A public misperception of insurance companies as faceless entities that do their best to avoid paying claims is not only unfounded, but potentially causing members to miss out on a wide range of benefits, industry figures say.
But insurance industry figures agree they face an uphill battle to educate the public about the extensive services they offer, and get these services in place earlier for those who need them.
Insurers offer extensive services to support members’ wellbeing both pre-and post-claim. Helping members recover more quickly, deal with chronic health problems and avoid the onset of secondary mental conditions is a win-win outcome for both the insurer and the member.
At a roundtable titled ‘Exploring claim conditions and supporting members back to wellbeing’ held in Sydney in July, hosted by Investment Magazine and sponsored by AIA Australia, participants agreed closing this perception gap was vital to achieving earlier interventions on health problems such as cancer, mental illness or musculoskeletal pain.
It would come as a surprise to many to learn that insurers pay more than 90 per cent of the claims they receive, said Nick Kirwan, senior policy manager, life insurance, at the Financial Services Council.
“I wonder if people go into the claims process with a bit of foreboding and they’re a bit frightened about the whole process,” Kirwan said. “They’re expecting to be challenged and quizzed and the perception might be that…the insurer might be looking for reasons not to pay the claim and not to help. But we know that actually insurers do really want to try and help, and are looking for reasons to pay claims.”
The industry needs to work together to break down these myths, and can do that by collecting high quality, transparent data and using it to tell compelling stories to the public, Kirwan said. For example, 20 per cent of all paid disability claims are for mental illness, and this is the same as the proportion of disabled people in Australia who are mentally ill, he said.
“So that says actually, you know what, we’re not dodging this. We are actually stepping up and paying our fair share of claims.”
Noel Lacey, head of insurance at Cbus Super, told the roundtable the industry needs to “avoid treading on banana skins” and ensure policies don’t give members false expectations only to let them down.
“If we start with the expectation that [members] will have read the definitions and the small print, think again,” Lacey said. “They won’t have done that, and that is why it is very important to understand what would people naturally expect their insurance to cover, and make sure it does.”
The challenge of early intervention
A range of factors prevent members from taking up the full range of benefits their insurer offers. Sometimes feelings of pride and self-sufficiency get in the way, while others fear a claim may impact other government benefits.
Many members simply don’t realise insurers can help them not just when they are on claim, but also help them transition into and deal with their “new normal” lifestyle post treatment.
Claire Cornfield, general manager, operations and service delivery for HESTA, said a growing concern was the mental health of young people and funds like HESTA with its young membership had a strong role to play in helping them stay connected with their communities.
Stephanie Phillips, chief group insurance officer at AIA, said musculoskeletal conditions are the most claimed and it is sometimes forgotten that the recovery process is more than just physical. Secondary depression and chronic pain are common. Finding ways for people to stop staying at home, cease or reduce medication and stop saying “I’ll never work again” are major achievements.
But the biggest challenge is for insurers to become aware early about problems so they can offer interventions. The average income protection claim comes in 18 months after the member’s incident, Phillips said, and by this time mental health problems can be advanced making intervention and rehabilitation more difficult.
Early intervention is “the most complex piece of the puzzle for us,” she said. “How do we make sure that the services that we’re providing meet the needs of the claimants, and then how do we do that earlier?”
Improving relationships with employers, workers compensation authorities, health care professionals and other parts of the supply chain is an important part of getting earlier notification and encouraging people to make enquiries about their insurance.
Funds with very large employers can work closely with them to improve the claim process and notification process. But other funds are spread across a wide number of employers, making it difficult for them to target and improve the claims process, said Phillips.
She said members need to know there are rehabilitation programs and wellness programs that can be accessed through the insurer before the claim has even come in.
“Whether it is mental health, whether it is cancer, whether it is musculoskeletal, I know from an AIA perspective, we have a program for everything,” Phillips said. “For us, the key and the goal is to try and have HR departments educated enough to understand they can access the services we provide way before the claim comes in.”
Another avenue to achieve earlier notifications is working more closely with general practitioners as the “gatekeepers of the health system”, said Dr Raghav Murali-Ganesh, co-founder of technology company CancerAid and himself a trained radiation oncologist.
Medical professionals inherently want to help their patients but are often pressed for time, and aren’t themselves aware of the services insurers and super funds offer members.
“If you can be made aware that there is an opportunity there to fix a really challenging issue, I think that is really powerful and you will get strong advocates, in my opinion,” Murali-Ganesh said.
This sentiment was echoed by Emma Brody, product insurance manager at Qantas Super who said funds don’t know that members are in trouble until they’re at the claim office. “And to me, it feels like we need to work all together. It is not just overseeing insurers, but it’s doctors, it’s employers, it is the whole community.”
Helping people help themselves
Despite the challenges, the industry is making progress. For those who fear the complexity of the claims process, some funds are finding ways to make it much simpler and smoother for people in need.
Katie Le Cras, head of operations, member experience, with AustralianSuper, said her fund removed claim forms last year, except for a simple doctor’s certification which is also sometimes taken verbally. Trialling this program, the experience of a highly educated woman who was the breadwinner of her family resonated with Le Cras.
“She felt relief when she contacted the fund about the claim, and somebody spoke to her about how you don’t need to, it is not hard, we will help you through it.” This woman then didn’t need to claim for another four months.
Simonie Fox, AIA group strategy manager for rehabilitation and claims said having these conversations has the added benefit of giving the insurer the opportunity to educate the member about the range of services available, and build rapport and trust. A member might not have known, for example, that they could get a doctor’s referral then get a free six-week exercise program which would improve their chances of recovery from cancer.
Murali-Ganesh’s experience developing CancerAid demonstrates the power of educating members about what they can do for themselves. The self-reporting tool helps cancer patients track and deal with their symptoms, as well as link up with a community of patients and survivors.
Seeking to improve engagement with the technology, the CancerAid team developed a six-week coaching program which involved contacting patients and explaining the use of the technology and the clinical benefits of logging symptoms. Coaching patients on the benefits they stood to gain led to a significant increase in engagement.
Emphasising his company is not a replacement for the health system, Murali-Ganeesh said his experience as a doctor showed him how the system can lose track of holistic support for patients who needed to be coached towards ancillary services which will benefit their recovery.
“Certainly, in things like seeing an exercise physiologist, seeing a dietitian, seeing a sleep consultant, seeing a psycho-oncologist, this doesn’t happen uniformly for every patient, there are a portion of patients who do but a greater portion of patients who don’t,” Murali-Ganeesh said.
“Some of the onus is on the patient and requires a behavioural change. How do we get everybody being a bit more aware and active? I think we deliberately need to increase patient activation and drive a patient behaviour change for them to take a little bit more responsibility.”
This approach of pro-actively educating members about how they can better help themselves appears to be gaining results for some funds. Figures at the roundtable agreed that the insurance industry has an enormous opportunity to better support people who are unwell–not just when they are on claim, but for the entire journey.
“A large percentage of claims that we have with cancer, they’re not on claim because of the treatment, they’re on claim because they haven’t recovered holistically from their cancer treatments,” added Fox. “There is such opportunity to support people who are unwell, and I don’t think that is seen by the Australian population.”
Forced to take a hard look at their practices following last year’s banking royal commission, super funds have found opt-in rates are quite high.
Phillips said this shows members are more engaged with their super and their insurance than the industry may have realised.
“I think we need to look at the fact people are now starting to get engaged and interested in their insurance, and really sell the positive side of the wellness programs,” Phillips said.
“Instead of doing just the two mail-outs a year for super, maybe you need to do one on insurance. Can you do a digital communication about the people you have paid benefits to who have had a great experience?
This view jibes with Tracey Allan, insurance & dispute resolution manager at HESTA, who also argued the industry needs to get a lot better at promoting all of its success stories. “I think telling them as a story, as a business story, is really, really powerful. We are starting to work on this but maybe we need to think about an awareness campaign as an industry.”