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Claims Case Study:

Updated: Oct 19, 2020

Originally published on 3 June 2020

“...talking with John, it was clear that all the preparation work, putting together the required documentation, would not have happened without AFRM’s persistence and support and advice.”

In May 2019, a law firm managing the estate planning of couple, John and Anna [names changed to protect client privacy], referred the couple to AFRM to investigate a potential Income Protection claim dating all the way back to 2012.

The team at the law firm were not sure if it would be possible to lodge a claim relating to an incident that occurred eight years ago but were confident in AFRM’s ability to accurately determine whether a claim was possible or not.

Anna had suffered an aneurysm and stroke while at work in 2012. The brain haemorrhage also resulted in a partial loss of vision.

The incident left Anna hospitalised for months with speech and mobility rehabilitation taking years beyond that. Anna is now very frail and walks with the aid of a walking frame.

She will never work again.

John is financially astute, working in the financial sector, and had commenced the process of trying to lodge a claim through Anna’s group insurance included within her superannuation fund in 2012.

However, due to the sheer weight of paperwork involved he set the claim aside at the time to focus of providing support to Anna in her time of most need.

Fast forward to 2019 and AFRM adviser, Justin Beeforth, met John to determine a plan of action.

Justin’s initial review of the Superannuation fund policy suggested Anna had a valid claim. Fortunately, the meeting with Justin had occurred the same day John had met with the couple’s financial adviser who had commenced paperwork to roll Anna’s superannuation over, out of the fund with the group insurance policy upon which Anna could make her claim.

The adviser was contacted and the roll over paperwork was immediately reversed.

With the first hurdle overcome, Justin and John set upon a months-long path of gathering all the appropriate documentation to support the claim.

The long list of formalities included some initial back and forth with the superannuation fund in order for it to recognise John as Anna’s legal guardian, a meeting with Anna so she could sign an authority for Justin to act on her behalf with the superannuation fund, insurers and medical practitioners.

Prior to even providing the claim forms, the superannuation fund insisted on receiving the date that Anna last worked, the date of her diagnosis and also the date she was certified unfit to work.

Then paperwork was required to opt-in to continue her insurance in her superannuation. Complicating the process, while dealing with the superannuation fund, it was discovered the fund’s group insurer had changed in the intervening years.

Reports were then required from her previous employer, her GP, and other treating medical practitioners to verify the details of Anna’s circumstances back in 2012.

The completed claim with all required supporting documentation was finally ready to be submitted in February 2020.

By mid-March, Justin received confirmation from the insurer that the claim had been accepted with payments backdated to 2012 and paid through to November 2015, when Anna turned 60, in line with the term of her policy. A total of almost $40,000.

Justin said that through talking with John, it was clear that all the preparation work, putting together the required documentation, would not have happened without AFRM’s persistence and support and advice.

When John thanked him for his help, Justin was quick to return the thanks, saying it was a team effort to get the complex claim across the line.

AFRM handled the entire claim on a pro bono basis.

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