Claims Management - An Advisers Perspective

Posted by Damien Jones on 15 August 2013

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If you’re an adviser who has never had to deal with a claim, the first experience can be quite daunting. We profiled two advice businesses with a strong track record in claims management to uncover their ‘best practice’ approach when it comes to dealing with clients and insurers at claim time…

Business – AFRM
Adviser: Mark Hoskin,
National Advice Manager – AFRM

“I think our skill as advisers is really demonstrated at claim time, rather than during the application process. It’s where the proof of what we do actually comes out.”

Mark Hoskin is the National Advice Manager at AFRM, a specialist risk firm with offices up and down the Eastern coast of Australia. The business has seen more than $47 million paid in claims to its clients, and is currently running 65 open claims cases.

At AFRM, claims management commences with a review of the client’s policy wording and PDS, so the adviser can examine the wording the claim is going to be assessed against.

“Those are the legal definitions that the client will be bound by, and determine whether the claimant is successful.”

Hoskin admits that it can be a tricky task, particularly with legacy products that may no longer be open to new business, or which have been subject to a raft of upgrades over time. The firm has an online library of past PDSs which reaches back over ten years, but sometimes the simplest solution, says Hoskin, is to contact the insurer direct for the correct policy documentation.

“We determine from the client what’s wrong with them, the reason for the claim, and then assess that against the policy wording. Of course, the insurer will tell us what we need to provide, but we like to feel as though we can have input into that as well. For example, sometimes when the insurer might write off to get something from a particular doctor, we have found out that it’s better to go to the client’s GP or another specialist, because they’re the ones that actually have the information the insurer is looking for.”

Next, the adviser will deliver the claims forms to the client in person, and sit with them while they are completed. “Some of my colleagues even book an appointment with the client’s doctor, and sit in their waiting room while they wait for the forms to be completed.”

Once the forms are submitted, Hoskin and his fellow advisers are always careful to ensure they are included on every piece of correspondence between the insurer and the client.

“It’s an interesting exercise, because the insurers are trying to be quite innovative, dealing directly with clients over the phone and reducing paperwork. But we want to be kept in the loop, particularly with new claims or tricky claims.

“We see ourselves as representing our clients at claim time. We do not want our clients to be railroaded by a case manager into saying something that might be misconstrued and result in the claim not being paid.”

Having an adviser involved in claims management is also important for the client’s recovery process:

“At application time clients are often thinking of insurance as a grudge purchase,” says Hoskin. “They don’t think about what emotional state they may be in at claim time. For example, what sort of headspace is someone going to be in if their spouse has just died? For the client, having a trusted adviser – who can get these things done quickly, can get the money in their hands without the constant requests for additional information, and do it sensitively while they’re grieving – can ease the pain at a time when they’re at their most vulnerable.”

Hoskin’s advice to other advisers is to put claims at the heart of everything they do.

we want to be kept in the loop, particularly with new claims or tricky claims

“We promote our claims throughout our advice process. Over the last 12 months we’ve been sending all of our clients a ‘claims contacts’ card with their review letter. It’s more a comfort for the client, to let them know this is what we’re all about. But it’s also keeping our name in front of them, and making them aware that if they think there might be something, give us a ring.”

Originally featured in RiskInfo Magazine - June 2013