Case Study – My First Claim (Karyn Hilton)


Before becoming an adviser, Karyn Hilton worked as a nurse. In this claims case study, Karyn shares how this previous experience helped her identify a potential trauma claim on behalf of her client. The claim also happened to be the first she processed for a client. This case highlights the importance of researching your client’s claimable condition and also working closely with insurance BDMs to leverage their product knowledge.


At a glance

Submitted by: Karyn Hilton
Business: William Buck Wealth Advisors
Client: Male, sole income earner, suffering from rare nervous system condition
Claim type: Trauma


 In detail

It was Karyn’s prior experience as a nurse that led to her lodging her first claim on behalf of a client who technically was not covered for his particular condition.

Karyn recalls the event: “The client was a married father of two and the sole-income earner. He was diagnosed with a rare condition called chronic inflammatory demyelinating polyneuropathy (CIDP). I was a nurse for a long time and had heard of the condition and knew it would affect his nervous system, resulting in him being confined to a wheelchair. He had trauma cover, and even though CIDP wasn’t a listed event I figured we could try to make a claim.”

After contacting the claims department, who agreed the claim was worth investigating, Karyn got to work collecting paperwork, liaising with the insurer and a number of medical professionals, and keeping her client informed every step of the way.

“With this particular claim, I felt everything from frustration to a sense of satisfaction, that in the end I made a difference. I can still remember that phone call. I asked my client if he was sitting down. He was at work at the time, just trying to go back part-time because he had to earn an income. I said: ‘The company is going to pay you $160,000’. I heard a grown man cry at the other end of the phone. I will never forget that.”

Of particular help to Karyn during her claim was her Business Development Manager (BDM), and she recommends new advisers leverage their relationships for more than just new business.

I heard a grown man cry at the other end of the phone. I will never forget that

“What advisers need to remember is that these BDMs know their own PDS and policy terms, so they can help you determine if the condition is covered, or what benefits could be paid. With my particular claim the client’s policy had a financial planning benefit attached. I was green in the industry and didn’t know what a financial planning benefit was. I gave advice to my client, I billed my client, and, thanks to the advice from my BDM, the client got reimbursed the benefit for my services.”

Karyn was also grateful for her medical knowledge, and believes the first thing advisers should do when they receive ‘that phone call’ is to research the clients’ condition.

“Find out as much about the condition as you possibly can; if that’s on the internet, the library, or by speaking to a friend who is a doctor. I think it’s really important to put yourself in the clients’ shoes, and to get some idea what they’re going through, or about to go through.

“I would also look at a prognosis, because I’ve had to have really tough conversations with clients who haven’t approached their doctor about a prognosis and I’ve had to bring it up. To get claims paid and to guide the client in the right direction you need to know what they’re dealing with.

“Knowledge is power.”