How to get your insurance claim paid, every time

How to get your insurance claim paid, every time

A question that is often asked, ‘So will the insurance company actually pay?’ Yes they do, they pay valid claims.

This is the issue, defining valid claims. Valid claims are claims that are both covered by the policy and the policyholders have been complete in their disclosure.

For example a cardiac event, similar to a heart attack, but isn’t severe enough to qualify as a heart attack under the definition of a heart attack on the trauma policy wording. This isn’t a valid claim, as it didn’t meet the definition of the policy document.

Your Dr and cardiologist may refer to it as a heart attack, but it’s not quite severe enough. Truth be told, sometimes they position it to give you a scare, and to be frank, you’ve had a scare and you probably need to change your lifestyle, but you haven’t had significant death of your heart tissue to cause long term disability or real impact on your earning ability, once you have worked through recovery of the initial event.

Psychologically it may be a different story, but that’s a different claim altogether.

The other common situation is you didn’t tell the truth, the whole truth and nothing but the truth about you medical and financial situation. This unfortunately is quite common and sometimes it’s inadvertent, but still significant none the less.

So back to the original statement and I’ll qualify that a bit further, How to get your valid insurance claim paid, every time.

You could say it's child's play, it's pretty simple in theory, sometimes a challenge in practice.

1. Go to your doctor and request a copy of your complete medical file

Don’t tell them it’s for insurance, they get funny about it as the insurance company pays them, and pays them well, for providing medical notes for insurance purposes, and submit this with your application.

(The insurers will only request your medical notes if they have a need to, based on your disclosed conditions. They may only request specific details; in either case it won’t highlight anything you may have missed until too late. This is a privacy commissioner direction and not an insurer thing. The insurers want the information because the insurer wants to get it right.)

2. Find a reputable insurance adviser

We’ll do, we’ve got an award to prove it, who works with all providers and will look to arrange the right sort of cover for your situation, including your current cover if its most suited. One provider usually doesn’t suit all, though some providers do suit a lot of people. This way you get to access the whole market with one stop.

3. Ensure you are completing a full application form.

The ‘book’ will have 30-40 pages in it. Don’t worry if you’re reasonably healthy, you won’t have to complete all of it. If you have lots of health conditions, then good, you’ll likely get a better answer from the insurance company if you are complete with your disclosure.

Full applications ask lots of very specific questions, making it harder for you to miss recalling details about your medical history.

Short form applications have much much fewer questions and the questions that do get asked are wide ranging. Like ‘Have you had any medical examination, blood test or x-ray in the last 5 years, are you currently undergoing treatment, tests or observations or considering seeking advice or treatment for your health?’

What a mouthful and you only have 4 lines to answer in this particular example. Meaning you are more likely to miss things that matter.

4. Check and re-check

Once you have your medical records, a good adviser and you have selected the appropriate cover and completed the application form, ask for a copy of the application back from the adviser and make sure you read it carefully and check your answers. (In all cases you’ll get this automatically from us) Anything that has been missed or need updating, make sure it is.

5. Getting your claim paid.

Assuming that you’ve done the above and your policy has been issued without any additional exclusions. You get on with life. When it comes to a medical event and you need to rely on your cover, hopefully you have selected a comprehensive enough plan that covers you across all the situations you need, you give your adviser a call and they will work through the claim process with you.

Because you were thorough with your application, there should be no issue with processing your claim and getting it paid. (Assuming the condition you are claiming for is actually covered by your policy, which is another discussion entirely)

You’ve got that?

Now what are you going to do about it? Give us a call, we’ll set you on the right path!

Jon-Paul Hale

Written by : Jon-Paul Hale

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Physical Address:
5i Miro Place
Albany
Auckland

Email: enquiry@willowgrove.co.nz
Phone: 09 973 2849

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