pdf Case study 1
Comparing 'Before the Code' and 'After the Code'
Before: 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: 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: 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 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
After: 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
After: 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
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.
After: 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
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.
After: 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
Before: 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.
After: 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
After: 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
After: 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
After: 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
Eventually, I received a letter from the insurer that the claim had been accepted and a lump sum was paid to me.
After: 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.
Before: I bought a car from a car yard for $40,000, using finance offered through the dealership. Once I made my decision, I was taken into an office by the salesperson and handed a stack of paperwork to sign.
After: I bought a car from a car yard for $40,000, using finance offered through the dealership. Once I made my decision, I was taken into an office by the salesperson and handed a stack of paperwork to sign
After: While signing the papers for the car finance, the salesperson 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
After: 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 salesperson explained that this would have an impact on the interest I would pay, and quoted my repayments with and without the insurance added
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.
After: 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 salesperson 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.