At last, the industry spotlights insurance claims

Michael Bailey: Damien, we’ve talked before about the example of an income protection claim because of a broken arm. You’ve said this is a prime example where the injury is easy to prove, and the recovery time is pretty standard – six to eight weeks. Yet the insurer is sending out a status update form that the claimant’s supposed to be filling in every month. Damien Mu: Yeah, let’s get a little smarter about what we’re doing. Claims where the injuries are intuitively obvious don’t need a teleassess – probably just a phone call to establish things, to allow us to fast-track it so that we can get the initial form, corresponding medical report, pay the claim and close it. Richard Weatherhead: We’re seeing a lot more cases of what we’re calling ‘pay and close’ claim assessments, where you’re paying out six months’ worth and then coming back and seeing where the claimant is up to. It makes a lot of sense. Colin Cassidy: But is that just a process? You’re saying to a person you’ve got a broken arm, you’ve got six weeks off work because the book – and there are books out there – has said ‘Broken arm, this occupation, six weeks off work’. But if you’ve got a relationship with that member, wouldn’t you be ringing the member up and asking how the member’s going?

Richard Weatherhead: That’s actually what we’re seeing – they have regular check points almost irrespective of how the claim is being paid, whether it’s closed or remaining open. Colin Cassidy: At HOSTPLUS we looked at the employer statement, and also at the claim forms. The insurance companies just seem to send the same claim form out whether it’s an accident, a sickness, a TPD claim, an income protection claim. The same medical report goes out to the doctors. So the first question asks, ‘When was the accident?’ And some doctors these days just put lines through things, because the guy’s had a heart attack. So the questions that we’re asking both the member and the doctors were not relevant, or if they were relevant, that could be question number seven in a form. So we’ve re engineered the forms to be able to sift what the complaints are – it’s not difficult to have a form for an accident that’s different from the form for a sickness. So therefore you’re getting better answers from the busy GP who doesn’t like completing forms in the first place, and the forms they are completing are relevant to that particular patient.

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