Claims Case Study:
Originally published 24 June 2019
“Not only were Rob and Bev willing to see if they could help with a critical illness claim, they never gave up trying to help someone that was previously not their client despite any difficulties experienced along the way.” “This, in my mind, speaks volumes about the ethics of AFRM and your focus on helping people, clients or not, when they need it.”
Client, Emma, was referred to AFRM by Accountant, Michael, last year. Michael had been assisting Emma through Family Law court proceedings. Emma suffers from a range of seriously debilitating chronic illnesses manifesting complex symptoms, combined with mental health disorders. The cumulative effect of all these issues made communicating with Emma challenging, if not extremely difficult, at times.
Michael was aware of this, having worked with her, seeking directions from her for the legal proceedings he had been assisting her through.
Her previous adviser had lodged a trauma claim on her behalf, but it had been declined because the insurer deemed she did not meet any policy definition for a specific illness. After becoming aware of this information, Michael approached AFRM because he had had previous positive dealings with us and was aware of AFRM’s expertise in claim management. The AFRM team dedicated to providing support to Emma soon learned that supporting Emma was indeed quite challenging because she was struggling financially, mentally and physically. Subsequently, AFRM’s team reviewed all of Emma’s medical reports and the claim forms which had previously been submitted to MLC. These reports were quite extensive.
AFRM re-opened Emma’s claim with MLC and requested that MLC assess the claim under “activities of daily living.” This was significant because it was a different approach to that considered by the insurer at the time it initially denied the claim.
It is the depth of AFRM’s knowledge of insurance policy terms and conditions which enables us to develop unique solutions on behalf of our clients.
Through the course of managing Emma’s claim, AFRM’s team had numerous phone meetings and exchanged a vast amount of email correspondence and text messages with Emma, addressing her ongoing concerns re her health and the status of her claim. Accordingly, AFRM’s team escalated the claim assessment with MLC’s senior management seeking for it to be fast-tracked to resolution. In March this year, we finally got her claim approved and paid. AFRM is continuing to support Emma; helping her to restructure her life insurance policy so she can leave her estate to her children in a tax-effective way.
Within 40 minutes of the distribution of our Q1 Client newsletter on 29 March, which had highlighted feedback we had received from clients, Michael sent us the following response:
"Hi Nick, "I will echo the comments in your email. "In case you were not aware, Rob and Bev Murray took on a client of mine a year or so ago. "She is going through Family Law proceedings, has very little in the way of financial resources and a long list of health issues. Her health issues mean that sometimes she can be a difficult client because she is often hard to get instructions and responses from. "Not only were Rob and Bev willing to see if they could help with a critical illness claim, they never gave up trying to help someone that was previously not their client despite any difficulties experienced along the way. "This in my mind speaks volumes about the ethics of AFRM and your focus on helping people, clients or not, when they need it.
"I was really happy to hear that she [Emma] recently received a critical illness payout from her policy. Whilst not an overly large payout, it is enough to provide some relief and options.
"To Bev and Rob, thank you both for not giving up and getting a successful claim through. "Michael."