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

The reality is there’s some funds with some arrangements where they don’t actually cater for loadings or exclusions, where there are other funds that do. So for those ones that don’t, there’s a higher decline rate. In addition to that, it’s important to highlight that we do see the high decline and drop out rates where a fund has a higher blue collar demographic. So that translates to looking at member communication. Damian Hill: One of the outworkings of this could well be, if there is a mental illness aspect to the claim, this sort of delay is loading up extra financial stress to it, so it can have flow on effects. Nick Galanakis: On that, we are also going to be taking steps to clumping particular claims into broad groups and analysing the sort of experience we get in respect of those claims. We’ve looked at claims that have been experienced over a period of about 20 years, a sample of just under 6000 claims of which about 560 relate to mental health conditions.

The accept/decline ratio for mental health claims of about 80/20 aligns with what we’re seeing with respect to other sort of conditions as well, but what length of delays are there for individuals with these sort of conditions. For example, we might see on average 170 days to assess and get a conclusion on a TPD claim overall in terms of the industry, but what are we seeing specifically for mental health patients. Is it substantially longer? What sort of requirements are being put on these individuals that possibly they’re finding it extremely difficult to facilitate and provide the information the insurer needs. It’s probably interesting to note as well although this covers some samples of claims going back 20 years, up until about 10 years ago, underwriters weren’t really properly categorising cause of claims, so a lot of mental health claims going back 10 years were actually just lumped into an ‘unknown’ basket. So moving forward, we need to make sure that we do get to the right sort of information and being able to benchmark and track that. Greg Staunton: Nick, would this be claims with mental illness as the primary cause and therefore recorded.

There’d be a lot more. Nick Galanakis: Correct, there are a lot more. There’s some notes down the bottom, what we basically said was there was a number of claims that might be, for example, depression from a back injury. That claim might have been lumped in with back injury not depression – there are a lot more on those lines. Peter Gebert: Another point I just want to clarify, until about five or six years ago many of our funds did not have all their members covered for insurance. So I also believe there’s another large sector that are not even probably in here because these are only the insured claims. Is that right? Nick Galanakis: Correct. Peter Gebert: We have a lot of other claims that are still processed that have no insurance but still have to be processed either as a death claim or a disability claim. And we haven’t got that data. Nick Galanakis: That’s a very good point, Peter. Moving forward we’d like to capture much more accurate data to be able to benchmark and track that sort of information. Helen Hewett: Can I just ask in relation to those claims Peter’s talking about, the uninsured claims.

, , , , , , , , , , ,

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