April 3, 2014
This case study, provided by AMP, looks at some of the issues insurers need to address when considering the insurance cases of mining employees.
At a glance
Submitted by: AMP
Client name: Tony
Client occupation: Mining engineer
Cover applied for: AMP Elevate income insurance benefit of $11,250 per month
Tony* had heard about the mining boom in Western Australia from friends and, with his experience of working in the mines in Queensland, didn’t want to miss out.
After securing a hands-on mining job as an engineer in the field, Tony consulted a financial adviser. He intended to work in Western Australia, given the current demand for his skills, and his job provided him with an income of $180,000 per year.
As well as putting in place a comprehensive investment strategy, Tony’s adviser suggested he take out an insurance package, including income protection. Because of the nature of his employment contract, Tony purchased an income insurance plan with a 30-day waiting period, a benefit period to age 65 and an insurable benefit of $11,250 per month.
“When looking at Tony’s application, the case underwriter took into consideration his occupation and specific duties. For a hands-on engineer we’d expect to see his duties include things like site inspections, office work and light manual duties,” said AMP Chief Underwriter, Debra Pitcher. “But if his application had included, for example, heavy manual work, we would have needed to go back and check his occupational rating.”
“We also considered Tony’s work hours and the nature of his role. Given that Tony worked in the mining sector, we were not surprised to see him quote varying work patterns, such as longer than normal hours, both at work and away from the site on a break. For other occupations we might question these conditions, but we understand the way people work in and around some mines, such as flying in to work for a couple of weeks and then flying out home again to spend time with their families.
“Due to work constraints, it’s often hard to contact people who work in the mining industry, so it’s really important to ask the right questions up front,” Pitcher said.
it’s really important to ask the right questions up front
Making a claim
One Sunday, Tony was bushwalking in rugged terrain close to the mine when he lost his footing on a narrow cliff track. He fell several metres down the cliff face, landing on a rocky ledge.
His injuries included a ruptured Achilles tendon, which required surgery. He was airlifted to Perth, where he spent a week in hospital. It was almost three months before Tony made a full recovery and was able to return to the mine.
AMP’s Head of Claims Operations, Ben Vanden Boom, said for cases where the treating physician has certified the insured off work for a specific period of time due to an injury, or if there is a reasonable expected return to work date, the claims assessor will often discuss with the insured whether their claim benefits are appropriate to be paid and finalised up front. This alleviates the need for ongoing medical certificates and paperwork and finalises the claim for the insured with little fuss.
“Tony received four weeks of sick leave pay from the mining company. Following the four-week waiting period on his plan, his income insurance payments allowed him to pay ongoing living expenses for the last two months of his recovery,” Vanden Boom said.