• AFRM

Claims Case Study:

Updated: Oct 19, 2020


Originally Published on 7 October 2020

“It’s tragic to see a person’s life turned upside down by such a freak accident and subsequent series of unfortunate events.”
“I can’t imagine how much worse off he would be now if he didn’t have the AFRM financial risk management plan in place at the time of his accident.”

This case study is about a how your life can change dramatically thanks to one chance, freak, accident.


How the damage done in a freak accident can be compounded dramatically if medical practitioners don’t accurately diagnose a serious injury the first time the patient presents.

It also underscores the importance of having a risk management strategy in place, so that it is there to support you when you need it most.


Finally, it demonstrates how the support provided by AFRM can help ease the stress and anxiety that arises for most people on long-term claim, having to file all the appropriate medical reports and other paperwork each month to continue to receive benefits.


On 22 April 2017, self-employed contractor mechanic, Mark [name changed to protect client privacy], was walking his dog on a leash when the dog suddenly went after a cat and Mark pulled back hard on the leash to restrain it.


Mark felt something pop in his arm at the time and the pain told him he had possibly hurt himself badly.


He drove himself to his small local hospital, where he was seen by the after-hours GP Access service.


The duty physician did not diagnose any serious injury and sent Mark home with the direction to seek medical advice if he wasn’t feeling any better in the few days.


Four days later, on 26 April 2017, convinced he wasn’t imagining his pain and discomfort, Mark presented himself to the largest hospital in the region to seek a second opinion.

A complete rupture in the tendon attaching his right bicep to the bone just above the elbow was diagnosed and he was immediately admitted to the hospital for treatment.


Significant concern was raised by the treating physicians because the chances of successfully reattaching a tendon to bone (and minimising long-term symptoms) are infinitely better in the first 24-48 hours than they are days after the incident.


On 28 April 2017, he was transferred to a small private hospital for specialist surgery to re-attach his bicep and tendon to the bone in his arm. The next day he was discharged with orders not to remove his sling for one month.


This was when Mark’s fortune began to really unravel. As a contracted, sole-trader, mechanic, Mark had no access to sick leave. So, even though he had literally ripped the bicep off his upper arm bone on 22 April, he turned up for work on 24 and 25 April. This is a fitter and mechanic’s job working on heavy machinery with a lot of heavy lifting involved.


Then, as noted above, he was in hospital 26-29 April.

And despite his surgeon’s advice, Mark went to work from 1-17 May, doing the best he could with limited use of his right arm. On 18 May 2017, his contract was terminated for “economic reasons.” He had been in the role 18 months.


In early July 2017, thanks to AFRM’s assistance, Mark’s insurer formally advised that his claim for Total Disability under his Income Protection insurance policy was approved to the value of between $8,000 and $9,000 per month.


He was required to submit reports with updates from his medical practitioners monthly in order to continue to receive benefits.


Initially, his specialist surgeon forecast Mark would be unable to work anywhere from three to 12 months because the injury had caused nerve damage within his arm. Over the coming months, his specialist provided Mark with a range of drugs seeking to mitigate his pain.


By September that same year he was also seeing a pain specialist who added several new medications to those Mark was already taking. It was suspected but not proven that the nerve damage was incurred during the surgery to re-attach his distal biceps tendon.


Mark was now in a monthly cycle of unsuccessful medical treatments and reporting updates to his insurer in order to keep receiving his benefit. AFRM supported him throughout this time, submitting his monthly reports to his insurer and liaising with the insurer on Mark’s behalf as required


By January 2018, his specialist reported that his right hand continued to be non-functional and that his condition was deteriorating with increased pain in his right hand and forearm.


By January 2019, Mark was having daily physiotherapy but faring no better. He was still experiencing significant pain in his right shoulder, bicep, forearm and hand; and had reduced strength and arm control.


Fortunately, despite not being able to work, the insurance protection put in place by AFRM provided Mark with replacement income in excess of $100,000 for the 2019 financial year.


By the end of December 2019, the insurer requested Mark attend an appointment with an Occupational Physician, appointed by the insurer, to undertake an Independent Medical Assessment of his condition.


By March 2020, AFRM followed up the insurer seeking to know the outcome of that appointment because uncertainty caused by the lack of communication by the insurer was taking a psychological toll on Mark.

Mark remains on claim to this day and continues to be supported by AFRM.


His AFRM advisor, Phil Hatherly, is hopeful that the insurer will ultimately accept that Mark is totally and permanently disabled and will formally recognise him as a long-term claimant, in order to reduce the ongoing mental health issues and stress caused by having to chase up his treating physicians to complete monthly reports for the insurer.

“At the end of the day it is just an awful situation to be in. He’s in pain constantly, is suffering depression as a result, and has lost his career. All because his dog tried to chase a cat,” Phil said.
“It’s tragic to see a person’s life turned upside down by such a freak accident and subsequent series of unfortunate events.”
“I can’t imagine how much worse off he would be now if he didn’t have the AFRM financial risk management plan in place at the time of his accident.”

AFRM Acting Managing Director, Rob Vitnell, added that in AFRM’s experience, many clients (irrespective of their occupation) do ultimately suffer ongoing secondary health issues, as Mark unfortunately has in this case.

“Often clients say that because they have a desk job, they only need their brain to work. That is, if they suffered an injury or illness they could still work,” Rob said.
“Mark’s case highlights how an initial injury or illness can lead to a cascading series of other physical and mental health issues over time.”
“When advising clients sometimes it is difficult to get them to truly understand the potential seriousness of the issues that can arise unless you highlight cases such as Mark’s.”
“The fact that Mark suffered ongoing issues, in particular nerve damage, severe and ongoing pain, plus the development of significant mental health issues given the overall impact of the circumstances on his life, clearly demonstrates the domino effect that can occur.”
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