They’ve included extraneous material, they just put options into their claim. Now unless that’s picked up on day one, the whole thing will proceed and proceed and proceed, until it will finally get to a point and somebody at the insurer with an appropriate level of expertise will get that set of documents and look at it and will say, hang on we’ve headed off down this track, it’s maybe six months later. And the whole thing is misconceived or the information that they’ve predicated is gone. And that can cause problems such as you’ve got the wrong insurer dealing with the claim. Perhaps there’s been a change of insurer. If those things can be recognised on day one, or close to day one, it makes things a lot easier. Another problem that I see is the claimant who because of their mental illness, is incredibly difficult to deal with. And the staff at the fund or at the administrator who are dealing with that client are getting very stressed themselves, dealing with it.
And I’ve had situations where people are running for cover when they hear that so-and-so is on the line wanting to know about their claim. Unless people are trained to deal with it, it’s very difficult. And I’ve certainly seen cases where claims have run on and on, simply because that person is so hard to deal with that it kept getting put to one side, or people were reluctant to return calls and the whole thing sort of snowballed and the claim ends up in that too hard basket. I’ve seen situations where people have made claims around depressive or anxiety disorder, and yet somehow those processing the claims have not put two and two together and said to themselves, ‘this person is anxious, I will have to deal with them in a way which is consistent with dealing with an anxious person – if I don’t return their call promptly they might have issues with that’. But clearly its terrific that so much work is being done on improving these things.
So from a legal viewpoint, what are the risks to funds if they don’t get better. I actually don’t think it’s any different to not doing any particular thing well in the course of running a fund. Clearly, the obvious one is if mental illness claims aren’t handled well they’ll end up in the superannuation complaints tribunal. I think that’s the obvious thing that will happen. Sometimes they will end up in court depending on the time frames and whether or not people fit within the criteria to take those claims to the SCT. And you certainly see plenty of those. Once something is in the SCT it’s managed according to the SCT’s processes, the insurer gets brought in, you will have additional costs in dealing with that compared to in-house. That adds to the administration cost at the same time it’s adding to the anxiety issues for the claimant at the other end of the line. And sometimes you get a decision where the insurer’s made to pay extra because they’ve delayed payment beyond a reasonable time.







Leave a Comment
You must be logged in to post a comment.