How far does the industry still need to go when it comes to Protection Claims Processes? – February Forum Recap

“In terms of these claims, it highlights a lot of the frustrations that we hear from advisors about claims processes and particularly regarding how insurers deal with claims and sometimes, if not dealt with in the right way, it can make the claimant or the beneficiary of the policy feel like they’re on trial a little bit. And that’s kind of exactly what this case feels like to me... a case where a client has had a heart attack. They have had it confirmed that they’ve had a heart attack, and this client had two policies, two critical illness policies. One of them paid out or accepted the claim within a few days of receiving the evidence that they gave them. And the other policy is still dragging its feet... We’ve given this evidence to our doctors as well and our doctors have said that it was clear the client has had a heart attack. The wording that was in place at that time not only required the spike in troponin but required evidence of an ECG… However, what our doctors have said is there is no way that based on all that evidence, that client hasn’t had a heart attack… Why do they need to go back for that ECG when it is so apparent that the heart attack has happened? We will be contacting that insurer very shortly to talk through with them why they need further evidence when another insurer paid out straight away on that... And that’s an example of someone potentially feeling like they’re being put on trial as opposed to going through a process where it’s a stressful time in their life.”

“Think about why we recommend these policies. It’s all about giving people peace of mind, giving people a financial safety net, and making what is a really, really difficult situation time easier. So it should reflect it in being well organised and I know that we’re dealing with insurers, but we should have a slick process and show empathy as well, you know, to that individual for what they’re going through at the time, it could be bereavement, it could be financial stress… I think we as advisers have a duty to help our clients through that process… A lot of the time a client needs someone that they know, a friendly voice, somebody that can support them and kind of help them navigate that process.”

“So the first claim I’ll talk about was a really, really good experience that I had, and it was with a client that had a cancer diagnosis. We were kept up to date and after the information was received and the claim was authorised, payment was made. So it was a really, really good slick process and the client was really relieved. As well as that, the actual support that they got from the value-added benefits was great. So this particular provider offered a sort of counselling and bereavement-type service. They were given a dedicated nurse that really gave them support and also family support as well, which they said literally was worth its weight in gold… My father lost his partner of 28 years. We weren’t given any support during that time. We weren’t giving any bereavement support. It’s really difficult to access those services anyway. So when providers can offer those services and they can be used at the claim as well, I think that they really are worth the weight in gold.”

“I just thought it’s worth mentioning that now the not-so-good experience that I had… The client developed back problems during COVID and it turned out that they had disc problems and a trapped nerve and they had to get surgery straightaway. They had to have what’s called a spinal fusion. This was going to be quite a lengthy recovery and so the provider was notified straightaway. As soon as they knew the prognosis, the forms were sent out very quickly. The client returned them speedily and sent in various consultant letters as and when she had them. She had a three-month deferred period. Weeks passed and I contact the claims team how we were getting on and mentioned that we hadn’t had any updates. The client had let the GP know that they would receive a GP report request and I just kept being told that everything was ongoing and that they had everything they needed. Two months passed and I spoke with my account manager. The GP surgery hadn’t even received a request for the GP report… we got to the three-month point. At that point, we were then notified that they had then gone to request the GP report and the reasoning was that they wanted to ensure that the client was definitely going to be off for three months before requesting the report, which I thought was absolutely bonkers! In this situation, we’d already provided evidence that they were going to be off work for at least 9 to 12 months. So the client had already had a financial impact with COVID and no savings because of that, whilst not being able to work. It was about five months before this claim was authorised. She was the main income earner in the house and had to borrow money from her mum.”

“Our very first claim we had in 2011 was actually for a friend of mine who tore his Achilles while playing football. The insurer declined to pay the claim based on a technicality which when we went through their own terms and conditions we then contested it and they ended up paying the claim. So I guess one of the good things about today and all the case studies that I’ve got is that there are several cases that we know. A lot of you guys on here today that without our support and our knowledge and expertise and challenging these decisions, a lot of these clients wouldn’t get paid out because they’re none the wiser. They wouldn’t know how to challenge these things because they’re not the experts. They rely on us. I think there were a few comments about it being our job to do that for the clients. It was really kind of rewarding to get that client paid out.”

“The second case we had from a bad point of view is a client who was signed off work due to back problems. Let’s just say the service standards are terrible and they took so long to assess the claim that the client was forced to go back to work because they couldn’t afford to have any more time off work. So they went back to work with their back injury. And the insurer then said, ‘Well, you’re back at work now, we don’t need to pay’. So as you can imagine, I was absolutely furious with that. There’s a lot longer story to that, but I just thought it was disgusting that the client had to go back to work due to their terrible turnaround times and then they refused to pay declined because they went back to it because they couldn’t afford to stay off work because their income protection wasn’t paying. I just thought it was shocking.”

“The same insurer very recently we spent over 2 hours on the phone trying to trace out what was going on with their claim. So eventually be told, ‘Oh, the claim was approved two months ago’. Where was the communication internally with that insurer? Why have I Wasted 2 Hours on the phone chasing this claim? As you can imagine I was pretty upset about wasting 2 hours of my time to find out they’d been paid two months ago. Maybe I should’ve spoken to a client, but obviously, I was trying to get updates to them before I went back to them… But there are a couple of insurers that it’s really, really difficult to talk to them about when it comes to claims. And that’s really frustrating because like a few people on here, we want to hold our client’s hand as soon as we find out as a claim. The first thing I do, and I’m sure a lot of you guys do, is pick up the phone with the client and offer support. But if you can’t hold their hand because the insurer is refusing to talk to you, it becomes very, very frustrating to help them”

“Claims do pay because in general, most people, when they think of insurance, they just think, ‘Oh, claims don’t pay’. And that’s what we need to educate people about… I had a client that claimed for terminal illness and on income protection and they waived the deferred period. He was told he had less than six months to live, but he actually survived two and a half years. He got his income protection the whole time.”

“There was a joint life policy and the wife had crashed her car and sadly died in the accident. The police officers actually suspected that she had taken her own life and that she deliberately crashed into the tree. There were two small children involved as well. The claim was assessed and it appeared that she’d actually had a very long history of mental health challenges, which they concluded that the husband didn’t know about. So there was nothing on the application form. As I said, it was a joint life policy and they had real sympathy for this family, real sympathy for the lady who had sadly died and massive sympathy for the husband left behind. They paid out half the sum assured. Technically, they probably should have declined it based on non-disclosure, but they paid the money out because they realised that this was a family in need. And actually one of the reasons why she probably didn’t disclose it was because she hadn’t even told her husband that she’d had this historical problem. So for me, that is a really positive claim that always sticks out for me.”

“I’ve got involved and liaised directly with the FOS because an insurer wasn’t budging. They were absolutely astounded and consequentially that claim got paid… It’s so important that advisors get involved in claims one to support our clients and real times of need, but also to highlight anything that isn’t quite right… I can’t always remember exactly what those claims professionals said to me, but I can certainly remember how they made me feel. Because they were supportive, they were caring, and they were checking in to make sure that I was doing okay.”

“Would say if you’ve got somebody that is really financially struggling and for whatever reason, the claim is taking a long time to progress, then it’s always worth asking if there’s anything that can be done to help that person financially or that family financially because you never know. My mum always said, if you don’t ask, you don’t get it. But you know, I’d always ask that because, you know, you might be able to get even if it’s just a few hundred pounds, that can make a huge difference to somebody in a real time of need.”

“We try to treat each claim as individual as we possibly can. So from the point of notification to collecting the evidence to decide, we don’t go down a one size fits all approach. We try to do it in a way that is acceptable to that particular customer. So online, by phone, email, and then we collect the evidence and then make a decision which essentially all the claims go through the same process: notification, get the information and make a decision. But we try and work with that customer circumstantially… We make sure that we don’t go out cold to customers with that decision, and that there are phone calls and a relationship in place with that customer so that if that decision is reached, it won’t come to them from out of the blue. We don’t try to operate a one size fits all approach. We consider each claim on its individual merits and the information we need. And then what we’re trying to do is build that relationship in that rapport with the customer throughout.”

“We look at support services and notify the customer or their next of kin that that’s open to them and their family and probably even extended beyond that if they want to use that support service. One of the things I’ve just done before I joined this call was to authorise some expenses where we’ve gone above and beyond for certain customers, where they’ve been in certain positions and our claims team have picked up on that and said, wouldn’t it be great if we could do this for the family? So we’re always looking to empower our claims specialists to look at claims with empathy and that individual focus, just to ensure that people don’t feel as if they’re a number going through the machine.” 

“Unfortunately a client’s daughter aged 13, nearly 14, was diagnosed with stage five kidney failure with an imminent decision of going onto dialysis. So we sent all the information over to the insurer and client. Sometimes they [the hospital] can send you the actual Files to download and we can send the insurer. So because Of that, we were able to send all the test results, scans, diagnoses, confirmation, blood levels, kidney levels, etc. And get a decision quite quickly. This was really good for the client because she’s taken the last 12 to 18 months off work to look after her daughter, who’s gone from stage three to stage five quite quickly. The insurers were very quick, and it took ten days. It did need a little escalation I’m not going to lie, just because they did come back to say, ‘she’s not on dialysis yet’, but because we then pushed back to say, ‘well hang on a minute, you’ve had the consultant’s letter saying that she will and it is imminent that she will be on dialysis very soon. Therefore, why are you not paying out?’ They agreed, so a good outcome and a good journey”

“My best outcome was a client who had an exclusion on her plan due to family history which she was happy with and she came to me a yr later to say she had breast cancer. She later found out the family history was incorrect so I contacted the insurer with the family members’ records and they removed the exclusion from the offset and then paid her out in full…” 

“ I have a client who I look after their business protection for. Shareholder protection came up for renewal and we submitted an application to Aegon for some additional life cover for one of the shareholders. And during that underwriting process, because the client had had a stroke about five or six years ago, at the time, she made no claim on her key person policy with Aegon, which had critical illness on it. I don’t remember discussing it with her, to be honest, as to why she didn’t claim. She made a very swift recovery and she was back to work within a matter of a few weeks. So I don’t think she thought it was very serious. It was before I was involved with the client, so I didn’t really have any influence at the time she had the stroke. But obviously during the underwriting, because we just disclosed the stroke, they identified through their back office systems that there was an existing policy in force which they double checked, and found that the doctor’s notes from the underwriting for the new life policy and the criteria would be met on the critical illness policy. So Aegon phoned me and advised me that they’d like to speak to the client because they feel that there is a potential claim there. I put the client in touch with Aegon and within a couple of weeks, the check arrived for £160,000. I think I was more surprised than the client that the insurer would go to that level of back-office checks!”

“What are the things that the corporate providers can learn potentially from the mutuals in terms of some of the key things that they’re doing that drive those better experiences and better outcomes? Surely as an industry what we want to do is improve that claims process because that’s the benchmark on which we judge ourselves, right? There’s no point selling insurance contracts unless, at the point of claim, we’re actually delivering what we’re trying to recommend to people. So fundamentally is there something that the mutuals that I’ve worked with in particular can teach some of the big corporates about how they can improve this process and we can all raise the standards to produce better outcomes for our customers?”

“My response was to stop selling insurance contracts if you can’t process the claims and the policies you’re selling. Stop selling that many insurance contracts just to be like one of the top few providers. It’s pointless.” 

“I suppose for me communication is absolutely critical when someone’s going through an incredibly stressful experience and they’ve got financial pressures or concerns. We’ve got to make sure they’re kept informed. We’ve got to manage their expectations, we’ve got to work with them through the process.”