Insurance from MLC Adviser use only We go the extra mile MLC Claims Contents This brochure is designed to bring you up to date with the latest changes and improvements in MLC Claims. Her’s what you’ll find within this document Important information This brochure is solely for MLC Financial Adviser use and is not intended for general distribution. MLC Limited (ABN 90 000 000 402, AFSL 230694) of 105-153 Miller Street, North Sydney NSW 2060, is a member of the National Australia Group of companies. Contents Here’s what you’ll find within this brochure. Introduction and welcome 1 The MLC Claims team structure 2 Pay & Finalise – a speedy and simple solution 3 Pay & Finalise – case study 4 To work or not to work 6 It can happen to anyone – the evidence 8 Living the message – real life case studies 9–11 Delivering on 12–15 our promise – statistical proof How we process your client’s claim 16 How you can help the process 18 Keeping your clients informed 19 Want to find out more? 20 MLC Claims – We go the extra mile Page 1 Welcome to the new world of MLC Claims I’m very proud of our exceptional Claims team here at MLC and what we do to support you and your clients at their time of need. Natalie Eckersall I’m equally proud of how we deliver on our promise as insurers, which is reflected in our team purpose statement. ‘We are committed to providing the best claims operation in Australia, as measured by client satisfaction. Our purpose is to effectively support the client by making the right decision fast and partnering to facilitate their return to work. We aim to make the claims process simple and convenient for policy owners and treat all beneficiaries with respect and compassion.’ Our Claims leadership team has over 86 years’ experience in the life insurance industry. Effective claims management is critical for any life insurer. At MLC we’re committed to being there when your clients need us most. Last year we paid out $566 million1 in claims, that’s around $2.3 million each business day. Working in partnership with you, we’re ready to support both you and your clients. Throughout this brochure you’ll find quotes from advisers and clients as testimonials to the help they’ve received from our Claims team. These real life stories remind me and my team of just how important it is for us to deliver the very best service offering to you and our clients. I sincerely thank you for your ongoing support and partnership. Natalie Eckersall General Manager, MLC Claims 1 This figure covers Retail and Group claims paid up to 30 September 2012. Page 2 MLC Claims – We go the extra mile The MLC Claims team structure Supporting you and your clients Our structure is designed to support you and your clients through the claims process and help them with their return to work. We’ve organised our teams so that we provide the best possible service offering and support to you and your clients. Our structure delivers: • a significant improvement in service experience through initiatives like ‘Pay and Finalise’ • greater partnering with our clients to help them return to work by offering services such as rehabilitation support. This service can help your clients get back to suitable work, or retrain for new work opportunities, while focussing on restoring their fitness and confidence, and “Thank you for all your support and help you have given me while I have been unwell. It is fabulous being back in full-time work and I have MLC to thank for putting me through rehabilitation. You really have saved my life.” A comment from one of our clients who went through our rehabilitation program. • dedicated resources including legal, accounting and medical specialists. These provide support with claims management, training and staff education. We continuously review our process and structure to make sure we offer you and our claimants the very best service. You can learn more about our current structure and the individual managers who lead these great teams on our website at mlc.com.au MLC Claims – We go the extra mile Page 3 Pay & Finalise A speedy and simple solution We review every claim received to see if it meets our Pay & Finalise criteria. If it does, we assess the claim for eligibility, review the medically advised period of disability and then pay the full benefit amount upfront to finalise the claim. This typically happens within five days of receiving the completed claim forms. This helps the client to focus on returning to work and getting on with their life. Our Pay & Finalise criteria is constantly evolving as we continuously improve our service offering, but some examples of claims that fall into this category include those where: • there’s appropriate medical certification for the anticipated period of disability • there are no complications (medical or otherwise) which would delay a return to work • the nature of the disablement can be objectively supported, eg fractures or hernias (claims which are subjective in nature are generally not suitable), and • there are no disclosure or pre‑existing concerns. Where a claim is accepted for Pay and Finalise, we’ll pay the benefit up to the anticipated return to work date. This is without the need for any further supporting documentation, such as ongoing medical certification or additional forms. This also means that neither you, nor your client, need to provide paperwork on a monthly basis for the ongoing claim. “A client of mine, who is also a close personal friend, had reason to claim for a very short time on her MLC Income Protection late last year. I spoke to her on the weekend at a social function we were both attending and she had huge praise for the gentleman from MLC who handled her claim and spoke to her on the phone with regard to it. His level of care and genuine interest in her well-being was greatly appreciated and she was very impressed with the whole experience.” A comment from one of our advisers whose client had made a claim. Page 4 MLC Claims – We go the extra mile Pay & Finalise in action John2 An accountant John has Income Protection (IP). On 26 October 2012, he suffered a fractured tibia due to a fall. John lodged his IP claim with us on 14 November 2012. John Accompanying his claim form was medical certification which indicated that he would be unfit for work until 21 December 2012. It also came with a medical report which accurately detailed the full nature of his injury. and that he was expecting to return to work in late December 2012. As a result of the conversation with John, who was confident of a return to work within a reasonable period, we paid his claim in full for the period 26 October 2012 to 21 December 2012. This was without the need for any further medical evidence or other statements of continued incapacity. John received an IP benefit of just under $11,460 for the period of disability and successfully returned to work in late December. We contacted John on receipt of the claim form, where he indicated that there was good progress of the injury, 2 The client’s name has been changed for privacy reasons. This photo is for illustrative purposes only. MLC Claims – We go the extra mile Page 5 To work or not to work It’s true, work is good for you. The Royal Australasian College of Physicians released a conclusive piece of research3 which demonstrates that work is good for physical and psychological health and wellbeing. And it helps with self-esteem. Long term ‘worklessness’ is one of the greatest risks to health in our society4, and the facts are disturbing.5 The facts • The health risk is equivalent to smoking 10 packs of cigarettes per day.6 • There’s a 40-fold increase in suicide rates for young men that are out of work for greater than six months.7 • In fact, the overall suicide rate increases by six times for those with longer term worklessness.8 • It creates a greater health risk than the most dangerous jobs in the construction industry.4 Yet, in spite of this overwhelming evidence, it’s clear that this message hasn’t received widespread acceptance in Australia, to the frustration of medical professional bodies.3 What’s the solution? While the solution to this isn’t simple, there are still many things that can be done. Investment in our people We’ve developed the claims management capabilities of our team, to incorporate bio-psycho-social factors9 during claim assessment; recognising that any combination of these factors can act as a barrier to recovery and return to work. Research4 shows that 70% of the principal barriers for returning to work are psychological/cognitive and include the workplace environment. Rehabilitation expertise MLC has a dedicated team of in-house Rehabilitation Consultants whose priority is to provide help and guidance to the claimants to resume suitable and safe work. They liaise closely with treating doctors to make sure the support provided is appropriate and consistent with the medical advice provided. Insurance from MLC How we help you on the path to recovery Rehabilitation Support Program This is the flyer eligible clients receive to help them understand how the MLC Rehabilitation Support Program helps them. Page 6 MLC Claims – We go the extra mile “I found the ongoing support from the MLC Rehabilitation Consultant and the External Rehabilitation Provider to be invaluable … they have been able to help me with all issues of providing advice as to the home environment and part-time work in a low stress environment.” A comment from one of our clients who went through our rehabilitation process. “I know without the services of the External Rehabilitation Provider in helping me to find a new job that I could do after my injury, I would still be claiming benefits. Early intervention This helps early recognition of claims cases that potentially have bio‑psycho‑social factors which could act as barriers to full recovery and the return to full-time work. It’s essential to actively manage the claim and engage everyone with a direct interest in the long-term good health and wellbeing of the claimant. Understanding the genuine capacity to work through proper consultation will not only help the claimant achieve the right levels of physical and mental fitness, but it will also help us manage their claims effectively and in a sustainable manner. I am extremely grateful to MLC and the Rehabilitation Provider for everything they did to help me get back to work.” A comment from one of our clients who went through our rehabilitation process. 3 Realising the Health Benefits of Work, Royal Australasian College of Physicians & The Australasian Faculty of Occupational & Environmental Medicine, 2010. 4 Professor Gordon Waddell, ‘Work, good for your patient’s health and wellbeing’, 2007. 5 Professor Sir Mansel Aylward, FINEOS Claims Global Summit 2011. 6 Ross J. Where do real dangers lie? Smithsonian 1995;8:42-53. 7 Wessely S. Mental health issues. In: K H-E, ed. What about the workers? Proceedings of an RSM Symposium. London: Royal Society of Medicine Press; 2004:41-6. 8 Bartley M, Sacker A, Schoon I, Kelly M, Carmona C. Work, non-work, job satisfaction and psychological health: evidence review: Health Development Agency; 2005. 9 Preventing incapacity in people with musculoskeletal disorders, Gordon Waddell, July 27, 2006. MLC Claims – We go the extra mile Page 7 It can happen to anyone No matter whether they’re male or female, a critical illness can strike at some stage in your clients’ lives. Who needs Critical Illness insurance? The general population data shown below is based on being aged 30 now. 20% 21% 3% 12% 14% 4% 1% 15% 7% 41% Statistically, before the age of 70 you: ill be diagnosed with cancer w will have a heart attack will suffer a stroke will suffer from another critical illness will die from something other than a critical illness, or will not have suffered a critical illness Source: Munich Reinsurance Group in Australasia, 2009. Page 8 MLC Claims – We go the extra mile 4% 58% Living the message: ‘We go the extra mile’ Ken10 A self-employed real estate manager Ken developed anxiety and depression and, as a result, sold his business, and consequently had no job to return to. Ken Ken’s claim was reviewed by the MLC Rehabilitation Consultant, as he was very keen to explore employment opportunities that would help him to return to work. Medical evidence confirmed that he wasn’t able to return to his pre-disability occupation so new employment opportunities had to be explored. Ken was subsequently referred to an External Rehabilitation Consultant where an initial assessment was completed to help in devising a plan to help Ken to return to the workforce. As a part of this plan, Ken participated in a Vocational Assessment (VA) where suitable employment vocations in line with Ken’s education, training and experience as well as his medical abilities were identified. The VA options were discussed with Ken’s treating doctors to make sure that the recommendations were medically appropriate. Ken then took part in a job seeking program through the External Rehabilitation Provider (ERP) who helped him develop a resumé and cover letter. The ERP also provided him with strategies and support to help him to apply for, and attend, interviews. As a result of this support, Ken was able to secure employment in an alternative occupation on a full-time basis, six months after starting to look for a job. 10 The client’s name has been changed for privacy reasons. This photo is for illustrative purposes only. MLC Claims – We go the extra mile Page 9 Delivering the best service We love hearing stories of how our work at MLC can have a positive impact on our client’s lives. One client, Jurek Leon, wrote us this letter about the experience he had when he had to make a second claim on his Income Protection policy. Letters like Jurek’s remind us just how important it is to give our clients the very best service we can. Jurek Re: Personal Inco me Protection Po licy Thoughts on how it was handled by MLC Dear MLC, It’s happened again . I’d rather it hadn’t but that’s the nature of Income Pr otection insurance. It’s something that we policy holde rs would rather not benefit from but are glad to have . So, six years after m y last claim, a ruptur ed Achilles tendon brought my work schedule to a standstill and I needed to be back in contact with MLC . How would it be ha ndled this time, I wo ndered? The answer: not muc h different...and tha t’s a compliment and a cre dit to you and to MLC . On this occasion, the personal contact fro m you with this claim is much ap preciated. At a time when I was shocked to learn tha t such a simple injur y would have such a huge impact on my ability to get thi ngs done, it was reassuring to have everything av ailable to me explained clearly an d dealt with prompt ly. Page 10 MLC Claims – We go the extra mile The way you kept m e informed of my op tions and the process that en sured the claim wa s handled smoothly and quick ly again, reassured me that Income Protection is essenti al – and that insuring with MLC is one of the best busin ess decisions I’ve ev er made. I’d rather not be writin g this testimonial. I’d prefer it if I never had a reason to make a claim. Bu t none of us know what lies ahea d so it makes sense to pay for peace of mind. As I said about my previous experienc e with MLC, I don’t take out insur ance policies beca use they’re worth it; I take them out because I am wo rth it. Thank you for your help and for remind ing me that I am in safe hands with M LC. Kind regards Jurek Leon Dear MLC, inal cancer shortly Our son was diagnosed with term after his 19th birthday. palliative He was started on six rounds of his affairs in order. chemotherapy and advised to get Will, asked for details Our solicitor, while organising his of his superannuation fund. details, we discovered When we found his MLC super th benefit. that it included a life insurance dea iser we were informed After consulting our financial adv death benefit under that our son could be paid out the the terminal illness clause. k we had the We rang MLC and within one wee y were very basic The out. fill to s required claim form and simple to complete. tly completed the two Our doctor and specialist promp plied all test results medical reports required and sup requested. Monday and by MLC received the papers on the were released and the following Monday the funds k account. ban transferred to his nominated left comfortably He can now enjoy the time he has without financial stress. ful caring staff, that Thank you MLC, and your wonder an emotional and helped us and our son through stressful time. This case study is published with the client’s permission but with their privacy protected. This photo is for illustrative purposes only. MLC Claims – We go the extra mile Page 11 Delivering on our promise In 2012, over a twelve month period, we paid out a total of $566 million in claims across all our insurance products.11 On the following pages are examples of some of the claims we’ve paid. MLC Life Cover Occupation Sex Age Cause Policy start date Amount paid Property Consultant M 48 Cancer – brain tumour 05/09/2008 $159,135 Homemaker F 51 Car accident 25/06/1997 $382,595 Labourer M 40 Thrombosis 23/05/1995 $161,820 Secretary F 54 Cancer - metastatic renal cell carcinoma 01/11/1995 $463,631 Fitter M 55 Cancer – Oesophagus (Metastatic) 15/07/2008 $106,811 Public Servant F 59 Cancer - Metastatic Mesothelioma 14/09/1988 $205,074 Director M 54 Brain tumor 20/11/2003 $662,090 Claims paid by cause Lump Sum– Life Cover “Thank you for your excellent and efficient service in completing the claim. I wish the media published stories like this to explain the value of Life Insurance and the companies that pay the claim when it is needed the most! Accident Cancer Cardiovascular Other Neurological Respiratory Suicide This is one of the most efficient claims paid in my 39 years of selling Life Insurance.” A comment from one of our advisers whose client had made a claim. 11 This is the combined claims for both MLC Retail (including MLC Personal Protection Portfolio/Life Cover Super, Protectionfirst and MLC Insurance) and Group Insurance up to 30 September 2012. Page 12 MLC Claims – We go the extra mile MLC Total and Permanent Disability insurance Occupation Sex Age Cause Policy start date Amount paid Shop Keeper F 49 Brain tumour 01/02/2007 $269,017 Gardener M 49 Motor Neurone Disease 20/02/2006 $370,653 Youth Counsellor F 43 Multiple Sclerosis 01/06/2008 $560,758 Maintenance M 43 Back injury 17/12/200 $401,378 Medical Practitioner F 59 Muscular Dystrophy 27/04/1999 $507,707 General Manager M 58 Cardiac Arrest 28/06/2005 $391,924 We paid out $161 million in Life Cover and Total and Permanent Disability claims in 2012. Claims paid by cause Lump Sum– Total and Permanent Disability Cancer Musculoskeletal Neurological Other Psychiatric Cardiovascular “The funds from this claim will change our lives. There are a lot of medical things that we are purchasing to improve the day‑to‑day hardships of her lifestyle. Also for the first time in our lives, we will have no debt. I can see an improvement in her outlook, giving her a whole new lease on life. And isn’t that what it’s all about?” A comment from one of our clients who made a claim. MLC Claims – We go the extra mile Page 13 Delivering on our promise We paid out $119 million in Critical Illness claims in 2012. MLC Critical Illness insurance Occupation Sex Age Cause Policy start date Amount paid Consultant M 36 Brain tumour 08/04/2010 $445,200 Receptionist F 40 Ovarian Cancer 04/04/2002 $137,045 Boilermaker M 66 Prostate Cancer 17/03/2006 $133,679 Homemaker F 41 Heart valve surgery 01/08/2004 $489,220 Sales Manager M 49 Parkinson’s Disease 18/07/2005 $ 747,281 Bank Officer F 45 Stroke 11/06/2010 $ 105,000 Technical Officer M 45 Seminoma Testicular Cancer 29/11/2007 $ 478,288 Claims paid by cause Lump Sum– Critical Illness “Thank you for handling my claims so promptly; as you can imagine there is much stress and worry associated with cancer, and the mere fact you responded so quickly is a huge load off my mind.” A comment from one of our clients who made a claim. Cancer Cardiovascular Neurological Other Stroke Page 14 MLC Claims – We go the extra mile MLC Income Protection insurance Occupation Sex Age Cause Monthly benefit Payments to 30/06/1212 Chiropractor M 53 Sciatica $ 6,546 $1,156,375 Hairdresser F 49 Back pain $2,646 $206,489 Lawyer M 62 Aplastic Anaemia $3,469 $583,144 Mining Consultant F 50 Brain tumour $1,822 $540,071 Surgical Assistant M 64 Cancer / Larynx $13,768 $1,046,120 Pharmacist F 64 Cancer /Liver $11,446 $911,766 Veterinarian M 63 Lymphocytic Leukaemia $8,326 $607,373 Claims paid by condition Portfolio Income Protection We paid out $113 million in Income Protection claims in 2012. Claims paid by occupation Income Protection – “I would really like to thank you so much for all you have done for me in assessing my condition and the first payment of my Income Protection claim. Knowing that this has occurred is so comforting and reduces the stress I have financially and enables me to concentrate on dealing with my medical condition. Back Cancer Cardiovascular Musculoskeletal Neurological Other Psychiatric A AA AAA ACT B BB C ML NON It was great to talk to you over the phone and very reassuring for me to talk to a caring and understanding person and organisation. I would really like you to pass this email on so that everyone knows what a fantastic job you are doing and what a great company MLC is.” A comment from one of our clients who made a claim. 12These amounts do not include reserves for continued payments. MLC Claims – We go the extra mile Page 15 How we process your client’s claim 1. Claim notification 2. Claim form issued 3. Claim form and supporting documents received To speed up the process, we need the following information: Forms are issued to the policy owner and must be completed by the claimant and a registered medical practitioner. In addition to the claim form the following, as a minimum, are required: policy number and claimant’s contact details cause and date of death or disability Income Protection and Business Expenses also need date ceased work and expected duration of disability, and for Critical Illness claims, give the nature of the medical condition. Death claims: The original policy document and a certified copy of: death certificate Will proof of identity. Total & Permanent Disability and Critical Illness claims: doctors’ reports from two treating doctors certified proof of age and identity, and the original policy document. Income Protection and Business Expenses claims: treating doctor’s report, and financial documents (in some cases). We will advise you if any other relevant information is required. Further information will be required by the Trustee for superannuation policies – including a certified copy of identity. Please note: This flowchart is a summary only. If you need further information, please call the number to the right. We may vary the claims process outlined above if the circumstances of any claim warrants such a variation. Page 16 MLC Claims – We go the extra mile 4. Assessment of claim 5. Advise of assessment decision 6. Payment of claim Assessment of the claim commences on receipt of a fully and accurately completed claim form and any other supporting documentation required. We will initially look to contact you first, to advise you of receipt of the claim and also whether the claim has been admitted or declined. Lump Sum: Our Pay & Finalise process is outlined on page 3. For all other claims the average timeframe for reviewing the paperwork is five business days. You have the option to be involved, or not, during the claim process. The policy owner is advised whether the claim is admitted, declined or if further information is needed. Payments are made by EFT or cheque (you may ask for the cheque to be sent to you). Monthly payments: Monthly payments can be made by cheque or electronic funds transfer into the policy owner’s bank account. Ongoing eligibility for Income Protection and/or Business benefits is reviewed on a monthly basis. For claims notification and more information, all you need do is call our Claims Hotline on 1300 125 246 for help. MLC Claims – We go the extra mile Page 17 How you can help the process Please let us know how much you wish to be involved in the claims process. Non-disclosure can result in a claim not being paid. To avoid this, when your client is applying for insurance, please follow these useful tips. the client should fill out the ✓Ideally application themselves. If you do complete the application for your client, make sure your client initials all pages. detailed file notes from your ✓Keep meetings with your client. doubt, disclose the information. ✓IfIf inyour client is unsure whether to include a piece of information in their application form, they should disclose it. commit or advise your client ✓Don’t that their claim will be successful, no matter how straightforward a claim may appear to be. sure your client answers all ✓Make the questions on the claim form and the continuing claim form. This will prevent delays as we won’t have to ask for details on the omissions. If you, or your client, aren’t sure about a particular question, contact one of our Claims Consultants to help you. sure your client provides ✓Make accurate details of their usual doctor (not just their treating doctor) to help speed up the claims process. if the waiting period hasn’t ✓Even expired, submit the forms early. That way, any further information needed can be requested early making sure that we’re ready to pay the claim on the first due date. “I was very impressed with the turnaround time and the fact that it was done before Christmas. My client was also very thankful for the Income Protection payment in advance over the Christmas period; this is why I sell MLC products.” A comment from one of our advisers whose client had made a claim. Page 18 MLC Claims – We go the extra mile Keeping your clients informed When you, or your client, notify us of a claim we email or post the forms to them with a helpful flyer. These flyers outline the requirements and answer some frequently asked questions about the policy or benefit that is being claimed. “I give MLC 100% for service. They kept me updated by phone and promptly paid my claim on my Income Protection policy for a bilateral knee replacement. The flyers are for: • Life Cover I had a claim with another insurance company on a different matter and I wasn’t allowed to talk to their claims team. I was only allowed to talk to their call centre. • Income Protection • Total and Permanent Disablity • Critical Illness • Business Expenses. I’m glad MLC don’t operate in that fashion.” These flyers are available for downloading from mlc.com.au A comment from one of our clients who made a claim. Insurance from MLC Insurance from MLC MLC from ance Insur Insur ance from MLC om e fr ranc Insu MLC Your insurance claim – keeping you informed ce suran you Your in– keeping claim ed rm fo in s l Illnes Critica Income Protection Your insuranc claim – keep e ing you informed Total and Perm anent Disa bility e ranc g you insu in Your – keep claimmed infor r Cove Life Your in claim surance inform– keeping you ed Bu sines s Expe nses MLC Claims – We go the extra mile Page 19 Want to find out more? If you have any more questions, simply visit our website at mlc.com.au or call our Claims Hotline on 1300 125 246. “Thank you so much for your compassion and your efforts in getting this claim finalised in such a timely manner. I have spoken to the client and he is very relieved. He is so very sick at the moment and he wanted me to personally thank you and MLC for giving him and his family peace of mind. My job is trying to convince people of the importance of having cover. This case proves the point.” A comment from one of our advisers whose client had made a claim. Page 20 MLC Claims – We go the extra mile Complaints We’re committed to providing a responsive, efficient, robust and fair handling of complaints and are affiliated with the Financial Ombudsman Service and The Superannuation Complaints Tribunal. This document has been printed on paper sourced from well managed, environmentally sustainable plantation forests and has been printed by an ISO14001 accredited organisation so there is a minimum effect on the environment. It is part of our campaign to maintain our carbon footprint and reduce global warming. Insurance from MLC Adviser use only For more information, call the MLC Claims Team on 1300 125 246, Mon – Fri, 8.30 am to 5.30 pm Australian Eastern Standard Time (AEST). Postal address: MLC Limited, PO Box 200 North Sydney NSW 2059 Registered office: Ground Floor, MLC Building 105–153 Miller Street North Sydney NSW 2060 mlc.com.au 65916M0613
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