At last, the industry spotlights insurance claims

And if we find out from Doctor X that he actually couldn’t deal with this illness so he had to send him to a specialist, we’ve then got to go back to the solicitor and get another medical authority and justify that medical authority to go forward again. So we find in so many of the claims, the lawyers become the hindrance to settling the claim quickly and efficiently rather than a help. And that’s not to say in all cases. There’s been a number of cases where the lawyer – because the member’s had trouble with English, et cetera – plays a very good role in getting it over the line very quickly because they’re giving true assistance. Michael Bailey: I know that insurers have resisted an industry-standard claims form, because they argue it takes away too much of their differentiation. But what other aspects of the process could we look at streamlining? Peter Blight: I think they are getting better for forms. Where I see the insurer misses often, and it goes back to the point Colin made before about the old employer statement, they get themselves caught up on a date. The employer statement says this guy stopped working for whatever reason it was, whether it was a crash or it was an injury or an illness, whatever it was, on this date.

And they get themselves caught up on trying to assess them solely and wholly on that date three or four years ago, where quite often this guy suffered further complications from it, depression, et cetera, and the guy is now disabled, but wasn’t back then. But there are very few funds these days that don’t offer this ongoing TPD when you leave an employer. So instead of concentrating on this date and declining it, it becomes a complaint to the complaints officer who’ll then say, ‘Hey, wait a minute. There’s clear evidence that this guy, two years down the track, could no longer work. He might not be disabled the day he left the employer. Why haven’t you assessed him here?’ And then they go through the whole process again. Get the full information. If someone says a guy’s got a mental illness or complication, find out then and there before you make your first assessment about these ailments and you’ll find a hell of a lot less claims will go through that complaint process and get dealt with. Michael Bailey: Damien, we’ve spoken before about the possibility of standardising the way that insurers ask for information about a claim the member may already have made through one of the State workers’ compensation schemes.

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