How to Build a Robust Claims Process

[This quiz is based around an interview taken from the MetLife’s Life Insights Podcast interview series]

Matthew Lane, Principal Adviser of Wealth Fundamentals, is there for his clients every step of the way – in particular, at claims time. In this podcast, Matthew shares his learnings and how they’ve enabled him to build a strong and caring claims process.

 

 

Matt Venus: My name is Matt Venus and my guest today is Matthew Lane from Wealth Fundamentals. Matt has been an adviser for the past 15 years and is well known for being both a technical adviser and someone who really engages very well with his clients to build long-term relationships.

Today’s topic, and why we’ve asked Matt to join us, is in relation to claims advocacy. So today, welcome Matt, thanks for your time.

Matthew Lane: Thanks for having me Matt.

Matt Venus: Matt, just a couple of things about your journey to get to your business and where you’re at right now. Tell us about your business, the history, maybe the staff structure and the types of clients you advise.

Matthew Lane: Wealth Fundamentals has been around since 2000. It’s a business that was started by my father Chris Lane, who’s had an extremely long journey in the industry working for one of the major life insurance businesses himself in a managerial role.

He stepped out in 1994 to start his own insurance business, and then in 2000 merged with another business partner to form Wealth Fundamentals.

Since 2000 we’ve been growing the business which was predominantly a life insurance business to start with. That was the root of dad’s background, and from there we have grown out to become a holistic or full financial planning business as well.

Within Wealth Fundamentals we have three advisers, there’s four support staff, and the client base we work with is traditionally your pre-retirees and retirees.

But over the last, probably five years now, we have really been focusing on that young professional market as well, looking to provide advice to clients around our demographic and age group.

I think there’s a lot of advice benefits that we can provide to the clients around investment advice, insurance advice, superannuation, and debt management, so the Wealth Fundamentals business has really expanded to what we call the fundamentals of advice.

From a business point of view, we’ve been around for 26 years now in various formats, had a lot of experience – especially on the life insurance side of things, which is the key part of our discussion today.

It’s something that we see as one of our key focuses, not only for the young professionals, but also our retiree market as well – where life insurance becomes a really key component for them if they have some younger siblings that they have to look after themselves.

Matt Venus: Thank you for that because it’s about understanding where you come from that often develops into the proposition you now deliver for your clients, and clearly with your father starting the business, and evolving into what is now a full holistic practice, is a great achievement.

So I guess the one thing about that journey is that over time you would have developed a way of dealing with clients and that client adviser relationship, not only in the advice delivery process. Maybe you can tell us a bit about what that looks like. But also then have that translate into what would you call a claims process as well.

Matthew Lane: So from the client adviser relationship’s something that’s so key and important to our business. We’re a business that has a small number of clients so we can really focus on that ongoing advice relationship.

Our whole model is about trying to find clients that are seeking advice, are willing to take on advice and are looking to create a goal and plan going forward. Therefore, we can work with the client over hopefully 10, 15, 20 years to develop that plan, and in building that advice relationship. Part of the key component of advice for us is the life insurance component.

So how that then builds out around the claims side and the discussion with the client upfront is [that] insurance is an extremely key part of any wealth accumulation plan.

So we have that discussion with clients all the time around…Where is it that you’re trying to get to, that there are going to be hiccups along the way, and that’s where that advice piece really steps in with insurance.

It isn’t just a product to be sold, it’s a really important process in your wealth accumulation plan. So what you are trying to get to ultimately is your goal, and where you are now, there’s a significant gap between those circumstances and if that occurs, that’s where we have that discussion with our clients around the life insurance needs.

How that then flows through into a claims process is the way we approach life insurance. It’s not about a product being sold and “excellent, tick the box, stick it in the bottom drawer, I’ve got something now”.

Right from day one, life insurance and the products that you take out is about the ultimate outcome which is a claim.

So we’ve got the cover in place to try and protect the gap that is between where you are now and where you’re trying to get to, but ultimately everything that we’re discussing in your needs for insurance is based around a claim eventually happening.

So that comes down to which product we’re recommending. That’s going to come down to your circumstances and which product has the definitions or benefits or pricing that ultimately fits in to that outcome. If something goes wrong, we need to claim.

So right from day one, and I think in the way it’s going at the moment as well – compliance, audit, regulators – are always looking at how is this in the best interest of your clients.

And we come back to, whether we like it or not, industry providers are doing a lot of the research on them. They’re favourable, unfavourable at times, but always that comparison is coming back to benefits that a policy provides, and all of those benefits come back to what’s going to happen at claims time, and which benefits we’ll be able to claim under.

So the process really needs to be considered from the start as to what is the end outcome, and the end outcome is having a claim if something goes wrong. So therefore, the initial process is always about what benefits are we needing to insure in case something goes wrong down the track.

That’s sort of something that we really built into our advice process, is that in consideration as to what we’re trying to achieve and I think claims has to be at the forefront of any of those discussions with the client.

Matt Venus: Yeah, that’s a really interesting way of being able to describe that and I think the one thing out of that statement, of that set of statements, is that you’ve got to get your client claim ready from the start because we don’t know whether the claim’s going to happen the week after we put the policy in place or 20 years down the track.

Matthew Lane: Also in terms of that positioning of the client too, through the underwriting stage is also setting that expectation of claims time. So if we’re underwriting at the moment, and a loading is placed on the policy, or an exclusion placed on the policy. It is also coming back to the client, to say “well at claims time now, we’ve got to be mindful that this medical condition isn’t included”.

So underwriting, it’s as difficult as it can be at times, it isn’t just a wall to get a policy in place. It’s again trying to understand that process at claims time, what we are actually going to be claiming for, and being able to claim for.

Matt Venus: Absolutely, putting a client into a policy is about that end-to-end process, but ultimately with the prize at the end of if something was to go wrong, to make sure that you’re claim-ready and that you’re there with a robust process to help them through that time.

So I guess that over the years you would develop and refine your process for claims or management for clients. Are there any unique services that you offer as part of that?

Matthew Lane: As you deal with more and more claims you refine your process all the time, but within the business, we have a dedicated claims manager.

Melissa’s been in the business for 16 years now, and part of claims management within the business is about – at a time when a client, more often than not is dealing with extremely difficult, personal, or health circumstances – to take a lot of that stress away from the client.

So within that process, having a dedicated claims person in the business, Melissa deals with a lot of the ongoing policy management as well so the clients have a very familiar voice on the end of the line or face-to-face where all this is dealt with them throughout the years, just doing some policy administration.

But once that event occurs, they’ve got someone that they’re familiar with and can talk to and we take on all of that, as much of the claims administration as possible in completing application forms, liaising with the life company, and getting as much information as we can together.

So the information the client has to collate, or medical appointments they need to go to for the necessary reports, is minimized as much as possible, to take that stress away from them.

Matt Venus: Would you say that’s probably the most important aspect when dealing with an insurance claim, is being prepared and making sure the client has everything they require for a claim to be successfully supported by the insurer?

Matthew Lane: Absolutely. I think the link between a life company and insurer is the biggest benefit that we can provide.

If there’s anything that comes out of the insurer that is questionable we have the experience there to go back straight away to the insurer and say “okay, can you please explain why you need this?” Or “here’s some information already”, so that once we finally go to our client to say “this is everything that we need”, we’re fully understanding of what the requirements are, and why these requirements are being requested.

I think that’s one of the biggest things that we’ve noticed over time is with gaining that claims experience in the business from the first clients where it was a bit of a “what do we do here?” And you go back and forth and have a million questions and requirements, to having that experience to say, okay, this is required, this is why, and this is what you need to do.

One of the things you need to do because A, B, C, D have already been completed by us, so you have a very minimal requirement.

Matt Venus: So I think your comment about learning on the job, I mean, that’s the experience thing that you can never buy… Unfortunately, you’ve just got to go through that.

So I guess the question might be if this discussion was to be pointed towards the new adviser, or someone who is new to the industry, maybe new to writing insurance, what tips would you give them?

Matthew Lane: I think the biggest thing you need to do is communicate. You need to communicate with the client at all times, at the first point of call when they call on you concerned that something’s gone on and they’re gonna have a potential claim they’re at their most vulnerable.

So you need to communicate to the client that we’re there for you, we’ve got the experience and we will take on board a lot of the claims concerns for you, and be the middle person between you and the life company.

So put their mind at ease that there is someone there for them, there’s someone advocating on their behalf, and they can concentrate on what it is that they’re dealing with at the time and not have to worry about the claims process.

So the first part is letting the client know that you’re there for them and we’ll help them through this process.

The next part of it is, as much as we experience underwriting and we get terms and we go back and question some of those terms, the same thing needs used to happen with the claims process as well.

The adviser has to be there acting on behalf of the client and really making sure that this process is happening as quickly as possible and understanding why these questions are being asked.

I think they’re probably the three biggest things; communication, communication, communication. They’re probably the three biggest things.

Matt Venus: Yeah, it’s funny isn’t it how unsaid things often create issues that could have been easily solved with just simply a phone call and a brief conversation. That’s definitely the wealth of experience you bring to the client.

Matthew Lane: From experience the moment anyone goes to lodge a claim, even if it is a genuine claim, you look at it, you just go “okay submit the paperwork, you’ll get paid”.

There is in the back of the mind, I think of all claimants, that something isn’t right with this and I’m not going to get paid.

So if you don’t contact the client, keep them up to date as to what’s going, after a couple of weeks of not hearing from the life company or from the adviser straight away the mind ticks into, “Oh, what’s going on here? What are they not going to pay the claim?”

And that anxiety can start to build up in the client that something’s going wrong with it, so that regular communication just to update them as to where they’re at in the claims process, what’s going on, and setting some expectations around time-frames, becomes really unsettling for the client during the claim process.

Matt Venus: So I guess, I’d ask you if you could reflect on a recent client experience that you’ve had which describes exactly those elements of how to work with a claim and get a successful result?

Matthew Lane: Yeah, so there’s one, we’re right in the middle of it at the moment. So we’ve got a client who has had an unfortunate circumstance with their health.

That circumstance has happened basically a month after the policy started. So there was naturally with the disclosure requirements that happened in the application process right up to the stage that if the application is accepted, we’ve got to that stage and naturally when the client called me and said, “this has happened”. I’ve known the client for an extremely long time now so I had no concerns over the genuine nature of the claim.

But right from the start, I said, “due to those non-disclosure situations and the event happening so soon after the policy has been accepted, there will naturally be some process here of communication around checking medical history”.

So, it was one of those that we have to work with the client. Again, coming back to that communication, and being honest with them upfront to say, “given [the] time-frames, this is going to be a little bit of a messier claim because of the requirements of the insurer to do their necessary investigations” .

But having that conversation with the life company to be able to say, “this is the process that’s happened”, discuss it with the client to say, “okay, this is why they need to investigate and look into the claim a little bit further around your medical history and the lead up to submitting the application”.

We’re able to put the client’s in mind at ease around what would happen through the process because all of a sudden, absolutely going through medical records and trying to see who you’ve seen over the last few months.

For a client straight away they freak out saying “why are they looking for all of my medical history? they’re not just asking me questions about what went wrong, and trying to look at everything here”. So that was a really successful conversation to be able to have with the client around what the expectations are.

Matt Venus: That’s as raw as it gets, it’s one that you’re currently dealing with, thank you for sharing that story.

How would you sort of think the client actually valued then that insurance just by understanding the process and then seeing it unfortunately, in their circumstance, come to life so recently from putting the policy in play?

Matthew Lane: Yeah, I’m hoping we get to that stage, we’re getting closer to the finalization of the claim, but it is extremely rare to have a situation where you have all of these insurance discussions and the claims need to occur so quickly.

So absolutely that benefit of being able to say, “this is why we put it in place” and ultimately this outcome occurring in such a short period of time has been a huge value add, and touch wood assuming everything’s going through and we get to that ultimate outcome.

At the end it will be a real advocate for insurance going forward, and I think that’s one of the biggest things that you can have is a really good claims experience because there are so many stories out there and media articles about the bad side of insurance and claims – and the really good stories don’t get communicated that much.

But working in the industry and seeing positive claims experiences, to be able to sit down with a client at the end of the day and go “here’s a cheque” or “here’s a payment”. All of this that we put in place has come through, and now your financial circumstances, that’s one stress you don’t need to worry about now.

The relief that you can see on the client’s face, it’s a really beneficial part of the industry and the good part of insurance where you can add that value and to say that they’re grateful is probably the biggest understatement you could make.

Matt Venus: That’s the business of insurance, it’s providing that financial support at the worst time of people’s lives.

I guess just to extend on that statement as well, you’ve probably dealt with a number of clients where the client unfortunately has passed away, and maybe you are helping family members who are dealing with their estate.

Have you had any particular comments from those members who’ve had to deal with such a sad time?

Matthew Lane: The best experience we had with a claim was in 2000, so a while ago now, but we had a client who was mid-forties and passed away, she had a very aggressive cancer and passed away at quite a young age. The client had triplets, and the kids were only young teenagers at that stage.

The wife passed away, so the husband left with three teenage kids and at that stage to have the insurance in place which was a significant amount of insurance for them to be able to turn up and say, “look, your circumstances are terrible, but here is a significant cheque to take away that financial risk”.

To be able to turn up and provide that financial security and then as also part of that process we engaged with some of the estate planning lawyers because at that stage with the payment and Super, they had to self-manage super fund, we were able to do some quite detailed estate structuring, using some Super and death benefit trusts and also the estate, in order to create some real effectiveness – especially given that they have some children under the age of 18.

It allowed a lot of tax beneficial payments to be used by some of the estate trusts that were able to be set up at the time.

Matt Venus: That’s an amazing story, and I think that’s the value right there. It’s the human element of taking away the financial stress, but also then understanding the whole person’s circumstance for that family, and it’s now that they have a whole different set of circumstances to deal with.

One of those major things around having someone manage the claim, but also that extra step around making sure that the proceeds match the advice that you’ve given them over time, that it’s appropriately dispersed the right way, I think is the real value of managing that claim right through to the end, even when the proceeds are received.

Matthew Lane: I was going to say that just comes back to the discussion right at the start. The claims experience is the outcome, so having that discussion around how we structure the insurance policy, and then once the claim occurs and having those proceeds then having that further discussion around this is the structure of the estate and how payments should be structured to minimize the tax, how they should be invested to generate the return – because often insurance is put in place to provide with some capital to invest to generate some passive income stream for the beneficiary as well.

So to be able to have all of those discussions with the client, that’s what the claims process is about, not just getting a cheque written and leaving the client to be on their own to work out what to do with it all.

Matt Venus: If you have a crystal ball about what the future could look like for claims, what would be on your short list for a couple of things that might add to the value of the way you manage claims and clients?

Matthew Lane: Yeah, absolutely. Technology is one thing, if we could improve the technology in the claims process, I think a lot of experience is being added to the underwriting process to make that simpler and easier and reduce the friction that occurs.

But our experience is the claims side of things is still extremely paper based and manually involved. If I could say, “let’s build something” I would love an individual client management portal that can be accessed that provides direct access to the claims manager and a portal where information can be uploaded into, documents can be uploaded, it can all be done electronically.

I’ve described it to someone as being like when you apply for government benefits via myGov, you plug everything in, you get to the end, and then there’s this checklist as to everything that needs to be provided, and you can just upload all of those documents and go straight through into the system. But you can still just log into that system and see where the process is up to.

I think it builds on that communication piece and the visual nature of the claim, whether it’s for the adviser or the client can actually access that portal as well to see where things are at. But that would be the ultimate outcome for me, is to step down some of that underwriting focus and technology brought through to the claim so that we can do things a lot quicker and easier with less friction.

Matt Venus: Well, you can consider that done Matt. That’s no problem at all Matt we can fix that.

But look that’s a great suggestion, I love what you said about making the claim a visible experience because often we start with insurance policy is a piece of paper effectively with a promise on it.

It’s got a big number on it often, but what does that visually mean for a client as you’re walking through that process to get to that ultimate outcome.

That brings us to the close of our podcast today, I want to thank you very much indeed for your time. It’s been really great speaking with you we’ve heard a lot about your business and the processes.

You had some great tips there for some advisers, and I think anyone who had been around doing this for a long time, just with this peer to peer interaction, like we have on the podcast can learn with some of the processes they’re doing and how they can improve those and if you’re new to the industry and doing insurance, I think you’ve given a whole suite of great tips there for today.

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