AFRM joins industry leaders to discuss claims-related issues

Posted by Bethany Shaw on 25 May 2017

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AFRM was part of a recent Round Table conversation run by CommInsure and RiskInfo during which a broad spectrum of claims-related issues was discussed – issues impacting life companies, advisers and their clients.

You can read the full article here. Below are some of the points made by Nick Hatherly, AFRM Director. 

Nick on why you should have an adviser at claim time

“Unadvised claims are a nightmare. Who was acting for that person?” Nick told the panel he thinks all insurers get it wrong: “…you want to build relationships with claimants, but that’s not your job. There should be somebody sitting in the middle who builds that relationship with the trust, and that’s the adviser. It has always been the adviser, [but] unfortunately not all advisers manage this process well.”

Nick on the 'moral' test of paying claims

Nick also suggested some claims are declined on legally valid reasons but sometimes may not pass a ‘moral’ test. He told the panel he thinks that sometimes claimants are let down from this perspective and says “…I think insurers need to look at the moral perspective.”

Asked if he was referring to all insurers, Nick said “Yes, absolutely. Never let the definition get in the way of a claim that should be paid.” His point here related to the intent of the policy and its wording: “What was the intent?  Did that happen? …and that’s probably the advocacy we can do as advisers – get to the intent, and from CommInsure or any insurer we deal with, trust in a relationship with you guys is the most important thing we have.”

Nick on trust and building relationships with clients

“I’m going to keep harping on about trust and relationship, and the trust and relationship sits with the adviser. We deal with the insurer but somebody has got to be that advocate. Somebody has got to settle that client down. I believe every time the insurer talks to the client, the client’s first thought is, ‘They’re trying to get me off claim’ and no matter how hard you’re going to try that is always going to be the perception, and we put ourselves right in front of that. And, on the other side, the adviser is the expert. We’re the ones who wrote those policies. We’re the ones who study those definitions. We put those sums insured in place. It’s up to the adviser to make sure that’s interpreted correctly,” Nick said.

Nick added that advisers who assist clients with claims usually see first-hand the emotional toll its takes on people, adding that adviser assistance was more than just handling claims processes but helping to deliver on the promise inherent in the insurance product. As such, he questions why an adviser who does not assist at claims time would even consider offering advice on insurance in the first place.

"We are dealing with people’s money and their health and they are not going to ring somebody and open up and reveal everything that’s going on in their life. They do for me. It’s amazing. The claim is five minutes of filling in forms and 55 minutes of being a psychologist, a counsellor, a social worker and whatever else, or just a listener. People need someone to talk to.”


Please note, this information has been prepared by Australian Financial Risk Management Pty Ltd (AFRM) ABN 21 001 696 868. AFRM hold an Australian Financial Services License (AFSL) 237186. The information is for general purposes only and has been prepared without taking account of your objectives, financial situation or needs. AFRM recommends that you seek professional advice before acting on any information contained herein.