Policy

Case studies

 Case Study 1

BEFORE THE CODE WITH THE CODE
After a recent injury, I called my insurer to ask about making an income protection claim as I wasn’t able to work. The person I spoke with sent me out a set of claim forms to fill out. After a recent injury, I called my insurer to discuss making a claim. The person I spoke with explained the features of the insurance I held including the benefits I may be able to claim on and encouraged me to lodge an income protection claim given the nature of my condition.  
After submitting my forms I waited for the insurer to come back to me. Unfortunately, when they did they explained they did not have all the financial information they needed and I would need to contact my accountant for the remainder. They also explained I had a waiting period, and it would be another month before I received any money, which I hadn’t planned for. I was contacted by my insurer, who explained the claims process, why certain information was being requested and that I had a waiting period that applied before a payment would be made. There was a delay getting information from my accountant and the insurer contacted her themselves to collect the information they needed.
I spoke to numerous people during my follow up phone calls to my insurer, and as a result it was hard to get anyone who fully understood my circumstances. I was assigned a primary contact person, and I felt she was well trained, and treated me with compassion and respect during a difficult time. I was kept informed of the progress of my claim every 20 business days.
I received money from my insurer in my bank account, though it was less than I had expected. A letter then came in the mail some days later with additional medical forms I needed to have completed. While my family doctor was not across my recovery at that time, I arranged an appointment with him to have the forms completed, as my follow-up appointment with the surgeon was too far away. It never made sense to me why they kept requesting so many forms to be provided. The insurer let me know their decision to accept my income protection claim within 10 business days of receiving all the information I had sent through, and my payments started.

My insurer monitored my condition by requesting statements or reports from my treating doctors at key points in my recovery, such as after my first follow-up appointment with the surgeon. They explained why they were requesting information at each point.

My insurer spoke to me about when I'd be ready to return to work. They suggested I contact my employer to discuss my options and come back to them.

When I spoke with my manager he explained he would allow me to return only when I had full clearance from my doctor. He said he wasn’t sure how to support me working in a reduced capacity.

When I saw my family doctor with my monthly forms, I asked him when he thought I might be ready to get full clearance as my employer needed it for me to return. I said I felt nervous about returning at once and shared how I am generally feeling quite isolated and anxious. He noted this on my forms for the Insurer and gave a return-to-work date for a few weeks’ time.
 

 My recovery was clearly central to my insurer’s concerns. They arranged for a health care provider to visit me and talk about my current circumstances. Before this visit, she clearly identified herself and I understood why she would be visiting me. She later spoke with my doctor and employer to plan my return to work, which was tailored specifically for me and my recovery. That my employer was informed and on board with my recovery and return to work together with the advice and guidance of my family doctor gave me peace of mind.
After submitting my forms again, my insurer contacted me to talk about my return to work. I said I was a bit unsure but my doctor said I may be right in a few weeks. The insurer indicated they could pay me a few weeks in advance up to that return to work date to finalise my claim. I was a bit unsure about this but needed the money, so I accepted.

The Insurer explained if my return to work was not successful I should contact them again. At that time they said an independent doctor would examine me. My claim was finalised.
 

At first I was working in a reduced capacity to help me ease back into it. When I was approaching full-time, I rang the insurer and we discussed a final payment. Before we agreed, they suggested I seek financial and legal advice.

Once we agreed on a final payment, my claim was finalised. They explained the health care provider would continue to check in with me over the next few weeks so that I wouldn’t feel overwhelmed. They also explained that I would have a recurrent claim benefit if things didn’t go to plan.
 

Case Study 2

BEFORE THE CODE WITH THE CODE
I made a TPD claim for a mental health condition. The insurer made multiple requests for information from me, which delayed the claim process. When I followed up about the time it was taking, it was hard for me to understand exactly where the claim was at or what the process was, or what more was needed to make a decision. I made a TPD claim for a mental health condition. I felt that the person who was assigned to be my primary contact understood my condition and treated me appropriately, and explained why certain information would be required for my claim.
Because I couldn’t work due to my condition, I told my insurer I was in financial hardship and that I was relying on Centrelink to cover household bills. I was told that TPD claims take time and a decision would be made when all the information was received. Because I couldn’t work due to my condition, I told my insurer I was in financial hardship and that I was relying on Centrelink to cover household bills. After I gave the insurer my Centrelink statements, I was told within 5 days that the assessment and decision on my claim would be fast-tracked due to my financial hardship. This was also confirmed in writing.
I was contacted by a man who said he was coming round to my home to interview me. I didn’t understand why the interview was required, and as English is my second language I didn’t understand some of the questions being asked. Due to my mental health condition, the interviewer’s manner made me very anxious, and I was uncomfortable having a stranger in my home while I was on my own. I was contacted by a man who explained he was working on behalf of my insurer and wanted to interview me to discuss my claim. He told me over the phone that he had a background working with people who had mental health issues, and asked if I would like to have a support person with me at the interview. He also asked if I was comfortable having the interview at my home.

As English is my second language, I asked to have an interpreter at the interview, and this was arranged by the insurer. I also asked if it was possible to have a female interviewer, and this was also arranged.

I felt that the interviewer treated me with respect and sensitivity, and said it was fine for me to take breaks during the two-hour interview when I felt overwhelmed.
 

I was contacted by someone from my insurer that I would be required to attend an independent medical examination. They told me who the doctor was who would be conducting the examination, and the date and time that I would have to have the appointment. My primary contact at the insurance company told me that I would need to attend an independent medical examination. He explained that insurers hold their independent medical assessors to high standards, and that they must also comply with ethical guidelines. I was able to choose an assessor from a list of doctors nominated by the insurer, which allowed me to go to someone near my home.
More time passed without me hearing anything from the insurer. I was concerned about whether my condition had been fully understood.

Eventually I received a letter from the insurer that the claim had been accepted and a lump sum was paid to me.
 

I heard from my primary contact at least every 20 business days to let me know how my claim was progressing.

About six weeks after my independent medical assessment, I was notified that my TPD claim was accepted. Because the claim was to be paid in a lump sum, my insurer suggested that I might want to seek financial advice to help manage the claim payment.
 

 Case Study 3

BEFORE THE CODE WITH THE CODE
I bought a car from a caryard for $40,000, using finance offered through the dealership. Once I made my decision, I was taken into an office by the sales person and handed a stack of paperwork to sign. I bought a car from a caryard for $40,000, using finance offered through the dealership. Once I made my decision, I was taken into an office by the sales person and handed a stack of paperwork to sign.
While signing the papers for the car finance, the sales person started discussing insurance for the car with me. He then told me that my loan could also be protected by insurance, in case anything happened to me. He said it was a really simple process – I just had to sign the last two pages of the paperwork. While signing the papers for the car finance, the sales person mentioned some other products I may want to consider, including a life insurance policy to protect the car loan in case anything happened to me. He explained that this was optional, and when I expressed interest in understanding more about it, he explained the eligibility criteria for the policy, what was and was not covered by the insurance, and that there was a 30-day cooling-off period if I changed my mind.
He also said I wouldn’t need to worry about payments for the insurance as it would be taken care of as part of the loan. He explained to me how the premiums for the life insurance policy could be structured, and that I had the option to include the insurance as part of my finance or to pay monthly. When I asked about adding it to my loan, the sales person explained that this would have an impact on the interest I would pay, and quoted my repayments with and without the insurance added.
I didn’t really read the papers too closely but signed and left the dealership.

I later found out that I had bought life and general insurance products as part of my finance package to protect my loan, and the amount of my loan was now $50,000 plus interest.
 

I felt comfortable signing up for the life insurance that had been described to me, on the basis that I would have 30 days to cancel it if I changed my mind. Before I bought the policy, the sales person asked me clearly if I consented to the purchase, and when I said yes, he showed me where I could sign a statement to evidence my consent.

I decided to keep the policy, and throughout the life of my loan, I was sent a yearly reminder about the life insurance product I had bought, explaining the cover that I held and how I could make a claim if needed.
 

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