• AFRM

Case Study:



“Thank you very much for your assistance, I can’t recommend you any higher, fantastic service.”

There are many rewarding things the Team at AFRM enjoy about helping our clients through the services we provide.

  • The satisfaction of knowing we have created the best possible financial risk management plan, tailored to each individual client’s needs, to ensure that their financial security is protected into the future.

  • Providing wise counsel and educating our clients about the numerous factors to be considered when formulating a sound financial risk management plan.

  • Receiving positive feedback to our newsletters and other communications as we seek to keep our clients informed.

  • And of course, the enormous satisfaction we all derive out of helping our clients when they need us most – at claim time.

Recently, we were absolutely delighted when those last two factors came together for our client, Pete [name changed to protect client privacy].


Immediately after reading the case study included in our AFRM Client Newsletter Q4 2021, distributed on 15 December, Pete got in touch.


The December case study told the story of how AFRM successfully made a “Specified Injury Benefit” claim on behalf of client, Ian [name changed to protect client privacy], for a broken collar bone even though the claim was made on a policy that had been cancelled a number of years ago.


Ian also had had exclusions written into that policy for shoulder and knee injuries - due to past reconstruction surgeries.


The potential for Ian to make this retrospective claim only arose because towards the end of an annual financial risk management plan review meeting his AFRM adviser, Chris Wlodarczyk, asked Ian if he had suffered any medical issues in the past that AFRM may not be aware of?

Ian reported that, back in early 2018, he had crashed his mountain bike resulting in a broken collar bone and a broken bone in his hand. He said he never raised it at the time because he had exclusions in all of his policies due to past shoulder and knee reconstructions surgeries.


Ian couldn’t see how he could claim on a broken collar bone when shoulder injuries were specifically excluded from his cover.


And, of course, there was the added level of complexity that that policy had been cancelled back in mid-2018.


Chris advised that if the original policy included a “Specified Injury Benefit,” that benefit can then be invoked in the event that specific, listed, bones are fractured/broken. He asked Ian to produce relevant medical records from the time of the mountain bike accident in early 2018 such as X-Rays, hospital discharge notes and any other relevant medical reports.


AFRM Claim Manager, Anthony De Lellis, then contacted the relevant insurer and obtained copies of the original Policy Schedules, definitions, and Product Disclosure Statement (PDS) and fortunately for Ian, the Policy Schedule’s definition of a “Specified Injury Benefit” included “collar bone” in its list of the broken bones covered by the benefit.


The policy defined the “Specified Injury Benefit” as: “...a benefit equal to the monthly Total Disability Benefit for the payment period from the date the specified injury occurred, even if the Insured Person is able to return to work during that period.” In Ian’s case that amount was close to $8,000.


So, having read that case study on 15 December 2021, AFRM client, Pete, reached out to us via email:


“Good morning,

“I’ve just read your email and the case study with the gentleman that broke his collar bone and the potential to make a claim.

“I’ve recently broken my ankle and never thought that this may be covered by my insurance policies – can you please advise if there are provisions for this with my policy and, if so, what you may need from me?

“I appreciate your guidance.

“Cheers,

“Pete.”


Pete had broken the bottom end of his fibula as a result of a mishap with his motorcycle.


Once again, AFRM Claim Manager, Anthony De Lellis, contacted the relevant insurer and obtained copies of the original Policy Schedules, definitions, and Product Disclosure Statement (PDS).


And this time around, fortunately for Pete, the Policy Schedule’s list of bone breaks under its “Specified Injury Benefit” included both “leg (below the knee and above the ankle joint tibia and/or fibula)” and “ankle joint.”


Jump forward to the second week of January 2022, and the insurer confirmed a benefit payment to Pete of almost $15,000, being the equivalent of two months’ worth of Pete's total income protection benefit under his policy.


Needless to say, Pete was quite chuffed by the positive outcome achieved on his behalf by AFRM.


“Thank you very much for your assistance, I can’t recommend you any higher, fantastic service.

“Cheers,

“Pete.”

 

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