Giving you the best chance of having your claim approved

When you make the decision to take out an insurance policy you’re putting your trust in the insurance company you choose to honour a claim if and when you have to make it.

On the other side of the equation the insurance company has calculated a premium based on the level of risk you pose to them.  It’s a contract built around trust on both sides.

The vast majority of claims are of course paid out on but there are a percentage that, for one reason or another are not.  In this continuing series on the ins and outs of insurance claims we’re looking at statistics supplied by AIA Australia, one of this country’s largest insurance companies.  What we’re seeking to do is inform people on how to avoid having a claim rejected by their insurance company.

In 2014, AIA paid a total of $860 million dollars in claims with an acceptance rate of 92.9%.  But what about the 7.1% that weren’t accepted, why weren’t they and how do you make sure your claim, with AIA or any other insurance company, isn’t in this rejected claims group.

These are the reasons claims were rejected by AIA:

The Claimant didn’t qualify for a crisis event for Trauma Cover.

All insurance companies have definitions of crisis events that are listed in the policies they issue.  AIA for instance has 49 definitions of a crisis event.  If your claim does not meet the definition of a crisis event in your insurance companies policy, or the severity does not meet the definition, the claim will not be paid out.

The Claimant did not disclose a pre-existing condition at the application stage.

This is a biggie.  Some people don’t disclose pre-existing conditions because they fear they will not be offered a policy, or they fear the premium will be higher.  Logically there’s not much point in going down either of these routes as an insurance policy a company can’t pay out on is not really an insurance policy.  What an individual might think they are saving in the short term in a lower premium, they will lose out in the long term in an unaccepted claim.

Some people make this mistake unwittingly, forgetting conditions they have, or that they have unresolved medical conditions.  Make sure you ask your insurance consultant or company if there is anything you need to disclose or if you are unsure whether you should disclose a medical condition or not, even if you are embarrassed about something and don’t normally talk about it.

Most times you will be asked all the relevant questions during your application.

Here’s a quick hit list to make sure your claim has every chance of being approved:

  • Make sure pre-existing conditions are disclosed.
  • Make sure you complete, or have your insurance consultant help you complete, all paperwork your insurance company requires.
  • Ask your insurance consultant what financial evidence might be required.
  • If mobility is a challenge for you ask your insurance consultant what medical examinations you might need and how you might access them
  • Make sure your insurance consultant follows up with any outstanding requirements that might slow down the payment of a claim.
  • Review the application document once completed and make any changes necessary during the cooling-off period.

For more information on any of the points raised in this article contact a Rate Detective Consultant today and we can provide you with general advice around claims including our experience with various insurance companies. 

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Published on July 7-th, 2015 in Insurance
Damon Rasheed is the CEO of Rate Detective, an Australian financial service comparison sites specialising in Life Insurance, Income Protection Insurance and home loans. Damon holds a Master's Degree in Economics from the University of Melbourne and has been involved in many start-up internet businesses.

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