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

Another issue is how can we train our case managers to effectively and safely question the treatment strategies of our treating doctor practitioners. Because return to work really is a part of the recovery process, and it’s a win win for everybody. John Mok: I’ve been working with a lot of our funds to address the underinsurance issue in the industry in Australia. Obviously income protection is part of this, it’s a great area that we have severely uninsured. We’ve been marketing to funds that income protection is really very different to TPD, the payment’s a lot quicker than what a TPD benefit would provide. There’s no six month waiting period, your income protection waiting period is often a lot shorter. But we need to make sure the process is efficient, especially on mental illness claims.

We know that mental illness claims account for 17 per cent of all IP claims, but more significantly they also accounts for 30-40 per cent of all IP claims cost. The average duration for a mental health-related IP claim is over four years. Workers comp doesn’t cover a lot of these mental illness claims, unlike physical injuries at work, so I think that proves that members are relying a lot on their life insurers to provide this sort of cover for their members. Sean Scallan: Our next guest speaker, is Amalia Faba from Superpartners, who’ll elaborate on call centre possibilities. Amalia Faba: I should just clarify the roles that we take in terms of administering the claims and insurance within Superpartners. From a claims perspective we have the case management teleclaims interviewing process that we launched in December, and have seen some really positive results.

We also have the other claims service model which is your standard, acting as an administrator I guess or the liaison point between the insurer and the member. And whichever scenario, whichever model you’re looking at, our experience is the less touch points, the better. The ability for the member to contact somebody who can help them from start to finish or be their central point of contact has proven to be quite successful. We’ve seen a reduction of close to 59 per cent in the TPD turnaround times. The other thing we’ve done is provide our people with some tools and coaching around how to deal with people that do have some sort of mental illness. We work very closely with Lifeline, and have our people go through a Lifeline training program. It has now become part of our standard so that people know how to deal with those sorts of situations.

, , , , , , , , , , ,

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