first step is to contact the insurer to inform them that a claim is to be made. They then prepare a claim pack which would generally consist of various documents, the main ones being the claimant’s questionnaire, the treating specialist’s questionnaire, one from the employer and medical authorities such as from Medicare, so that the insurer can obtain your medical information.

The claimant’s form is to fill in personal details, symptoms experienced and diagnosis that has led to the claim, as well as providing the doctors details.

The treating specialists’ statement is effectively to provide medical evidence of what the individual is going through, whether a specific illness or a condition/injury or disability. Accompanying the specialist’s statement is likely to include any correspondence between specialists, surgeons and general practitioners, as well as findings from any tests or scans carried out. The aim is to provide the insurer with a clear enough picture for them to make a decision as to a legitimate claim or not. Some claims can be quite clear cut with a specific diagnosis, whereas others can be more subjective in nature.

The purpose of the employer’s statement is to provide the insurer with employment details of the insured person. The role they performed, their duties, hours worked, income, time off work and how the medical condition has affected their ability to perform their role. This is particularly important when assessing the likes of income protection or total and permanent disablement claims where definitions are based on ability to work.

The last component I’ll mention are the medical authorities the insurer will obtain, including that of your doctor and Medicare and private health insurance records. There are a couple of purposes here – firstly to have the permission to request current reports from your doctor or treating specialist, and secondly, to check your past medical history. A process undertaken upfront at the start of many policies is medical underwriting, where the insurer assesses us as an individual risk. During this process, we have a duty of disclosure to the insurer to let them know of any past medical details that form part of their questionnaire, which could be relevant to their decision around offering insurance terms. If, at the time of claim, the insurer discovers that information was withheld, this could impact the outcome of the claim and whether they would have offered insurance in the first place, or with an exclusion. I have actually had an instance in the past where the insurance company made the decision they never would have offered insurance in the first place, and cancelled the policy since inception and refunded all of the premiums paid to that point in time.

The purpose of this blog has been to give some insight into the claims process. As I mentioned earlier, hopefully it’s never relevant to you! But if you find yourself in the position, you can have peace of mind that you have a carefully considered strategy in place to protect your or your family’s financial future, as well as peace of mind that you have advisers who truly care and are here to guide you each step of the way through your claim.