Viewing entries tagged with 'claims'

The Value of an experienced adviser when it comes to claims!

Posted by Philip Young on 15 August 2012

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In early May we put the insurer on risk of a pending claim for one of our clients who collapsed whilst on holidays in Melbourne.  The episode was the result of a siezure but there was no prior history of seizures.  MRI scans showed a right parieto-occipital meningioma (benign brain tumour).  Our client was operated on in May and the tumour removed and she recovered well.  A Trauma claim was lodged prior to the operation and the insurer as part of the claim process set about obtaining medical reports from the neurosurgeon and then went back to the specialist seeking further clarification as to whether or not the claim met the definitions in the contract.  This was important as they needed be be sure the diagnosis met the definition of Benign Brain Tumour in order to pay the Trauma claim. On 30 July they declined the claim based on the medical reports. After meetings with the client to seek their approval we wrote to the insurer on August 6 advising that we disagreed totally with their decision.  We referred them to the upgrade provisions and the definitions contained within the contract and to the determination by the neurosurgeon.  On August 8 the insurer wrote to our client, referring to our letter and agreed to pay the claim.  Undoubtedly, this was an excellent result for our client and confirms our belief that our most important role is to be there when our clients need us the most, at claim time.  So far we have had over $40M paid in claims to our clients.

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