The true value of good wealth protection advice is realised when you make a successful claim on an insurance policy. Ultimately, the sole purpose of having an insurance policy is receiving a successful payout, when you need it most. Unfortunately, most policyholders don’t understand the process of making a valid claim on a policy, unless they have been through it before. It’s important to be aware of the claims process to ensure you don’t miss out on valid claims, and you don’t waste time and effort when a claim may not be valid. Here’s a simple guide on how the claims process works.

Contact your adviser

The first step in the claims process is to inform your wealth protection adviser of any health event that may have impacted you. Your adviser will then assess whether the health event could trigger a claim under one of your insurance policies. If it is identified that a claim is valid, the adviser will then request the claim forms from the insurer. As many insurance products often have built-in features that policyholders aren’t aware of, we sometimes see situations where a client has suffered a small health event, but did not inform their adviser because it did not result in a significant impact on their situation. In some of these instances, the adviser was able to confirm that a valid claim could be made and benefits were paid to very surprised policyholders. Remember, your adviser is a vital first point of contact in the claims process.

Complete the Claim Forms

All insurers require a claim form to be completed. Your adviser will organise this with the insurer and arrange with you for this to be completed. The claim form includes a section which needs to be completed by your treating medical specialist. This is a vital step in the process, as it allows the insurer to identify the severity of the health event, assess whether the claim is valid, and assess the benefits payable to the policyholder. For income protection claims, forms will need to be completed on a monthly basis, due to the month-to-month benefits payable by these types of policies.

Enter the Claims Assessor

All claims are assessed by the insurer’s claims assessor, who will assess the claim forms and communicate with your adviser regarding their assessment of the claim, or if any additional information is required in order to complete their assessment. Your adviser also plays a pivotal role in this step of the process, by ensuring a favourable and speedy assessment of the claim. Your adviser is well-positioned to consider whether an assessment may be inaccurate, and can engage with the claims assessor to ensure a better outcome for the policyholder.

The Payment is Made

Once the claim is approved by the assessor, payment is typically made within a few days. Where the insurance policy is held within superannuation, the trustee of the super fund is required to approve a condition of release before payment of insurance benefits can be paid to the life insured or beneficiaries. This can delay the payment of benefits a little.
At Elston, we pride ourselves on our claims management service. We have seen how our involvement in the process has delivered exceptional outcomes with our clients’ claims.

If you would like more information please call 1300 ELSTON or email info@elston.com.au and an adviser will be in touch.