Insurer conduct in Product DesignIssue 15
The main way we do this is in how we design our products to ensure we are providing the best quality protection in the market. We have robust practices in place to create and maintain insurance products that are relevant to the needs of Kiwi individuals and families and are as affordable as possible compared with the market.
Partners Life has always maintained a philosophy of delivering market-leading products at a reasonable price to our clients. Like the adage: “Let another praise you, not your own mouth” we rely on the independence of rating houses to do our talking for us. Over the past 7 years of operation, we have ranked at the top or near the top of multiple independent research houses. With such a strong product offering we believe that advisers, who put their clients' interests first, will include Partners Life as the appropriate product provider to many of their clients – because they want to ensure the product they recommend performs the way their clients anticipate.
At the end of the day, we strive to ensure our clients feel valued and that what they are purchasing will do what it is intended to while maintaining the best possible customer experience along the way. The following are just a small sample to show how we have carried out this plan, and how we will continue to carry out such philosophies:
Unique Products in the Market
Just because some insurers might offer cover that operates identically to each other, doesn’t mean that we do. In fact, we have introduced several unique covers that are the first of their kind within the insurance market which are intended to address any gaps where seemingly similar types of insurance may not quite fully cater to a client’s needs. Examples of these newly designed products include Terminal Illness Cover and Severe Trauma Cover. Some of our automatic features include:
For any continuous product that is paid for, it’s safe to assume that one would generally expect at the very least, something that either stays the same or gets better. Our policy wordings do not include any ability for Partners Life to unilaterally, detrimentally change any terms and conditions during the life-time of your coverage. Once you have bought it, for the entire duration of the cover term, only you can decide to amend or cancel it. This is what guaranteed wordings means and is something we passionately believe is the fair way to offer life and health insurances. Non-guaranteed wordings which are offered by some of our competitors, operate like Fire and General insurance contracts, where the insurer can change the terms or conditions of cover within a defined notice period, meaning what you bought may no longer be what you are covered for if you eventually need to claim.
Not content to just guarantee the cover as you originally bought it, we frequently look at ways to improve our insurance products by listening to feedback from clients and advisers and we made the decision early on that any positive additions or improvements to our existing policy wordings would also be applied to existing customers. This ensures no one is disadvantaged by having old, inferior versions of policy wordings. In other words, your cover with us will always be the best we have available at any point in time.
We have made over 260 beneficial enhancements to our products which have been passed back to all of our clients with the applicable cover in place. This is set in stone through our Guaranteed Upgrade of Future Benefits feature.
An example of one such positive enhancement is the change we made to our Reconstruction Benefit within our Private Medical Cover. Previously, only reconstruction surgery for affected areas was covered if it was deemed to be medically necessary. As a result of our claims experience, we identified that reconstruction of non-affected areas was often considered necessary to achieve symmetry, which might be an important component to the emotional recovery of a claimant. As a result of this real-time experience we not only paid those particular claims outside of the policy wordings that existed at the time, but we also made changes to our policy wordings (for the benefit of new and existing clients) by removing the 'medically necessary' requirement for reconstruction surgery. We are confident that this puts our clients in a greatly enhanced position should they ever find themselves in the position of relying on this Reconstruction Benefit in the future.
Fair and Reasonable
We underwrite our policies on the basis of honest health disclosures made to us by clients during the application process. The more we know of your health, occupation, pastimes, and family history, the better position we are in to offer insurance to you on the most appropriate terms. If, at claims stage, it is discovered that material information was not disclosed to us, the law allows us to walk away from not only the claim, but also the cover altogether. Instead we will re-underwrite the cover as at the date of application taking into account the information that we should have been made aware of at that time.
If we determine that we would still have offered the cover being claimed against had we known the non-disclosed information, we will proceed with paying the claim. We believe this is the fairest outcome and one that protects clients who have placed their trust in us. We are so committed to the concept of this Fair and Reasonable claims assessment process that we have enshrined it into our contracts through our policy wordings.
If it’s Grey, We Pay
A number of benefits require the comparison of a health condition against a specific definition of what is required for that condition to trigger a claim payment. We understand that there may be circumstances when the condition as described by the appropriate specialist does not comfortably fit within the definition in our policy wordings, but where, on balance, the outcome to the client is likely to be the same as if it had been conclusively met the definition.
Instead of simply declining the claim in these circumstances, Partners Life will instead pay the claim. This promise we make to our customers also means that we are not going to unnecessarily make people go for further diagnostic or gruelling procedures just to see whether the situation is indeed an exact match with our criteria for when it comes to a claim – claimants in these cases have already gone through enough. We consider providing this peace of mind to our clients is a demonstration of the empathy and ethics of our company.