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How a leading insurer manages income protection insurance claims [Sovereign]

This article is from a Sovereign adviser newsletter.  At Moneyworks, one of our clients has greatly benefited from being a Sovereign client at time of income protection insurance claim.  Check out her story here.  Adriennes story.

We thought you might be interested in the Sovereign approach to claims.  

Placing your clients' health and wellbeing first our holistic approach to case management

At Sovereign, we pride ourselves on putting clients’ well-being first at claim time. Often this sees us offering support over and above the black-and-white print of your clients’ policy document.

A shining example of this is the holistic case management service we provide to clients making an income protection claim. We will work in partnership with your client’s GP to identify the best path to recovery and if appropriate, we cover the cost of, and coordinate access to, qualified rehabilitation specialists. What’s more, we put this in place as soon as your client claims, regardless of any wait period.

This often results in faster recovery and return to a normal quality of life for your client if they suffer an injury or period of depression.

Sovereign’s Income Protection Case Management and Rehabilitation Service

  • A Case Manager is assigned to each client when they claim, regardless of any wait period they may have
  • We work with your GP and other rehabilitation specialists to devise the best path to your recovery, we then coordinate the services and pick up the costs
  • Many clients who benefit from this service are self-employed or business owners – getting back to work is very important them
  • We often provide this service during a claimant's wait period, so they should contact us immediately when sickness or injury strikes
  • Sovereign's philosophy for active case management and proactive rehabilitation is about helping a client back to their previous state of wellbeing, and back to work. We introduced this service after seeing the enormous difference it could make to the quality of our income protection clients’ lives. Over the years, we’ve invested in and grown this service, learning from the many clients we’ve helped. So much so that today, we believe we lead the Australasian market in this capability.

Working in conjunction with each client’s GP, we provide many income protection claimants with access to qualified rehabilitation specialists such as clinical psychologists and occupational therapists to help them recover and if possible, get back to work.

This is not about getting people off claim, it’s about helping clients regain their sense of personal wellbeing by staying in the workforce and feeling fit to enjoy their family life and contribute to the wider community.

“From a rehabilitation perspective, it’s the bigger picture we’re looking at. It’s not a one-off, tick-the-boxes approach and it’s definitely not about trying to push someone off claim,” says Reeta Anthony, Sovereign’s Claims Manager Disability Income.

"Successful case management and rehabilitation is about getting people back to their normal function of life. It’s a good win for the client and yes, it can reduce risk for Sovereign. At the end of the day, it’s a win-win for both parties.”

Sovereign's approach

We offer an extensive case management service to clients in need, which we believe is more comprehensive than ACC‘s current approach.

Our approach sees income protection claimants receiving their monthly benefit entitlement (once their wait period has passed) and rehabilitation to get them back to health and back to their existing occupation if possible, or for certain cases, we will arrange vocational retraining.

Taking a holistic approach to income protection claims means we not only address the injury and/or mental health of the person, but may also offer support to their family so that they can concentrate on getting their loved one well again.

In addition to providing access to clinical psychologists and occupational therapists, our case managers often work with other providers including other life insurers, ACC and rehabilitation specialists to make sure we really do get the best outcome for your client.

“When looking at rehabilitation for claimants, it’s important to have the right people on the case to help the person recover and break out of what can be a downward spiral,” says Reeta.

“Ultimately, we take each individual case and tailor a plan to meet the client’s needs.”

Does it work?

Success rates vary depending on the case and diagnosis. Mental health rehabilitation, for instance, is often more difficult than a broken leg.

As a rule of thumb, our claims team find that 60% of mental health rehabilitation cases return to work within 12 months whereas, 80% of injury-related claimants will return to work.

Assessments and treatments are expensive; on average, it costs Sovereign $24,000 to get someone back to work. However, the long-term prognosis of a client only needing a short period away from work, or avoiding claiming all together, makes the expense well worth it – not to mention the benefit of your client returning to work and regaining their sense of personal wellbeing. In some instances, with early intervention, the client never actually goes on claim in the first place.

A case study

Many people’s first thought isn’t to call their insurer when a medical crisis hits, but for Harry Smith* the owner of a graphic design business on Auckland’s North Shore, it was one of the most important calls of his life. Within 24-hours of Harry calling for help with the depression that was threatening his wellbeing and livelihood, a Sovereign representative was explaining the claims process and gathering the information necessary to assess his situation and to make a claim.

Once Harry’s claim form was complete, we had consent to liaise with his GP to gain a better understanding of his condition and offer the expertise of our case management team to co-ordinate suitable rehabilitation services.

Despite Harry’s Income Protection policy having a 26-week wait period, we were able to put a case manager in place to help him with his recovery immediately because he notified us straight away. Further, although Harry’s spouse didn’t have a policy with Sovereign, we provided access to a Cognitive Behavioural Therapist to help her cope with what was a tough situation.

Rehabilitation support including visits to a clinical psychologist during Harry’s wait period cost Sovereign $15,000, but the result was Harry started feeling much better and returned to running his business after just eight weeks. Not only did this help keep his business on track, it meant that Harry received holistic specialist treatment without having to worry about the cost, and was back at work well within his 26-week wait period.

* We’ve changed this client’s name, occupation and location to protect their identity.

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