Some life insurers make claims, we just pay them. FOR ADVISERS February 2012 AIA.COM.AU
2 Some life insurers make claims, we just pay them This brochure has been designed to assist you to explain the benefits and importance of life insurance with your clients. Our claims experience should help you demonstrate to your clients what claim causes are most prominent today and what products will therefore suit their needs. You can count on a life insurer that pays claims When it comes to claims management, timeliness and accuracy are critical. AIA Australia makes every effort to pay claims promptly and ensure that every claim that should be paid, is paid. We are committed to making what is potentially an extremely stressful process for your clients as simple and as easy as possible. In 2011, we paid over $445 million in claims that s over $1.7 million every working day. Death $241,654,344 Crisis Recovery $23,255,461 Total and Permanent Disablement (TPD) (including Waiver of premium) $88,640,486 Income Protection (IP) $91,250,696 CCI & Whole of Life $806,433 Claims paid in 2011 ($) $806,433 $91,250,696 $241,654,344 Death Crisis Recovery TPD (including Waiver of premium) $88,640,486 Income Protection CCI & Whole of Life $23,255,461 Our claims philosophy Pay valid claims in a timely manner Assess each claim on its own merits Be genuine in our approach as real people who care and handle each claim with the sensitivity and professionalism that customers deserve. Customers can take comfort in knowing we ll be there when they need us.
Some life insurers make claims, we just pay them 3 Causes of claims In Australia, the leading causes of death 1 continue to be heart disease and cancer. With an increasing number of cases recorded each year, AIA Australia s market leading definitions enable the thousands of people diagnosed with these illnesses to claim when they need it most. Causes of Death claims paid out by AIA Australia in 2011 7.5% 25.0% 5.8% 0.2% 9.8% 40.3% Other* Other unknown 11.3% * Other causes include: Chronic Pain Syndrome, Complications of Pregnancy, Digestive/Genito-Urinary System, Endocrine Disorders (e.g. Diabetes), Infectious Diseases, Respiratory Conditions, Skin Disorders, Suicide/Suspected Suicide. Other unknown causes are heavily made up of Group claims because they are not underwritten and not required to disclose cause of death. Other unknown Other Female % Male % 0% 20% 40% 60% a leading cause of death 2 An estimated 114,000 new cases of cancer were diagnosed in Australia in 2010. is a leading cause of death in Australia more than 43,000 people are estimated to have died from cancer in 2010. The most common cancers in Australia (excluding non-melanoma skin cancer) are prostate, bowel, breast, melanoma and lung cancer. 1 http://abs.gov.au/ausstats/abs@.nsf/products/d6e935d5501d5964ca25788400127b18?opendocument 2 http://www.cancer.org.au/aboutcancer/factsfigures.htm
4 Some life insurers make claims, we just pay them Causes of TPD claims paid out by AIA Australia in 2011 13.0% 4.6% 14.3% 10.4% 43.1% Other* Other unknown 4.2% 10.3% * Other causes include: Chronic Pain Syndrome, Digestive/Genito-Urinary System, Endocrine Disorders (e.g. Diabetes), Infectious Diseases, Respiratory Conditions, Skin Disorders Other unknown Other Female % Male % 0% 10% 20% 30% 40% 50% In 2011, AIA Australia found conditions to be the main cause of claims for TPD, including back/neck conditions, fractures, arthritis, accidents and other musculoskeletal conditions. conditions are defined as diseases of the bones, muscles and their attachments, including joint problems, such as arthritis. Although there are more than one hundred musculoskeletal conditions, the most common are osteoarthritis, rheumatoid arthritis, osteoporosis and back pain. Notes from our Doctor Chief Medical Officer Pramodh Nathaniel We ve identified musculoskeletal conditions to be a major cause of TPD claims, with many of them being potentially reversible with early and appropriate management. A structured return to work program conducted in a timely manner following an injury or illness is an important facet in regaining physical and mental well-being. This is the reason AIA Australia has heavily invested in establishing one of the largest Rehabilitation Teams in the market to provide busy treating physicians with an additional resource in managing your clients well-being. By restoring their health and selfesteem in conjunction with reinstating their income, your clients will enjoy the health benefits associated with being engaged in the workforce whilst being supported by us. Our rehab specialists are tightly integrated within the claims process for management of relevant claims and in interacting with the client and their treating health professionals. Rehabilitation can involve: re-skilling or retraining; career advice and redirection; graded exercise programs; counselling; modification of work environments; and the supply of ergonomic equipment.
Some life insurers make claims, we just pay them 5 Causes of Crisis Recovery claims paid out by AIA Australia in 2011 11.2% 2.7% 4.3% 4.3% 16.6% 63.6% Other* Other unknown * Other causes include: Digestive/Genito-Urinary System, Infectious Diseases, Mental Disorders, Respiratory Conditions Other unknown Other Female % Male % 0% 10% 20% 30% 40% 50% 60% 70% 80% Again, we have identified to be the leading cause of claims for Crisis Recovery which is why we ve structured our definitions to be amongst best in the market 3. In addition, your clients can be confident that should they need to make a claim, AIA Australia will pay for all heart attacks as confirmed by a cardiologist regardless of their severity, and you can be confident that you re partnering with one of the best in the business. There is a heart attack in Australia every 10 minutes 3 1 in 2 Australians will be diagnosed with cancer by the age of 85 4. 3 http://www.heartattackfacts.org.au/ 4 http://www.cancer.org.au/aboutcancer/factsfigures.htm
6 Some life insurers make claims, we just pay them Causes of IP claims paid out by AIA Australia in 2011 6.6% 5.3% 12.2% 9.3% 3.0% 46.2% Other* Other unknown 17.4% * Other causes include: Chronic Pain Syndrome, Complications of Pregnancy, Digestive/Genito-Urinary System, Endocrine Disorders (eg Diabetes), Infectious Diseases, Respiratory Conditions, Skin Disorders, Suicide/Suspected Suicide Other unknown Other Female % Male % 0% 10% 20% 30% 40% 50% 60% In 2011, AIA Australia paid out over $91 million in Income Protection claims and nearly all (98.72%) of those claimants were unable to work due to injury or illness for over a three month period. Alarmingly nearly 50% of those claimants were unable work for over 18 months. Notes from our Doctor Chief Medical Officer Pramodh Nathaniel AIA Australia understands that stress-related disability is a difficult problem to manage with a number of factors which could potentially influence the outcome. Mental health illness could be the primary source of the incapacitation but it could also complicate and influence other conditions like. Of concern to the long term health of people with such ailments, research shows that people with these conditions who are on compensation have a decreased chance of overcoming the condition and returning to work 5. 5 Tisza SM et al Current trends in workers compensation stress claims. Current Opinion in Psychiatry (2003) 16; 571-574.
Some life insurers make claims, we just pay them 7 Average age and top causes of AIA Australia claimants In 2011 the average age of an AIA Australia claimant for both males and females was interestingly 49 years of age. The top causes for both male and female claims in 2011 were: Death 1 2 Cardio-vascular conditions IP/TPD/Crisis 1 conditions including back/ neck (while males also suffered from fractures) 2 3 Mental disorders Reasons for declining a claim In 2011, we paid over $445 million in claims with a 96% acceptance rate. Unfortunately, there are a small percentage of circumstances where we decline a claim and the common reasons why include: Client does not qualify for a Crisis Event We cover 46 Crisis events. A client must meet the definition of a Crisis Event in order to make a claim. If their condition is not listed as one of the Crisis Events or the severity of their condition does not meet the definition, they are not eligible to make a claim. Claimant did not disclose a pre-existing condition at application stage Not disclosing a pre-existing condition upfront can really impact the client at claim stage. It s imperative that pre-existing conditions are disclosed at application stage to avoid a decline. What you can do when your client needs to make a claim Before a claim: communicate the benefits the claimant may be entitled to ensure pre-existing conditions are disclosed. During a claim: assist with completing documentation that AIA Australia may require; assist with gathering financial evidence if required; if mobility is a challenge and you can assist, offer to take the claimant to see their treating doctor (if practical) for claim form completion; follow up on any outstanding requirements which may slow down the claim payment; and reassure them that their claim will be considered with empathy and integrity by AIA Australia. After a claim: help to reduce any stress the claimant may be experiencing from their condition; and be there for your client and ensure any ongoing needs are met with empathy and understanding.
For more information contact a member of the AIA Australia Client Development team on 1800 033 490 or visit AIA.COM.AU This publication has been prepared for distribution to professional financial advisers only and is intended to provide general information. Any decision to purchase any product should be based on the detailed information contained in the current product disclosure statement in consultation with a financial adviser. Applications for the issue of AIA Australia products will only be accepted on receipt of an application form accompanying a current product disclosure statement. AIA Australia Limited (ABN 79 004 837 861 AFSL 230043) AIA06865 02/12_IAS1055