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Surprising delay tactics used by super funds

Every week hard-working Australians are contributing to their superannuation fund, giving them piece of mind that they will have a source of income at retirement and access to Total Permanent Disability (TDP) insurance should they need it. Unfortunately, thousands of these Australians are discovering how difficult it can be to access these protections when tragedy strikes and injury or illness leaves them unable to work. Every day, countless Australians battle with their insurers to access the insurance benefits they desperately need in times like this.

Shine Lawyers’ General Manager of Superannuation and Disability Claims, Will Barsby, spends his days going up against the insurance giants on behalf of Australians in need.

“For those of us fighting in this space, just getting someone at these companies to ascertain eligibility and entitlement information can be almost impossible.”

When Australians are turning to their insurance providers, it is usually in a time of desperate need, and far too often they are being met with time-wasting tactics, deployed in an attempt to wear them down and abandon their claims.

The Shine Lawyers Superannuation and Disability Claims department has compiled a list of the most common tactics employed by superannuation fund providers to avoid paying out on your claim.

A young woman is on the phone in her living room. She has made a call and received the news she was hoping for. What could that news have been for i wonder.

The Tactics

Delay

  • Constant requests for different information
  • Insisting they haven’t received documents that have been sent
  • Transferring cases to new staff members so investigations have to restart
  • Sending the claimant to multiple medical practitioners, also known as ‘doctor shopping’
  • Not answering calls or putting claimants on hold for long periods of time.

Because the hurdles created by insurance companies can be so exhausting, genuine claims are frequently abandoned by those desperately needing support.

Deny
For those claimants that finally do get an answer, it may be either a very small offer or the super fund policy holder rejects the claim because the illness or injury doesn’t match the exact wording on the policy. In some cases, policies have out-dated medical definitions included, used as basis to deny claims.

Defend
Far too often we see insurance companies operating on a ‘take it or litigate it’ basis, as they offer unrealistic or no payment amounts to those that can no longer work and need ongoing medical treatment.

The Toll

When people are looking to make a total and permanent disability claim through their superannuation fund, they are usually in a desperate situation. They are no longer able to work and have to cover the costs of expensive medical treatments and/or operations out of their own pocket.

Mr. Barsby knows firsthand the devastating impacts the TPD waiting game can have on Australians and their families.

“We have one family of six at the moment who have been forced to live in a tent in a friend’s backyard while their insurance company sits comfortably behind its stone walls.”

More devastatingly, others have decided to cut their life short to save their family money or to end the pain they are experiencing.

“We have a handful of suicides every year among TPD clients who lose whatever will to live they had in going up against the big boys of the insurance industry.”

The Report

Earlier this month, the Australian Securities and Investments Commission (ASIC) released a report summarising the findings of a review into the life insurance sector.

Mr. Barsby was not satisfied with the depth of the audit and believe several key areas were missed.

“It didn’t cover TPD which is the biggest part of the problem and where the majority of Australian’s actually have life insurance.”

“The information gathered appears to have come solely from the insurance sector provided data, without any input from key stakeholders.”

The ASIC report revealed that that the most poorly performing insurer in terms of claim denials was rejecting 37% of claims. The corporate watchdog refused to reveal the name of the company however hours later, Westpac’s life insurance component BT Financial Group (BTFG) issued a public statement admitting they were responsible for the one in three denial of claims.

Appallingly but not surprising, the ASIC report indicated that some insurance operators where offering staff bonuses based on their decline rate. This is just one example of the internal infrastructure within the industry to deny claimants’ payments.

In a separate statement to the ASIC report, the regulator said that insurers in the future would have to report what percentage of claims they denied. It is unclear whether this information will be made public.

Mr. Barsby calls for ongoing auditing,

“While I believe ASIC’s review was greatly needed, and the intention was positive, it can’t just stop there. The conversation has started, and that is a source of hope, but the insurance industry must be overhauled, and subject to regular scrutiny.”

Written by Shine Lawyers on . Last modified: August 18, 2017.

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