Claims Case Study:
Originally published on 5 March 2020
“I had a youngish family and a busy wife working full-time... So not having to deal directly with the insurance people myself was a huge bonus, for which, I remain very grateful because it just took the stress out of all that completely.” “And because it was AFRM, I think they (the insurers) trusted AFRM.”
In this case study, we are delighted to share the story of Michael (name changed to protect client privacy).
Michael has been battling non-Hodgkin Large B Cell Malignant Lymphoma since first being diagnosed back in December 2012. Twice, after treatment, he has gone into remission and twice he has relapsed.
When his last relapse was diagnosed in early 2017, he was told he had six months to live.
Since the original 2012 diagnosis he has endured numerous bouts of chemotherapy, radiotherapy and stem cell transplants (bone marrow transplants), battling his way back to health each time.
Michael’s story is one of resilience – one of never giving up – and a “miracle” of timing.
He was a long-term AFRM client. His original adviser being one of AFRM’s co-founders, the now retired, Phil Young.
Prior to the 2012 diagnosis, Michael was very fit and took pride in the way he looked after himself to ensure he stayed well. He was a senior medical practitioner and knew how to stay healthy ‒ and he loved his tennis.
Like many people today, he has a blended family, with five children from two marriages. Three children from his first marriage and two from his 29-year second marriage to Bianca (name changed to protect client privacy), an equally successful medical practitioner.
Fairly astute when it came to finances, Michael realised early on that he needed to take steps to protect the financial future of his children and wife, who is a decade younger.
Taking AFRM’s advice, he took out Income Protection, Trauma and Life Insurance policies.
“I knew I needed to have sound insurance in place because I have got five children. The youngest one is only 16 now. So, I knew it was important to be able to cover off if something happened,” Michael said.
“I was very fit and healthy and was feeling like I was protecting myself against cardio-vascular disease, diabetes and that sort of thing. But that doesn’t protect you against cancer; particularly this one, which is now I think the fifth commonest cancer in the world – malignant lymphoma.”
“I was diagnosed on the day of my wife’s 50th birthday.” (In December 2012)
The first round of chemotherapy in early January/February 2013 knocked him around and he became quite unwell during that time. Fortunately, his Income Protection and Trauma insurance policies were there to support the family financially at that time.
“I recovered enough to go back to work, but I was unable to perform at the level that I thought was safe,” he said.
“My medical advisers told me that I should retire before I harmed anybody. Essentially, that is what I was worried about. I was very anxious anyway. I believe about half the people in NSW who have cancer have serious financial worries.”
So, during 2014 he officially retired and by late 2015 more bad news, more enlarged lymph nodes were found.
“After that first relapse (in 2015), I had what is called an autograft; an autologous bone marrow stem cell transplant,” Michael said.
“I was very unwell after the transplant, but I recovered (in 2016) enough to go back to playing regular tennis – and for me that’s sort of an arbiter of my physical and psychological wellbeing.”
“If I can play men’s doubles tennis against people who haven’t got any major health problems and hold my own, I am pretty happy. I am not a bad tennis player.”
“During all that time, until the time I turned 65 (in 2016), I had no dealings directly with the insurance companies at all. It was all handled by AFRM. It was extremely helpful.”
Michael said he was particularly grateful when AFRM picked up a shortfall in his Trauma Insurance benefit and challenged the insurer.
“Having AFRM with me was extraordinarily helpful because I was meeting with my GP each month to get him to complete bits of the form for the Income Protection. The Trauma Insurance got paid out and I think the insurance company was challenged by AFRM that they were short.
“Because he knew the contract so carefully, he got them to agree that they’d made an error. So that’s all very helpful because (at that time) there was no way I was going to read anything like that.”
Having endured illness related to his treatments through 2013 and 2014, leading up to his formal retirement from work, was certainly taking its toll on his mental health too.
But by late 2016, Michael was back to playing tennis and leading a very full and active family life.
By early 2017, he, Bianca and the two children from their marriage had enjoyed an action-packed holiday, completing the 25km Mt Kosciusko Summit walk in Mt Kosciuszko National Park in exceptionally chilly weather and also surviving an eventful catamaran sailing expedition on Lake Jindabyne, which culminated in an unexpected dip in the icy waters leading to a bout of hypothermia for Michael.
Not one to let something like that slow him down. Not too long after, he went to Melbourne to catch the last five days of the Australian Open in 2017. It was busy times and things were pretty much back to normal.
“I came home (from the Australian Open) and the kids went back to school – and I went and had routine blood test that showed that I had what’s called hypersplenism,” Michael said.
It was February 2017.
“The spleen was so enlarged it was right down to my pelvis. The cancer had come back with a vengeance,” Michael said.
“That’s when I was told I probably had six months to live.”
At around this time, he was again working with AFRM and his accounting firm to ensure appropriate strategies were in place to protect the long-term financial interests of his wife and family.
By then Justin Beeforth had taken over as Michael’s AFRM adviser.
Looking at the family situation holistically, Justin recommended that Bianca’s insurance cover be adjusted and updated, to ensure her ow financial risk mitigation strategy was sufficient to look after her and her kids, decades into a future without Michael around.
The plan was later agreed by Michael and Bianca and implemented.
In March 2017 at Bianca’s suggestion, Michael also asked for his Life Insurance policy beneficiaries to be amended to simply be himself. The idea was, why make the three adult children from his first marriage wait until after Bianca died to benefit from their father’s estate? Why not use the Life insurance payout to provide funds to the three adult children from his first marriage now?
“I came down (to AFRM) to ask what would happen to that policy when I died because that was what we were expecting to happen,” Michael recalled.
Michael said the plan was to give each $50,000 immediately and another $200,000 upon his death. With only months to live, a terminal illness claim was filed in April of 2017 and it was paid out in May 2017.
Michael said he didn’t even know it was possible to be paid out on a Terminal Illness claim while you were still alive but, again, that was thanks to the efforts of AFRM.
In 2017, Michael investigated a then experimental treatment (called CAR T-Cell Therapy) being done at the Massachusetts General Hospital in Boston, USA. He remains forever grateful to his wife for getting him to Boston for a consultation. To this day, he cannot recall how she managed it with him being so sick at the time.
“I went to Boston to enrol in this experimental treatment. It cost about a million dollars for an Australian to go and have the treatment over there,” Michael said
“But I didn’t have it because they advised that I come back to Australia and have further treatment here, which I did.”
“And right when things were looking bad - and they were, because I didn’t respond to the chemotherapy this time – I miraculously got onto an international immunotherapy trial. And I had what is called a soft remission.”
Michael said a soft remission means that during the three months he was having the immunotherapy treatment, the lymphoma “melted away.”
But when he had a follow up PET (positron emission tomography) scan a few weeks later, it showed the early signs of the lymphoma coming back again.
“If I hadn’t had the immunotherapy treatment, I would have just died,” Michael said in a matter of fact tone."
“By then I was referred to the transplant haematologist at North Shore at Sydney and he advised more chemo and I had some more radiotherapy too, which I had had previously as well."
“And it all went away. And almost two years ago, I had a bone marrow transplant from my sister."
“Currently, I am in remission.”
Michael attributes being in the highly unusual position of having received a terminal illness payout while still alive was purely down to AFRM’s expertise and the respect with which it is held by insurers.
Having AFRM on his side also gave him the ability to focus on getting well again rather than worrying about his family’s finances.
“I had a youngish family and a busy wife working full-time as a specialist doctor as well. So not having to deal directly with the insurance people myself was a huge bonus, for which, I remain very grateful because it just took the stress out of all that completely,” Michael said.
“And because it was AFRM, I think they (the insurers) trusted AFRM.”
Michael said the past few years have been personally rewarding. The financial outcomes secured by AFRM has allowed him to see his oldest three children enjoy a financial boost thanks to his Terminal Illness pay out.
And wanting to see the best for them, he decided not to be too strict about holding back the extra funds for each of them until he died. Accordingly, his eldest have enjoyed financial support in the form of funding for home renovations and school fees.
“It was nice to be able to do that while I was still alive,” he said.
Having spent the best part of the last eight years seriously unwell and being told he had just six months to live, we asked Michael how amazing it must feel to still be here and what have been his biggest learnings throughout this incredibly difficult experience?
“I was grateful that I had taken the advice that Phil Young gave me and that I was properly insured in all those three areas – life, trauma insurance and Income Protection insurance – so, I am very grateful to them (AFRM),” Michael said.
“And the other thing I have learned from all this (the stories in the media about insurers not paying out) – is if you have got a cheap policy then it has probably got so many exclusions and problems that it is not worth having.”
Michael also agrees that policyholders should not be hasty when facing premium increases. He said the focus should be on your ultimate needs and not the price of the premium.
“You only get what you pay for, I think. The thing with Income Protection of course being tax deductible, I was happy to be insured to the full amount that I was entitled too,” he said.
And what about his personal arbiter of his own “physical and psychological wellbeing” – is he back playing tennis?
“Yep. I am not playing as well as I want to, but I am improving. And as I like to point out to the three guys I play with and against on a Sunday morning at the clubs I belong too, I am probably the only person who is actually improving,” Michael quipped.
“I have been known to walk up to people at the net at tennis and say: ‘How does it feel being beaten by a bloke who has had two bone marrow transplants?” [laughs again]
We ask Michael for any final words of advice for people who may find themselves in the same position as he did?
“It is very easy to think it is not going to happen to you. I was completely shocked when I was diagnosed,” he said.
“I was thinking of hypertension and cardiovascular disease and diabetes and things like that and what I could do to make sure that I was not going to be at risk of those – but then the Big C strikes you…”
“The chap in Boston, who was very good I must say, and it was worth going over there really.”
“He distinguished between the biology of the mind, the biology of the body and the biology of the cancer. And they are not necessarily the same.”
“You can have a pretty fit mind and a pretty fit body and be calm and not anxious and depressed, or whatever, but that doesn’t mean that you are not going to get cancer.”
In March 2020, Michael will have been in his latest remission for two years.
“About 40 per cent of people die in the first year after an allograph (a bone marrow transplant from another person – in this case, his sister). My chances of relapsing now are diminishing rapidly as I hit two years,” he said.
So how amazing must it be to have defied the odds so far?
“Yeah, I haven’t been all that well for a fair amount of that time,” Michael conceded.
“You have to keep reinventing yourself to find purpose and meaning. And reinventing myself and finding purpose and meaning has been a challenge.”
But you’ve still got your tennis, haven’t you?
“Yes,” Michael agreed with a smile; “…And I’ve got a 16-year-old daughter too. She still wants and needs a fair amount of guiding. I am helping her learn to drive ‒ and things like that she is very grateful for ‒ and I am very grateful for the opportunity to do it.”