A key Australian industry service provider has called on advisers and advice businesses across the ditch to exercise greater diligence when preparing and submitting claims on behalf of their clients.
Trevor Battersby, Director and Founder of TPD Claim Support, told Riskinfo that sub-standard work by either advisers or their support team members when preparing clients’ claims is causing needless delays or declined payments in some instances.
He says while “insurer bashing” is a popular sport, companies can only assess what has been submitted to them.
“There is minimal to no training in writing claims, and it is the most critical part of the process,” he says. “Quality in quality out, garbage in, garbage out.
“As professionals we are in control of the claim submission and we simply need to raise our standards in this area.”
Battersby says a well-researched and comprehensive claim can make the process easier for everyone.
“A defined research and submission methodology will reduce claim time frames and eliminate ineligible claims quite quickly,” he says. “It’s up to us to complete a quality submission.”
…the most significant error he sees is lack of medical evidence…
Battersby says the most significant error he sees is lack of medical evidence.
“You must confirm with the personal disclosure statement and know the difference between a medical specialist, medical practitioner, and health professional,” he says.
“A psychologist is not a medical specialist, and we constantly see claims being submitted with a GP and a psychologist, not a psychiatrist.”
He says advisers charged with completing a claim form are “future forecasting” what an insurer will look for.
“Removing hurdles before they become a problem will avoid those numerous one and two-week delays on each email from the insurer requesting more information,” he says.
…Even more pertinent is that if a client is not eligible, call it now…
“Even more pertinent is that if a client is not eligible, call it now. You simply cannot submit a claim and hope, and then blame the insurer when a claim is declined.”
Battersby says most of the claims his firm has been asked to take over have lacked clear evidence or the expected and necessary information required by the insurer.
“If you focus on great systems and process you will minimise any litigation threat when things go wrong,” he says. “In the absence of these key submission processes you are again flying blind if you can’t produce this evidence should your client seek legal advice.
“Do not let the insurer control the process,” he says. “Work hard at the start and the rest will flow.”
Battersby says a good claim submission should include:
- An eligibility checklist or questionnaire (key)
- A claims fact find (key & critical)
- Initial original application (key & critical)
- Personal statement or telehealth assessment (key & critical)
- Timeline, financial constraints, acting in best interests
- A reading of the PDS definitions checklist of eligibility, medical evidence, and income evidence definition
- A well-defined goals-based strategy (critical if multiple insurances being applied for)
TPD Claim Support will be one of the industry service providers which will form part of the industry expo that will be present at each of this year’s Riskinfocus 25 Risk Advice CPD Tour events around Australia in March.