Our Claims Review ProcessIssue 16
Our philosophy is to pay all genuine claims as quickly and with as much empathy as possible. Conversely, to protect all of our clients and ensure fairness, we are vigilant in making sure we do not pay any claims that are clearly not genuine based on all the available evidence. We are proud to have paid over $328 million in claims since our inception.
Our commitment to a claims process that is fair, accurate and delivers good client outcomes is baked into everything we do. Our privacy principles, fair and reasonable claims assessment, ‘if it’s grey we pay’, and our Guaranteed Upgrade of Future Benefits are just some of the examples of our focus on creating a positive experience when you need to claim. Another crucial component in our claims approach is our Claims Review Committee.
The Committee is made up of senior representatives across the business. They bring a diversity of views and experience ensuring that every claim reviewed receives full consideration to identify any and all opportunities to change a decline into a pay. 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.
This thorough interrogation of declined claims does lead to a reasonable (but minority) of technically declined claims being overturned and those claims then being paid. The Committee also reviews claims where additional information has been provided by a client after being initially declined. This allows us to assess if the claim can be paid considering the additional information.
Given the robustness of our claims assessment processes, the majority 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.