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A real-life scenario of the claims process

29 May 2019

When you buy long-term insurance, an adviser or a broker offers you a policy, which you accept to ensure that your financial future is protected. This may seem quick and simple; however behind the scenes much more goes into ensuring policyholders receive appropriate cover from their long-term insurer.

Debbie Fisher, a Specialist in Activation Integration in the financial services industry took out dread disease cover after speaking to her financial adviser about her family history of serious illnesses. In 2017, she was unexpectantly diagnosed with a brain tumour. During an angiogram, however, unexpected complications resulted in an emergency craniotomy. She was off work for six months and needed to relearn basic skills like walking.

Debbie shares her step-by-step experience that led to her insurance pay-out by Liberty.

  1. Underwriting
  2. Besides your financial adviser who will provide you with forms to fill -out and ultimately sign, an underwriter is another person you may encounter, usually telephonically or in some instances, face-to-face. The nurse that comes over to draw some blood forms part of the underwriting team. The insurer determines what coverage you qualify for based on the comprehensive information that you provide. It is therefore imperative to be truthful.

    Debbie fully understood the underwriting and claims process. “Yet, many people underestimate the importance of an accurate and complete overview of their health. Even if you think it’s unimportant, declare it anyway.” 

  3. Claims investigation
  4. When the time comes for one to claim, the information provided is verified, hence the importance of regularly providing accurate information throughout the life of your cover.

    Debbie says having a financial adviser to act on your behalf is essential at this stage “My adviser completed all the forms and understood all the requirements of the cover. I was too ill to complete the forms myself or to even relay essential information. I don’t know what I would have done without my financial adviser.”

  5. Non-disclosure
  6. At Liberty, if there is a discrepancy with the information, then the risk is re-assessed. Non-disclosure of information becomes an issue and Liberty assesses each case on its own merit because sometimes mistakes do happen. Only in extreme cases, where relevant information is deliberately withheld, are claims rejected and premiums returned to the policyholder.

    Following her experience, Debbie says it is just not worth neglecting to share essential information.

  7. Pay-out
  8. Next is the pay-out stage, either in a lump sum or in monthly instalments. The most critical part here is knowing from the outset how pay-outs are made and what they cover. Debbie’s illness cost in excess of R1 million and misconceptions about her coverage could have been financially devastating. Debbie stresses: "read the terms and conditions properly. If you’re not sure what all the clauses mean, ask your financial adviser.”

  9. Recovery

With your financial needs covered, you can focus on recovery or lifestyle adjustments without financial stress. Debbie quickly discovered this. “Risk cover influenced my recovery and my progress. Correct cover and accessing it when you need to can affect not only recovery time but also how well you recover.

“When I returned to work, I took things slowly and built up my working hours gradually. My dread disease cover, my manager’s support and, especially, my family were influential in my successful recovery. The amazing support from Liberty also went a long way in my recovery period because the team empathised with me, which made me feel like I was part of their family,” says Debbie.

If you have a family history of critical illness or would like peace of mind for you and your family in the long-term speak to your adviser about Liberty’s Lifestyle Protector cover.

This article does not constitute tax, legal, financial, regulatory, accounting, technical or other advice.  The material has been created for information purpose only and does not contain any personal recommendations. Please consult your Liberty Adviser or Broker should you require advice of a financial nature and/or intermediary services.  Liberty Group Limited (Reg. no 1957/002788/06) is a registered Long Term Insurer and an Authorised Financial Services Provider (FAIS no 2409).

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Liberty Group Limited (Reg. no 1957/002788/06) is a registered Long Term Insurer and an Authorised Financial Services Provider (FAIS no 2409).