If you have an adviser – you tend to get better claim outcomes

Regulatory reviews in Australia have found the claims acceptance rates for the life insurance industry between distribution channels. The difference is marked – claims acceptance rates for advised retail policies was 92.1% compared to 87.8% for direct policies. For a good review check out Jack Howitt’s article here. 

Jon-Paul Hale emphasises the importance of advisers at claim time, which perhaps provides an explanation for part of the gap: Hale has questioned the use of automated portals when it comes to claims time. From his experience, there are plenty of claims where, had the clients claimed through the portals without his involvement, the clients wouldn’t have had such good outcomes. He gives a range of examples and cautions that clients can forget what cover they have and how it works – all at a time when they may be feeling overwhelmed from the medical situation they are facing. 

On the other hand, the difference between group and retail policies in Australia leans back the other way – more towards how the policy was underwritten as a potential cause for the difference in outcomes. Group insurance policies have some of the highest claims acceptance rates at just over 95%. Howitt’s explanation is compelling:

“This is likely due to the fact that group life insurance policies are typically underwritten on a group basis, which means that insurers have less risk associated with each individual policy. Retail advised policies may have lower claims acceptance rates due to the fact that they are typically more complex and may involve higher risk individuals. Direct policies may have lower claims acceptance rates due to the fact that insurers have less information about policyholders.”

More news:

Adviser to pay former clients compensation after he breached their privacy and caused them stress

Stats NZ report finds Māori businesses lead in employee wellbeing and flexibility

Survey finds 90% of family doctor clinics plan to increase their fees