Australians today might be as unhealthy as they’ve been at any point in history, underscoring the need for the insurance industry to develop wellness and prevention programs to avoid a potential deluge of claims.
The industry has already found success in shifting away from just paying claims to developing rehabilitation programs and other ways of helping claimants return to work. Now its attention is shifting again, to programs designed to head off claims before they develop.
The Investment Magazine Insurance in Super Summit in Sydney heard that delays in handling claims remain the number one cause of complaints about superannuation received by the Australian Financial Complaints Authority (AFCA) – even though the number of complaints as a percentage of total claims made each year is very small – and in addition to handling claims better, there are steps the industry can take to reduce the number of claims overall.
But there are regulatory and legislative issues that impede the development of fully effective programs – such as the prohibition on insurers funding certain treatments.
AIA Australia head of wellbeing Lucy Hartley called on the government to consider providing “support and running a pilot to see whether we can fund treatment for those common mental health or [musculoskeletal] conditions that we see, whether it’s a program of psychotherapy or physiotherapy to see whether we can really impact on the health of Australians early and even prevent claims from happening”.
Zurich Insurance chief claims officer Matt Paterson told the summit that as an industry “the work we’re doing in rehab and wellness is really starting to pay dividends”.
“What we’re trying to do now is really move up the curve and try and focus more on prevention,” he said.
“We’re very good, maybe, when we get a claim and helping people return to work, particularly with income protection. But when it’s too late, we often miss out on that.”
AIA head of wellbeing Lucy Hartley said the industry has come on in leaps and bounds in developing rehab services, and the evolution continues.
“Originally, we focused on claims, and it was all about supporting recovery. And across the industry… we’ve got really developed and excellent rehab programs that support people once they’re injured and unwell,” she said.
Changing human behaviour
Hartley said the concept of 5-5-90 – the five modifiable human behaviours that can affect the five most common non-communicable diseases that cause 90 per cent of deaths in Australia – illustrates the potential to alleviate claims by focusing on prevention.
“Everyone in this room knows the things that we should be doing to remain healthy, whether it’s around healthy eating, moving, sleep, social interactions, et cetera,” Hartley said.
“Yet we are probably, as Australians, the most unhealthy that we’ve ever been. Two out of three Australians are overweight or obese. We have a rising mental health rate in this country, and our youth mental health is deteriorating, year on year.
“So, although we know what we should be doing and we have the tools to monitor our health as well, the problem is are we doing those things and how do we support our members in maintaining those sorts of healthy behaviours in preventatively avoiding these chronic conditions?”
Paterson said Australians are already quite familiar with and quite good at protecting physical assets, “but are we actually any good at that with a human folk and our customers?” he said.
“When we talk about claims handling and we talk about people’s illness, injury fractures, mental health, et cetera, we’re very much talking about claims as how do we pay these claims really quickly; how do we get them back to work?” he said.
“When we talk about group insurance, one of our challenges that we well know in this room is engagement with our members and customers is quite difficult because often they take out a policy and may not need it and may not touch it may not even know they have it.
“What we can do is really elevate the focus on rehabilitation and wellness. We’re all trying to do that now. How can we do that more?”
Turning to wellness
Paterson said there are around 70 rehab consultants employed in-house by insurers, which is dwarfed by the number of claims handling staff, and in any case the consultants are “more focused on recovery, less focused on prevention”.
“So, rehab is one thing, but I think we need to turn our mind to wellness,” he said.
The IISS session on a new era of rehabilitation and wellness heard that programs aimed at advocacy, awareness and education about wellness and prevention must be coupled with support for claimants and those around them.
Tim Hewson, founder of the Mongrels Men’s mental health and wellbeing charity, said the insurance industry faces challenges in properly supporting the growing number of Australians with mental health issues.
“It is an end-to-end lifecycle proposition that’s required, which is encompassing everything. from the client to the member to the adviser to the person who answers the phone to the staff within the insurance [company], the superannuation fund, through to the carers,” he said.
“If you can inform, educate, and increase and improve awareness, then you’re a long way towards a more holistic [solution] and so therefore, it is more of a whole ecosystem [issue].”
Hewson said that in addition to providing direct support to those experiencing mental health issues, “it’s about giving it a face and a voice, which is why I’m here”.
“It’s part of the work that I do, not just through the [Mongrels Men], and that’s part of the awareness piece, for me,” he said.
“The greatest challenge I have, and this isn’t necessarily a government issue, is a funding challenge – to fund to grow. We want to impact a million men in Australia every year. To do that, we need to scale up from our current 12 locations to 2000. That’s a funding challenge. We can do that ourselves, but we will achieve much more if we can do it through partnerships with industries like this.
Grassroots involvement
“I would love to work with every single insurer and superannuation fund in this industry…to think about what we can do at grassroots community-based level to help improve the health and wellbeing of Australian men and women so that they don’t need to feed into the system, so that the burden that the insurance and super industry carries is far less than it is now.”
Paterson said that while the good work and the progress made by the insurance industry should be celebrated, there’s more to be done and “the entire ecosystem really needs to lift and step up and talk collectively”.
“This is not an insurer problem, this is not a government problem, it is the entire ecosystem,” he said.
“It’s not just life insurance [it’s also] health insurance, general insurance. The stats and the data are frightening around the prevalence of what’s happening with mental health, with claims, et cetera.
“Lifting the conversation and having a real ecosystem discussion and building a roadmap for things like mental health that we all collectively line up to, we’ve signed up to, and we know our role to play.
“It’s not just about how quickly we get to the claim.”
