The critical illness claims process

I recently returned from a Million Dollar Round Table (MDRT) meeting held in Vancouver, where I had the privilege of conducting a session entitled How to Package the Critical Illness Sale. The hour-long presentation discussed the importance of critical illness insurance, reasons why it should be integrated into an estate plan and a methodology of calculating the amount of critical illness insurance and the plan designs. I also discussed underwriting, presenting the case and the claims and adjudication process we follow in our office.

Managing a claim

We’ve been fortunate over the years in that we only had, until recently, a couple of critical illness claims. However, since returning from the MDRT meeting, we’ve now encountered four critical illness claims, all related to various forms of cancer. At this point, one claim for $750,000 has been approved and the other three, amounting to another $750,000 or so, are being adjudicated.

Through these unfortunate circumstances, I’ve discovered managing a critical illness claim requires a unique skillset: Instead of speaking only to the client’s family, in most critical illness insurance cases, you’re speaking to both the family and the client as well. So it’s extremely important to balance the sensitivities of an individual who’s facing a critical or terminal illness and the practicalities of managing the claim.

Questions such as, “If I don’t survive the surgery, how is the claim paid?” and “How long after my diagnosis, if I do survive the surgery, will I receive my payment?” have to be handled in a sensitive manner. True professionalism and compassion are the orders of the day. It’s very important to be available to answer all questions, assist the insured in completing the forms and provide an empathetic ear.

Meet with issuers

Early into our involvement in the critical illness insurance market, we visited the head office of the company that issues the majority of our critical illness plans. It was important for our office administration to meet and associate a face with those who would be adjudicating our claims.

We reviewed the procedures and discussed the process in an attempt to be sure we could review any problems and deal with any issues that might slow down the claims adjudication. We created the relationship between our office and the head office—and have since found this relationship to be invaluable in the processing of claims.

If you’re interested in pursuing the critical illness market, I would recommend you meet with the adjudications professionals and discuss the process of claims and adjudication before your first claim. It’ll provide a level of comfort and professionalism to you and to your clients.

Critical illness insurance is a product that provides dignity. It arms our clients with the financial resources to face the battle for their lives, providing choice for individuals who are struck with a critical illness.

And a final note: at the time of the claim, it’s important the insured doesn’t lose confidence in you as a professional, or in the plan you’ve designed for them. Being prepared and supportive of your client is an integral part of the critical illness claim.