Andrea’s Claim

Andrea’s Claim – An Insurance Claim Case Study By Kristopher Meuwissen


*Names changed for privacy

What I’m about to tell you is the story of the first ever claim on insurance that I helped one of my Melbourne clients through. I was much younger then and predominantly giving insurance advice to clients.

I started working with a mother of two aged in her 40s, let’s call her Andrea. Andrea had a small loan against her home with a young family of two daughters, who were in their mid to late teens. Andrea was recently divorced. This meant that Andrea was the sole breadwinner of her family and household.

Andrea decided to take the step and get a full financial plan done, which we covered things such as her wealth plan, her insurance, as well as a retirement plan. When it came to her insurances we were covering her for income protection, life insurance, total and permanent disablement, and also trauma insurance. This all took place in about 2013.

Everything was going beautifully and smoothly for about two years. In 2015, I called Andrea and asked her how things were going, and to organize a time for us to sit down and review her circumstances, to check in to make sure that she was on the right track with her financial plan. It took me a little while to actually get a hold of Andrea, I’d called her a number of times prior to her answering the phone, and it had always gone to voicemail. Finally Andrea actually answered the phone. Andrea then told me something, and I’ll never forget the way that I felt.

Andrea told me on that phone call that she had bowel cancer, and whilst it wasn’t really extremely serious, that she was currently receiving treatment for it, and it looked like the doctors were going to have to operate. Andrea asked me if it was okay to postpone our review during this period of time as she just didn’t feel well enough to sit down and go through a financial plan. After initially being taken aback and being a little bit lost for words – because I’ve never had a client who had had a serious illness before – I asked if she was okay and what the prognosis was. She told me that whilst it was in its early stages, it was still very serious, and everyone was quite worried, herself included, and she was very distressed and very upset, and was also out of work for quite a bit and was only able to work a little bit at a time. I asked her a few medical questions about her condition, what it was called, and how much it had progressed, what her doctor said the prognosis was, had she seen a specialist, and straightaway after the phone call, I told her I’d call her back in the next hour or so, and have a look and see if there was something that we could do for her.

I called her insurer, who at the time, I believe, was AMP, and asked them if she had a claimable event, as it was a cancer, to which they replied that she had a claimable event under her trauma insurance as well as her income protection. I organized the paperwork to be sent to our office and prefilled in and gave Andrea another call.

I called Andrea and told her that she was going to be able to claim on her insurance, and the claim amount was going to be over $100,000 for the trauma policy, which is going to be tax free, and the income protection was going to pay her from the point that she was unable to start work, after a waiting period. She had a waiting period of one month, and so they were going back pay her two months’ worth of income protection payments, and then continue to pay her until she was back working full time.

Andrea, understandably, was beside herself. She was really upset on the phone and crying with tears of happiness that she was now able to take all the time off work and stop worrying about when she was next going to get paid and what was going to happen. It meant that she was able to wipe out the last little bit of her loan with an extra fifty-odd thousand dollars after the fact, that she was able to spend on making sure that she was getting better, and making sure that she was looking after herself.

She was also getting paid the income protection, which meant that her regular expenses were getting paid for, and she was able to keep on top of things during that period of time. Andrea in the end was very fortunate, and her bowel cancer claim didn’t go on for too long. She stopped claiming after 6 months when she was able to get back to work, and her cancer was in remission after her treatments.

The insurance payment allowed her to take the time and not worry about money. She was able to get better, help herself, and springboard into the next chapter of her life. Afterwards, Andrea had paid off her mortgage, had recovered from her cancer scare, she was able to reinstate her trauma insurance, and she still had upwards of $40k left over which she was able to put towards an investment account that she could start contributing to.

Insurance is not there to put you in a much better position than what you were in prior to claiming on it, and it is never a preferable option to have to claim. We always want our clients to be fit and healthy, but it is a bittersweet feeling to see a client get through a terrible event in their life without having huge financial burdens.

It really makes the process of the insurance worthwhile.

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