Toward an end-to-end process for handling mental health insurance claims

What they need is a product that actually can respond to that, so that twelve weeks of the year they have another option than digging into long service or rec leave or whatever because they will use up all their sick leave. They need a product that can cover that sort of occurrence. So I think there’s opportunities for great innovation. Based on a much more thorough assessment of the way these different illnesses manifest, and what the prognosis for return to work is for most conditions now. Helen Hewett: As well as having the insurance arrangements, we also need to have a good education program to educate employers about issues and to look at how much more flexible work arrangements can be when people are having these episodes.

Because one of the employers who speak to us said that they’ve been very supportive and they’ve made it know to all of their employees. But still there were a number of employees who were very reluctant to come forward and put their hand up and say I need some time out or to change my working arrangements, because they felt it might mean the end of their advancement in the company. Sean Scallan: Now Heather Gray, a partner specialising in funds management and superannuation at DLA Phillips Fox, will talk us through the risks to funds if the claims process is not improved. Heather Gray: As a lawyer I tend to see the hard cases, the situations where the normal fund processes haven’t worked that well. The one that’s dragged on forever, the one that seems to be intractable, the one that’s heading to the Super Complaints Tribunal, the one where the administrators or people within the fund are at the end of their tether because they don’t quite know what to do. So the impression I have about these sorts of claims is that they’re a complete nightmare.

But of course I do only see a small number that get to that point, and I appreciate that for most of these claims, even if they take a bit longer than is ideal or they’re a bit harder than one would like to see, they do get resolved and everything’s fine. So I’ll just preface my remarks with that, because as lawyer you do tend to think the worst when you see these things because you see the hard cases. The sort of problems that I see with mental illness claims often stem from a lack of awareness on the part of the people who are handling them – and its terrific hearing around the table about some of the advances that are being made in dealing with these sorts of claims, having a single point of contact and handling them in a way that’s very sympathetic to the needs of the claimant. But nonetheless there’s still a lot that needs to be worked on. The sort of problems that I see can be quite simple things, where a claim has perhaps gone off the rail right at the very beginning because somebody had filled in a form in a odd way. And I have seen people put in forms where they were confused about when they were employed, they were confused about what they did, they were confused about why they left employment.

, , , , , , , , , , ,

Leave a Comment

Why super needs a ‘zero-defect mindset’  for operational risk

From cyber-attacks and credential-stuffing scams to fragile third-party ecosystems, the super system is facing a reckoning about how resilient it really is. As the implausible becomes inevitable, funds must sharpen their focus on operational risk.

Sort content by