Claim time is ‘when rubber hits road’

A client who was able to continue building a new home despite being off work for 18 months is one of the recent highlights for Brave Day.

Saturday, August 24th 2024, 6:52AM

A client who was able to keep his financial life on track – including continuing with the construction of a new home – despite being off work for about 18 months is an example of the difference that well-planned insurance cover can make, Dean and Tania Young say.

The couple, who own insurance advice firm Brave Day in Auckland, say it’s at claim time that all their work really comes to the fore.

Tania says the client in question went to have a bilateral knee replacement, one leg at a time, last year. But the first operation involved medical misadventure and he has been off work since.

“His medical insurance was paying for the procedure, and he’s had his mortgage protection policy paying him since the standdown period passed.

“Since 13 weeks after the incident, he has been receiving a monthly benefit amount from his mortgage protection policy. He still isn’t back at work, still hasn’t had the second knee done and he’ll be off for probably at least 18 months, maybe longer.”

A premium waiver benefit has meant he has not had to pay his normal premiums and the mortgage protection policy has no ACC offset, so he also receives support from ACC.

“He and his wife had committed to and started building another home,” Dean says.

“They needed through that period to have both their incomes – that was required to continue with the build and move their lives forward. If he didn’t have the cover, their whole life – that build – would be put on hold.

“Their life is able to continue to move forward, as per their original plans, because he has the right cover, despite this major incident that took place through no fault of his own.”

While the client has been off work, he has also been able to trigger events increases on his life and trauma policies as he and his partner take on more debt to build the home.

“We’ve been able to increase their cover while still being on claim for mortgage protection,” Deans says.

“They were paying a high premium and we had discussions with them prior to his event about the premium but no one complains about premiums at claim time… he’s likely to be off work another six or eight months and the great thing about the policy is when he goes back to work he starts paying for it again and they’re covered for an event in future.”

Dean says the client didn’t have the full cover he has now when he first took advice in 2006, but regular reviews along the way have allowed for it to be topped up.

“The review process has been really important as their needs changed over time from a young married couple to having a family and building a new house. Their needs have changed considerably over the last 18 years, but their cover has kept up when they required it.”

Tania, who is the general manager and claims manager for Brave Day, says another case that stands out for her is a young woman who was diagnosed with breast cancer two years ago, aged 30.

“It was quite aggressive. Her medical insurance responded…She had all the treatment and she had a trauma policy so she had also had a lump sum payment that went to her upon diagnosis. Her income protection kicked in and she’s been on claim for two years now.”

The woman has a young child, Tanya says, and her trauma payout allowed her to bank some eggs in case she wanted to have more children in future. “Having extra cash allowed her to do that and make the decision really quickly. The cover paid out, giving them the flexibility to do that. We touch base with her every three months to see how it’s going.”

Dean says it’s proof of the value of insurance advice that she is the daughter of clients. “It’s intergenerational. Her parents saw value and when her daughter got married and there was a family in the wind it was important to have that conversation.

“It’s not usual for a young lady of 30 to claim on multiple products and have essentially a lifechanging medical event – to have multiple products in place already at that age to pay for the procedure, and give a lump sum and ongoing cashflow, made a significant difference in her life.”

Dean says Brave Day tries to impress upon clients through regular correspondence that as their children get older, it will be important for them to understand insurance. “They may not feel a need for everything initially but at least they have an understanding so when they have life milestones we can add cover as we go.”

He says claims “weigh heavily” on the Brave Day team. “To be honest, the longer we are in the industry, the heaver it seems to get. Our reputation is on the line at claim time, that’s when the rubber hits the road. That’s something we’ve always tried to be geared up for. It’s obviously the most important part of what we do for clients.”

He says it’s vital to them, to have someone who is an owner of the business in the claims manager role. “We’ll never pass that stuff on.”

Tania says often people who are claiming are those who’ve built up relationships with Brave Day over the years.

“Some people we might have had as customers for ten years before they have a claim, we get to know them. They’re not just numbers to us, they’re real people – that makes a massive difference. It’s a very emotional time for everyone involved.”

Dean says Brave Day takes a deliberate approach of hiding some of the “back room” process of claims from clients to avoid making a stressful time more difficult.

“A lot of the time at claim time, our clients have no idea what goes on. We’re very conscious to only make contact with them with an answer or when it’s absolutely necessary if there’s information we can’t supply that the insurer is after.”

Tania agrees. “We try to shelter them. Not all claims go smoothly from the get go, so we like to shelter them and not tell them there’s a potential issue. We never tell them what’s going on, just work away in the background and ‘hey presto’ at the end we produce a result.”

Dean says it makes sense, when often claims are triggered by significant medical crises.

“We always felt ‘you get on and get better, leave the insurance to us’. That’s part of our values. We have had big claims, that literally have been declined multiple times, that we’ve had to fight for them, we’ve asked for it to be reassessed and it’s gone to committee. Two spring to mind where they’ve been declined three times. The client has no idea so that’s where we feel we’ve done a good job from go to woe.”

They say that advised clients have significantly better outcomes than those trying to go it alone. Relationships have been built up with the insurance companies they deal with, so the process is streamlined. “We know they know what they’re doing, they know we know what we’re doing. It just makes our claims go smoother.

“They’ll pick up the phone and have a chat if there’s a problem and we’ll thrash it out … if we have a problem we’ve got immediate lines into the head of claims at the companies we deal with. We can go straight there if we have to.”
Tanya says it’s not only with the big claims that they can make a difference, either.

Often, through checking in with clients, they are able to find opportunities for clients to make claims they might not have even realised were possible.

“We’re always asking whenever we engage with anyone ‘what’s changed in your world, has anything happened we should know about’.

“People tell us about that melanoma they had chopped off and we can probably do something with that – there are all sorts of things people tell us – ‘oh I had a stent a couple of years ago ‘, we tell them they can claim on that. It’s about staying in touch, always listening for things that their policy is going to respond to. People are always very happy about that.”

In other cases, Dean says, they’re watching out for opportunities that allow people to increase or top up their cover over time without having to go through full underwriting or even completing an application.

“For clients, one out of every 1000 will get the policy document from the insurance company and read it. People don’t understand the clauses. The difference from our point of view is dealing with multiple insurance companies, staying aware of all these little things – it can be a real benefit to clients not just at claim.”

Dean says having a solid claims team in the business is vital to back him up as an adviser.

“I’m the adviser, the face. We’ve always had the extra resource – whether it be Tania or the lady who does the medical - specifically for claims. Right through the whole time we’ve been in the industry, 25 years, we’ve had specific resource, not just me to do it.

“That comes back to the fact we realise that’s our reputation. It’s great for me when giving advice, sitting in front of a client, I can confidently say what we’re going to do because we have the experience, I know the resource, I trust the people in our business that we’re going to do the right thing. That comes across very well at the start of the relationship.”

Tania says people need to realise insurance is there to help. “People say insurance never pays. Actually, it does. It’s our experience that if you meet the definition of the clause, it pays… it’s just you have to have the right structure and having it reviewed regularly is really important. If you’re unsure, ask your broker or adviser – tell them if something is going on, so they can give you some advice.”

Tags: claims