Insurance is only as good as the fine print

Insurance is only as good as the fine print.

Quality cover means that you can be assured that claims will be paid, quickly and efficiently.

One of the companies I work with has just produced their claims info for June 2020- June 2021

93% of claims were paid.

If you had a 93% success rate with something then you would be trusted to be able to do a job and do it correctly.

That being said,

Why don’t 7% of these claims NOT get paid?

Great Question:

There are 3 mains reasons:

1. The condition did not meet the medical definition. This will usually effect Trauma and total and permanent disability. These covers need to meet specific requirements to get a claim over the line.

For total and permanent disability for example, you would need to meet the definition of TOTAL AND PERMANENT DISABILITY, are you going to be PERMANENTLY disability, or only for a period of time.

• You put in a claim, but you actually return to work before the wait period ends.

You may have broken a bone and were supposed to take 6 weeks off work. However after 4 weeks you are back at work. During this time you started the claims process so that it was all ready to go after the waiting period. This therefore is a claim that has been declined.

• Not all relevant information was shared at the time of application.

When you claim the insurer needs to collect relevant information. If during that process they receive NEW information that they didn’t have beforehand, they need to take this into consideration when you are claiming. If it is relevant to the claim then it can effect the claim. However this is the least common reasons for claims being declined.

For most insurers, they adhere to the Mantra of

“if its grey, we will pay”, this means that if it’s a grey area in the claim, its better for them to pay out.

Insurance companies are a lot more focused on good client outcomes than they have been in the past. An example of this is in regards to someone who didn’t disclose that they were a smoker. Then they had a claim for cancer. The medical notes came back saying that they had been a smoker from before the cover was issued. Technically this Non-Disclosure could Null and Void the whole policy. However the Insurance company paid the claim, but took out the premiums that would have been paid at the smoker rates, out of the claim payment. This was a fair and reasonable conclusion for the client.

With new legislation in New Zealand fair client outcomes are embraced by all the main insurance companies that I work with.

My job is to be the person who knows the fine print, translates that into easy to understand language and then if a claim occurs to make sure we can claim on the relevant policy wording for you.

The fine print is important.