Behind The Scenes – Insurance Claim

I have worked for Sofie for several years now and I thought it might be interesting for her clients to gain insight into some of the lesser-known services Sofie provides and a case study that demonstrates how the assistance of an adviser during a claim can pay dividends.

The Claims Assistance Service is an add-on service, and includes:

• Determining whether you are likely to be successful – review your circumstances and the injury/medical condition against the terms & conditions of your insurance policy,
• Commence claims process with the insurer,
• Assist with completing insurance applications forms,
• Obtain supporting documentation,
• Dealing with the insurer on your behalf,
• Liaising with your employer and medical practitioner, if required.

Case Study

Sofie was approached by a new client last year who was looking for an Adviser to manage their Superannuation.  During the preliminary ‘fact-find’ meeting, Sofie discovered that the client happened to be off work for a medical condition (and had been for several months).  Sofie asked whether the client had made an insurance claim through their Super, but they had not because they were unsure of the process and felt that chances of success were low.

Always ready for a challenge, Sofie asked the client for permission to pursue the Income Protection claim.

As a professional removed from the emotional stress of making a claim – it is invariably a long-drawn-out process with much form filling and follow up telephone calls – Sofie was able to methodically follow the process and update the client of her progress over the course of several months.  Sofie gathered Doctor and Employer statements, medical evidence and financial information as required by the Insurer.  Dealing with insurance claims can be a very frustrating process, but Sofie knew what to expect having negotiated with insurance companies regularly during her time as an Adviser.

Sofie also pushed for recognition that the client had been originally diagnosed with the ongoing medical condition in 2016 and had periods away from the workplace between 2016 and 2022.  Her determination paid off.  After 5 months of continual correspondence and information gathering, the client was notified that their insurance claim would be paid, backdated to the first instance of time away from work in 2016. 

The client is still on claim and now receiving regular monthly payments to replace part of their lost income until they are able to return to work. The outcome for the client is that they can focus on their recovery without worrying about money and they don’t have to use up their Super to fund their living and medical expenses. 

Hilary Warwick