How to Avoid Your Insurance Claims Being Denied.

Sometimes, people can get the image of insurance companies as money hungry corporate folk looking for any possible reason to deny all possible claims. Fortunately though, in the risk insurance market in New Zealand, that image doesn't hold true. The major reputable insurance providers that we deal with have a great record of paying out claims that are owed, provided they meet the specific conditions of the policy (which is why it's always a good idea to read the policy wording and know exactly what's covered).

In general, there are only a few reasons why your insurance claim could get denied, and as long as you avoid them, you can strongly depend on your insurance paying out when you need it during your difficult times.

1. Non-Disclosure: If you have a personal risk insurance policy and suffer injury or illness due to a condition you had prior to taking out your policy, and you failed to disclose this on your original applications, the insurance provider could reduce your claim or deny it entirely. We take considerable time with our clients to go through these forms and make sure every base is covered, but if you are going it alone, here are some things to keep in mind:

• Declare everything, no matter how small or minute you may think it is. If the condition isn't deemed to be serious by the insurers, your policy won't be affected in any way by declaring these things.
• Consult with your personal doctor or specialist first to remember any health issues you may have forgotten about.
• It is never a good idea to lie about current health status (or not being a smoker) to save money on premiums. The insurance company will find out upon claims (they are generally thorough) and will reduce or deny your claim because of it.
• You do not have to disclose conditions you develop after the policy is taken out and they will not affect the premiums you pay or any claims you take out. This is a good reason for you to consider taking out insurance when you are younger and healthier.

Proper and full disclosure may be the most important thing when taking out a policy.

2. Premiums Haven't Been Paid: An insurance policy is a contract between you and the insurer, which states that they will pay agreed upon amounts if its conditions are met. One of those conditions is the prompt and up to date payment of the agreed upon premium (the cost of the insurance policy). If the premiums haven't been paid up to date before the claim is formally requested, the insurance company may deny them or ask for payment before the claim is processed. Thus, its important not to get too far behind on your insurance payments as this is generally one of the only reasons claims get denied.

3. Conditions Have Not Been Met: If the specific condition or occurrence you're trying to claim for is not specifically covered under your policy, the claim will be denied. Sometimes a specific medical condition for instance can range in severity, and if the severity of your condition doesn't meet that specified in the policy, it won't qualify for a claim. The good news is, all of these details will always be specifically and thoroughly outlined in your policy wordings, so reading it thoroughly before, during and after taking out your policy is always highly recommended by our team.

In our more than two decades in the insurance industry we can assure you that insurance companies aren't looking to deny your claims. In return, their expectations of you are that you are honest, truthful and complete in your disclosures and maintain the agreed upon payments for the policy. If you have done so, you can rest assured that you will have very little to worry about when it comes time to make a claim.

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Medical Insurance Special Offer

Spratt Financial and Southern Cross are proud to offer new clients a special deal so that you can get the medical insurance you need. A lot of people struggle with getting medical insurance for their pre-existing conditions. With this deal, once your policy has been in place for three years, nearly all types of pre-existing conditions will be covered! Better yet, we have been able to obtain additional discounts to make medical insurance even more cost-effective.

Features of this offer are as follows:

•             Pre-existing medical conditions will be covered after three years*
•             Receive a 10% discount off your first year’s premiums
•             Receive an additional 10% Healthy Lifestyle Discount – if eligible
•             A further 2.5% discount for payment with Direct Debit
•             This gives a total 22.5% discount on first year’s premium and 12.5% discount thereafter

This offer closes 30^th September 2015, so take advantage of this fantastic opportunity, you can contact us by email here or through our website's easy contact form.

*A few Chronic Conditions may be excluded, which we can discuss with you. 

Defining Insurance Terms

A lot of the jargon and terminology surrounding insurance can be difficult for people not familiar with the industry to understand. Worse, many insurance companies or brokers use these terms expecting full knowledge. Here is the definition of some of the most important terms you might come across when dealing with insurance.

1. Policy 

An insurance policy is a contract between yourself and the insurer. The policy provides conditions that once you fulfill, you will receive payment from the insurer in the amount agreed to when the policy is taken out. For example, a life insurance policy is an agreement between you and the insurer to pay a certain amount (called the sum assured) in the event of death. A Total Permanent Disablement Policy will provide payment once you fulfill the conditions of being unable to work due to illness or disablement for longer than a specified period of time. And so on and so forth. An insurance policy is what you pay premiums for as well as what you make a claim upon.

2. Premiums 

The price you pay to keep a policy in force. Most premiums are paid monthly, and the amount depends upon the type of insurance, the sum assured and other factors such as your age, your health or the amount of people covered by the policy.

3. Claims 

A claim is the action you take when you have fulfilled the conditions of your policy and wish to be paid out the sum assured.

4. Pre-Existing Conditions 

A pre-existing condition is a physical health or mental health condition which were already present at the time of taking out the policy. Pre-existing conditions can be excluded from your insurance coverage or can cause your premiums to be higher, as the insurance company is taking on a higher risk by insuring you.

5. Exclusions

Events or conditions that are not covered by your insurance policy. For example, in many life insurance policies there is a suicide exclusions whereby death by suicide will not result in the insurance paying out ie. it is 'excluded' from your cover.

6. Insurance Broker

An insurance broker is different from an insurance company in that a broker does not sell insurance to you directly. A broker searches the marketplace on your behalf, taking your needs and your individual circumstances into account to secure the best possible deals on the insurance policies you are looking to take out. A broker's job is to work for the client and work for their interests and not the interests of the insurance companies. Our company, Spratt Financial Services is a team of insurance brokers, operating under this definition.

7. Waiting Period 

The waiting period is the amount of time (agreed upon at the time of taking out the policy) which must pass after an event before you can collect your insurance benefit. For example, in an income protection policy with a waiting period of 4 weeks would mean that you will receive your agreed upon benefit from the policy 4 weeks after being rendered unable to work by illness or disability.

8. Living Benefits 

This is a feature that can be included in life insurance policies that allows you to receive payment on your life insurance before you die under certain circumstances. Usually, these involve diagnosis of terminal illness such as cancer or the need for specialised care.

9. Waiver of Premium

A feature that can be added to an insurance policy that will ensure that your insurance remains in place and active if you fail to make premium payments due to illness or disability. The waiver of premium will usually remain in effect for as long as you are disabled and unable to make premium payments. This feature will cost an additional premium.

10. Qualifying Event

An occurrence that triggers your insurance payout or claim. For instance, a death in the case of life insurance or a surgical procedure in medical insurance.

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