Being fair when it counts!

Issue 15



Being fair when it counts!
There are many moving parts to an insurance company with each one of the different departments performing their own crucial role. Undoubtedly though, from a client perspective, none is more critical than Claims. The entire lifecycle of a policy – from initial sale to year-on-year servicing – are all in anticipation of the moment you need to claim on your policy.

Claims are typically a time of heightened stress and emotion due to illness, injury or death and we do not want to add to that stress in any way. We have a philosophy that all genuine claims are paid as quickly and with as much empathy as possible. To protect all our clients, we will simply not pay any claims that are clearly not genuine, based on the available evidence.

 

To ensure we protect the Kiwis that have placed their trust in us, we have built our claims philosophy on certain key principles that guide how we operate when you need us most. We have enshrined those principals into our contracts – contractually obligating ourselves to go beyond what the law requires of us.

 

Privacy:

 

To assess claims fairly and accurately we do need to access certain sensitive client information. Appropriately protecting this information is of the utmost importance to us out of respect for a client's privacy and to protect the reputation of Partners Life and the industry as a whole. To ensure this we:

 

    1. Only access information when it is truly required (this is in accordance with the Privacy Commissioner’s recommendations)
    2. Only use the information for the purpose it was collected
    3. Provide access to the information on a strictly 'need-to-know' basis
    4. Store private information in an appropriately secure way
    5. Provide all staff with appropriate and regular training in relation to privacy.

 

Fair and reasonable claims assessment:

 

'Disclosure' is the information provided to us on the application form when applying for cover. It forms the basis for the cover we can offer and any terms that apply to that cover. We have worked hard to ensure our application questions are specific in terms of what we need to know and are easily understood to help clients complete the questions accurately.

 

Sometimes though, clients choose to leave out or understate the requested information about their circumstances or health when applying for cover. When making a claim, this information is inevitably discovered, and in these circumstances an insurer may legally not be required to pay out any insurance cover and/or keep any cover in place.

 

This has never felt fair to us and we have always strived to do better by our clients than simply what the law requires of us. Instead of walking away from the claim and/or cover altogether, we will instead re-assess the original application as though we had all the correct information to begin with.

 

If this means we would have still offered cover, albeit possibly with different acceptance terms, then we will assess the claim against those corrected acceptance terms, meaning the client is in the same position they would have been in had the application form been completed accurately. This ensures all claims are considered on their genuine merits and are not simply avoided on a technicality.

 

This approach protects everyone: the clients who obtained cover on terms they shouldn’t have, and also all other clients who had accurately disclosed and agreed to the applicable acceptance terms accordingly.

 

“If it’s grey we pay”

 

Claims can be complex and require skilled insight to ensure they are assessed and paid correctly. Not every case is black or white though and certain claims do fall in that midway point where it is not clear if it should be accepted or declined based on the definition required to trigger a claim. This grey area poses a level of uncertainty for clients we do not believe is fair and so we have implemented a “If it’s grey we pay” philosophy to our claims process.

 

Practically what this means is that if all available information and evidence has been received, and it is still not clear if the claim should be accepted or declined, we will pay it.

 

Forcing you to prove a claim beyond all of the available evidence and information creates an incredibly unfair power imbalance at the point of claim. It is the last thing anyone struggling with a distressing life changing event should have to deal with and we believe it is us, the life insurance company, who should carry that risk – not you.

 

 

Claims Review Committee

 

To ensure our unique claims philosophies are applied consistently, we have a Claims Review Committee. The mandate of the committee is to review claims that technically should be declined or might be considered as 'grey' to see if sufficient reason can be found to justify paying the claim.

 

The Committee is made up of senior representatives across the business to bring a diversity of views and experience which ensures that every claim considered receives full consideration to identify any and all opportunities to change a decline into a pay.  The outcome of the committee has been that a reasonable but minority percentage of all cases considered by the committee do lead to the technical decline decision being overturned and those claims then being paid.

 

It is important to note however, that the majority percentage of claims considered by the committee are still declined. These are the ones where it is certain that the claim does not meet the required definition, or that the cover being claimed against would not have ever been made available had the application been completed accurately. It is important that we do not pay claims which are unfair to the vast majority of our clients who do fully disclose. These are the claims we consider non-genuine and which could significantly increase premiums for all other clients, were we to pay them.

 

We are incredibly proud of our claims philosophies and our track record of protecting Kiwis when they need us most. 

 

If you require any assistance with lodging a claim please speak to your financial adviser or contact us on 0800 14 54 33.

 

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Return to blog home

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