What happens when there is a claim?

   10 Jun 2019

What happens if you have to make a policy claim? Here is an overview of what can happen.

Often enough, our clients aren’t quite sure what to do if they do have a claim, or if their particular circumstances are able to be claimed upon. When purchasing your policy, it’s important to know what your coverage is, and we do our best to ensure that our clients know exactly what the options they’ve taken include. However, there’s a lot of paperwork, and a lot of numbers and technicalities that can be overwhelming when looking over these policies. This is why we would suggest checking in with your broker if you have any issues which you feel come under the coverage of your policy.

In some cases, we’ve had clients who have forgotten about their policy coverage, or didn’t realize they could claim on an illness or injury that they’ve had. In one instance, a client came looking for a review of a policy written by another financial institution some years prior. Upon review of their policy and the introductory discussion and questions we always ask of our new clients, it became clear that one of the family members had experienced a serious illness several years prior. Even though it was several years passed and the client had fully recovered, their protection did cover the illness. We were able to file a claim that was successfully paid out. This is one more reason to review your policies regularly with your adviser!

So what is the process if you have a claim?

It’s really quite straight forward, in most cases. Just give your broker a ring if you believe something has happened that falls under the coverage of your protection policy. Our job is to make the process as easy as possible for you during a difficult time, and we work hard to ensure that things run smoothly.

In most cases, the claim will require some papers to be gathered; pay slips, death certificates, or verification from doctors being some of the most common, depending on the type of coverage and the claim being made. Your adviser will let you know specifically what is required.

There are some forms from the insurance company that need to be filled out, but your adviser will help you through that as much as possible, answering any questions or concerns that may arise.

After that, we handle any back and forth, keeping you aware of what is happening along the way. It can take as little as a couple of weeks for a payout to occur, and we keep an eye on the claim throughout the process to make sure that, as much as possible, it doesn’t get delayed in the process. There are a few factors that can delay or cause rejection in your claim, which we’ll discuss in another blog, but for this blog, we’ll assume that this is a straight-forward, strong claim- which most are!

However, if we or a client feel that a genuine claim is not approved we will appeal the claim on behalf of our client and do everything possible to get the claim approved. It’s very important to remember that we will work on behalf of our clients at all times.

Once you’ve gotten the payout, that’s it, you’re all set and your claim has been completed. It’s a common misconception that life or serious illness claims are rarely paid out, many people believing it’s as low as 60%! However, the companies we work with all paid out over 90% of their protection claims in 2018 and continue to do right by our clients in the area of claims payouts.

We would strongly advise that you discuss your future needs with your adviser at this point in the process. It’s important after a claim to make sure that your remaining coverage is adequate for your needs or if you should consider different coverage options given the changes in your circumstances.

If you’re interested in discussing your protection coverage options, please contact us today!




Written by Joe Dunne