I’m not one for written musings. At least not in a professional capacity. I’ve had an experience in my work as a Financial Adviser recently, that left me feeling compelled to write it down and share it with others. If it changes just one life, it will be worth my time.
I met a family earlier this year for the first time. Husband had good household earnings, pension planning opportunities as a higher rate taxpayer to be considered, a company Director and above all, father of three. Fairly typical structure, it would seem.
We talked about health, dependents, and the future, as you would expect, and I was informed that the client (the husband and father), had been diagnosed with a rare heart condition back in 2017. The condition had meant he would be on medication for the rest of his life.
‘Do you have any cover in place?’ I asked them.
‘I’m not sure, I think there was something we took out with the mortgage 5 years ago, but I have no idea what it is’ the Gentleman’s wife replied.
I responded, ‘Let’s try and find it and see, just in case there is any illness provision on there, you never know’.
After some searching, we came across some paperwork from a well-known life insurance provider. I won’t mention who, for reasons that will become evident shortly. Having assessed the paperwork, it turned out that the gentleman’s condition was listed under a critical illness segment of his policy. Six figure potential pay-out.
With a cause for cautious optimism, I told them that I think they may have a legitimate claim, but not to get their hopes up as it has been over two years since diagnosis. After a number of weeks of scrambling for medical information from consultants who had moved around hospital trusts, the provider eventually had everything they needed.
Due to some intricacies in the policy wording, the client’s claim had been rejected because the condition was not yet severe enough to trigger the critical illness payout.
We appealed with further evidence to the contrary. We involved other consultants who had worked with client at various points in his health investigations. We fought, and fought, and fought.
It was rejected yet again as the heart reading was 1% healthier than what it needed to be, in order to trigger a claim and be deemed as permanent, despite meeting the diagnosis and all other parameters. It was described as a borderline case, a ‘grey area’. In my opinion, anything right on the line should give benefit of the doubt to the client, always. Otherwise, we risk deteriorating consumer confidence in the provisions they pay for. And rightly so.
At this point it was looking unlikely. I had calls with the Ops director, regional managers, underwriters, claims management teams and everybody in-between. I felt I was failing. I couldn’t stop thinking about it.
Having consulted my network, we tried one more appeal before embarking on an arduous process with the Financial Ombudsman Service which had no guarantee of being successful.
With various discussions ongoing, they agreed to reopen the case for yet another appeal. I felt like I was beginning to develop a heart condition of my own with this, who knows what it was doing to my clients. I was also awash with guilt for getting their hopes up in the first place.
After 5 months of battle, arguments, stress, highs, lows and guilt, I am pleased to confirm that in November 2019 the provider overturned their initial two assessments, accepted the claim and paid my clients a sum of money that will alter their financial security forever, should the delicate health position take a turn or slow down earning capacity in the future.
It was the biggest sense of professional pride I have experienced in my entire life. It blew any fee-yielding, or complicated case, out of the water. I called them as soon as I found out that it was all over. Coincidentally and rather beautifully, it was also their anniversary, and in fact, a Friday.
Worth every minute, although I’m probably not the favourite person at said insurer!
What I’ve learned from this:
- Financial protection is single handedly the most important financial foundation you can give your clients. Some will never claim and may feel you’ve cost them money. But for the ones that do, they’ll thank you for the rest of their lives that you had the difficult conversations and made them pay a monthly fee to something that isn’t tangible, nor exciting.
- Never back down from a battle. I will never take no for an answer if I believe the client has just cause.
- Consider policy definitions and policy structure just as importantly as any other factor such as costs, number of definitions. The simpler the definition, the better for all involved, including the claims handlers!
- The weight of a large network behind you can make all the difference when dealing with providers.
- To always involve myself centrally to any claim, whether I advised on the original policy or not. An Adviser involved can make all the difference to the client outcomes. Enthusiasm at point of advice, vigor and tenacity at point of claim.
- It’s not all about the intricacies of financial planning. The basics are just as, if not more, important. I will never skirt over discussing protection ever again.