A key industry service provider has called on advisers and advice businesses to exercise greater diligence when preparing and submitting claims on behalf of their clients.
Trevor Battersby, Director and Founder of TPD Claims Support, has told Riskinfo that sub-standard work by either advisers or their support team members when preparing clients’ claims is causing needless delays or declined payments in some instances.
He says while “insurer bashing” is a popular sport, companies can only assess what has been submitted to them.
“There is minimal to no training in writing claims, and it is the most critical part of the process,” he says. “Quality in quality out, garbage in, garbage out.
“As professionals we are in control of the claim submission and we simply need to raise our standards in this area.”
Battersby says a well-researched and comprehensive claim can make the process easier for everyone.
“A defined research and submission methodology will reduce claim time frames and eliminate ineligible claims quite quickly,” he says. “It’s up to us to complete a quality submission.”
Battersby says the most significant error he sees is lack of medical evidence.
He says advisers should check the product disclosure statement and know the difference between a medical specialist, medical practitioner, and health professional.
You simply cannot submit a claim and hope…
“A psychologist is not a medical specialist, and we constantly see claims being submitted with a GP and a psychologist, not a psychiatrist.”
He says advisers charged with completing a claim form are “future forecasting” what an insurer will look for.
“Removing hurdles before they become a problem will avoid those numerous one and two-week delays on each email from the insurer requesting more information,” he says.
“Even more pertinent is that if a client is not eligible, call it now. You simply cannot submit a claim and hope, and then blame the insurer when a claim is declined.”
Battersby says most of the claims his firm has been asked to take over have lacked clear evidence or the expected and necessary information required by the insurer.
“If you focus on great systems and process you will minimise any litigation threat when things go wrong,” he says. “In the absence of these key submission processes you are again flying blind if you can’t produce this evidence should your client seek legal advice.
“Do not let the insurer control the process,” he says. “Work hard at the start and the rest will flow.”
Battersby says a good claim submission should include:
- An eligibility checklist or questionnaire (key)
- A claims fact find (key & critical)
- Initial original application (key & critical)
- Personal statement or telehealth assessment (key & critical)
- Timeline, financial constraints, acting in best interests
- A reading of the PDS definitions checklist of eligibility, medical evidence, and income evidence definition
- A well-defined goals based strategy (critical if multiple insurances being applied for)
TPD Claims Support will be one of a host of industry service providers which will form part of the industry expo that will be present at each of this year’s Riskinfocus 25 Risk Advice CPD Tour events in March.
As an experienced life risk advisor with many claims under my belt, I agree with all the sentiments expressed in this item. But what is not said is that claims management is much easier if there is a genuine (not transactional) relationship between client and adviser and both parties are able to engage with frankness.
And please remember, the client sitting before you will be under significant stress, financial and/or emotional.
If that relationship does indeed exist, then the adviser should take one more step and spell out one particular maximum: "I will fight like hell for you to get this claim paid, but IF I find that you have misled me in the information you have provided, then all bets are off, and/or a fee is now payable for future work"
Part of the issue as I see it is that new advisers don't take the time to study definitions in income protection and trauma policies, particularly at a time when a claim is afoot.As the article says, the adviser has to have a pretty well-founded idea of the possibility of success and indeed then translate that to the client. False hope is a disaster for all parties.
There is one sentence though the does bother me: “Even more pertinent is that if a client is not eligible, call it now". I agree with the sentiment but I would strongly suggest that the adviser handling the claim discusses the matter with his AFSL re-potential breaches of the Standards of FASEA.Starting with Standard 5, the communication criteria.
This is not a job to be passed on to someone sitting in the back office, it has to be in the hands of the adviser.
Our experience and knowledge as risk specialists should tell us that a claim is probably not going to get up but then again we are not making the final decision in the circumstances that are impacting on that particular claims officer at that particular time.
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