June 1, 2011
In this claims case study, Melbourne adviser, Aaron Zelman, shares the difficulties he encountered managing a claim for a client who spent most of her life living outside Australia.
At a glance
Provided by: Aaron Zelman
Company: MediBroker (Founder at LifeScope Advice)
Client: Female, UK ex-pat, diagnosed with cancer
Claim type: Trauma
Mr Zelman was contacted by one of his clients, who advised him she had recently developed an aggressive cancer. A trauma insurance claim was initiated for the client, which included Mr Zelman fast-tracking the gathering of medical records from the client’s doctor and from Medicare. Unfortunately most of the client’s medical records were held in the United Kingdom, where she had lived for much of her life.
Obtaining these records from the UK was extremely difficult. The insurer had outsourced the management of this claim to a third party medical services group, which it also uses for underwriting purposes. But things didn’t go smoothly:
- The third party firm requested medical information, required to properly assess the claim, from the wrong doctor in the UK.
- Time zone differences made direct telephone contact almost impossible.
- The correct doctor was identified, but time delays led to frustration from the claimant.
- This was further exacerbated by unavailability of staff in the UK, weekends, Christmas and other public holidays and personal time off for key people involved.
Mr Zelman stayed in contact with his client throughout this process and needed to assure her the requirement for the UK based medical information was valid. But further difficulties arose in attempting to pay for the report:
The perception in the mind of the client was that the life company was to blame for dragging its heels
- Payment had to be received before the report could be sent.
- The UK medical office had a different way of invoicing for these services and a credit card could not be used.
- A bank draft was transferred but unfortunately the account details provided by the UK finance department were incorrect because they were not used to managing this type of payment. They were also not sure how to process it.
- Mr Zelman offered to personally pay for the report but this offer was rejected by the UK finance department.
In the mean time, Mr Zelman was working with the Australian medical services group as well as with senior executives from the insurance company to find a way to cut through the red tape or to do whatever was required to process the claim.
Eventually the parties found a way to pay for the medical report. The claim was quickly assessed and accepted and the client was paid her claim benefit of approximately $200,000.
Some points to note:
- The perception in the mind of the client was that the life company was to blame for dragging its heels in assessing her claim, even though much was being done to collect the information (admittedly via an outsourced third party).
- The client was on the brink of making a complaint to the Financial Ombudsman Service because of the delays, in spite of Mr Zelman staying in contact with her and working hard behind the scenes to help facilitate what had to be done.
- Mr Zelman uses the analogy of his hitting a tennis ball over the net and expecting a return within a brief period. In this case, it took about a week for the ball to return from the other side of the net.
- Mr Zelman sent around 30 emails, made countless phone calls and spent around 100 hours of his time from the beginning to the end of the process.
- He did not charge any fees for his time and effort.
Mr Zelman suggests that surely insurers must have experience with processes involved in requesting, obtaining and paying for medical reports from other countries. He feels there may be a lack of ‘knowledge share’ for what can be a crucial element in a claims process.