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Case Study

We have often said that AFRM will always go the extra mile to ensure we obtain the best possible financial outcomes for our clients if the time ever comes that they need to make a claim on their insurance.

The following update to a previously published case study serves to illustrate that point well.

You may recall that in November 2021, we published a case study about our client, James, a middle-aged, married professional with two young adult children, for whom AFRM was successful in obtaining a lump sum Trauma benefit payment following James being diagnosed with prostate cancer.

This was a challenging claim to get over the line due to the fact that James’ policy was relatively new, having been established in mid-2020 in the wake of James wanting to reduce his levels of cover in order to reduce his annual premium payments.

The primary challenge arising when the insurance company chose to closely examine James’ medical history to ensure full and proper disclosure had been made at the time the new Trauma policy had been established.

The complexities of the claim were successfully managed by AFRM Claims Manager, Anthony De Lellis, and James received a benefit payment of about $300,000, representing a full settlement of his entitlement under the Trauma policy.

In the case study published last November, we also reported that as part of the review of James’ financial risk management plan, with the objective of reducing his overall premium payments, that AFRM also locked in for him a new Agreed Value Income Protection (IP) policy, which included a Critical Illness Option.

So, naturally, after AFRM was successful in getting James’ Trauma Claim accepted, we immediately raised the issue of his Critical Illness Option under his IP policy with the insurer.

Given it was the same company, AFRM also asked if the insurer’s same Claims Manager could assess the new claim and if the same medical information used to support the original Trauma claim could also be used to support the IP claim – politely suggesting that it would be somewhat onerous to require James and AFRM to go through the entire formal application and medical discovery process all over again relating to the exact same illness.

AFRM’s Anthony De Lellis noted that AFRM’s interpretation of the wording of the IP policy’s Critical Illness Option suggested that James was eligible for the defined “Critical Illness Event” benefit for “Cancer” which was six times his monthly benefits from the date of diagnosis of his Prostate Cancer.

Unfortunately, the different policy required a different claims manager to assess it because any IP claims were handled by a different group of specialists within the insurance company.

AFRM acknowledged that but again requested that the new claims manager rely upon all of the previous materials supplied to support the previous Trauma claim rather than have to go through the entire formal application process all over again.

The insurer responded saying it was willing to waive the “Initial Attending Doctor’s Statement,” and to accept other supporting medical documentation used in supporting the previous Trauma claim.

However, it insisted that AFRM and James fill in and complete the full formal “Initial Claim Form for Income Protection” before it would allocate a new case manager to the new claim.

Working with James, AFRM’s Anthony De Lellis, was able to get all of the newly required documentation finalised and formally submitted to the insurer within two days. This was late October 2021.

On 1 November, Anthony was pleased to report to James that his IP Critical Illness Option claim had been accepted by the insurer; paying the maximum possible benefit which totalled close to $90,000, including a refund in premium payments of more than $3,000.

This was in addition to the approximate $300,000 James had received in his previous Trauma claim benefit payment.

Suffice it to say James was extremely happy with the level of service and support provided by the AFRM team.


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