FSCL complaint foreshadows implications of non-disclosure, and more daily news

After speaking with an adviser a woman proceeded to cancel her $300,000 policy and add a trauma/critical illness policy. After suffering a back injury a month after making the changes, the woman’s claims were denied.

“The woman met with an insurance adviser to review her cover – she already had a $1 million life insurance policy with one insurer and another $300,000 policy with another, but no trauma, critical illness or mortgage replacement cover.

The adviser recorded that she was working 28 hours a week as an accountant in her own company and studying part-time.

It was recommended she combine her life insurance policies with one of the existing insurers and cancel the $300,000 policy. The adviser also said she should include some trauma or critical illness cover and mortgage protection cover in case she could not work for a period of time.

The woman accepted the adviser’s recommendations. She cancelled the $300,000 policy and a new policy providing cover for trauma/critical illness commenced in October. In November she tripped and fell, injuring her back.”

When speaking with the adviser the woman noted that she worked 28 hours and studied part-time, when claiming she told her insurer that she worked 30 hours a week and informed ACC that she worked 40 hours a week. Her insurer discovered that she wasn’t  working and instead was a full-time student. The woman proceeded to lodge a complaint against the adviser stating that she wasn’t informed that she would need to provide financial statements and a result of the advice she’s cancelled her $300,000 policy.

“She submitted a claim under her trauma/critical illness insurance, stating that she had been working as an accountant for 30 hours a week. She also stated on her ACC form that she had been working for 40 hours a week.

When the insurer asked for documents to corroborate her income, she was unable to provide convincing information. The insurer then discovered that she was a full-time student. The insurer declined the claim and voided the new insurance policies but later reinstated the $1 million life policy that she had before the changes were made.

The woman complained that the advice she had received from the adviser caused her to lose the $300,000 life insurance policy that she had cancelled on the adviser’s advice. When the complaint was not able to be resolved directly with the adviser, she went to FSCL.

She told the dispute scheme the adviser had not told her she would have to provide financial statements to support any claim.”

Although the FSCL concluded that the advice given was sound advice, the chain of events highlights the importance of risks of non-disclosure.

““We were satisfied that the advice to increase the cover with one insurer and cancel the smaller policy was sound advice and had not caused any loss,” FSCL said.” Click here to read more

Advisers reading the reports will notice inconsistencies and gaps. The story is plainly larger and more complex than is being shared. As such, there is no real basis for making form judgments. In more general observations we should probably note the increasing likelihood of client complaints and the difficulty of managing disclosures - making sure that clients are really clear about the importance of accurate disclosure and helping them to achieve that - for their benefit and ours. After all, complaints just cost us all money and reputation. 

In other news:

Southern Cross: a Risk Partner – Sales and Marketing role is currently being advertised

Strategi: Strategi are offering remote AML/CFT audits

RBNZ: Reserve Bank extending mortgage deferral scheme

RBNZ: Monetary Policy Statement Explained Q&A with RBNZ Chief Economist and External MPC Member

FMA: Sorted Money Week has begun


ACC to delay invoicing

ACC are delaying CoverPlus Extra invoicing for three months. Although CoverPlus Extra payment plans will be paused, all customers will remain covered at their agreed amount. Customers on a payment plan with an outstanding amount owing may have their next installment taken before being paused. ACC will be in touch if there are any further changes.

Click here to see ACC’s response to COVID-19


ACC reveals billion dollar fall-related claims data

Apparently falling over is the most common way Kiwi's injure themselves. In 2018 ACC spent $1.1 billion on fall-related claims. The number is claims increased to 785,063 up from the 781,122 received the previous year. Click here to read more. Any kind of information like this reminds me that while avoiding the risk is a great place to start (wear sensible shoes, think safety first, use a grab rail, get fitter) there is no way I would want that as my only strategy. Some mitigation and then financial risk transfer is definitely in the picture. 

 


How likely is death in a plane crash?

Of course, it depends. The main factors are whether you fly on commercial airlines, or military transports, or choose a wingsuit and jump off a cliff. If you chose the first option, it's pretty safe:

 

I still remember the "passenger accidental death benefit" rider that used to be offered by some insurers. In fact, flying on a commercial airline is one of the safest things you can do. Riding your own motorbike one of the more dangerous.


Winston Calls for Kiwi Insurance Company

In this Newstalk ZB report Winston Peters, Deputy Prime Minister, has called for a new government-owned, New Zealand Insurer. Peters is talking about a general insurance company, but before you consider the wider question - life insurance - Gerry Brownlee has points out that, in effect, NZ already has one: AMI, as a result of the bailout required after the Christchurch earthquakes.

If you apply the same logic to life insurance, the state already owns at least one of those: Kiwi Insurance Limited, part of the Kiwibank group of companies, is already state owned. Plus, the New Zealand Superannuation Fund owns a substantial stake in Fidelity Life Assurance Company.

There could be many directions of argument on the idea of a new general insurer, owned by the state. Although there strong strand of economic nationalism behind what Peters has said he might find that there are others that worry about the high levels of concentration of insurance brands under two large Australian-owned insurers. Those voices might welcome a new insurer joining the field. Still others might reflect that like-it-or-not government is always, kind of, the insurer of last resort, (for example - supporting AMI, running ACC and EQC) so acquiring still more risk might not be such a bright idea. The first step is to be clear about whether there really is a problem with general insurancee in New Zealand - what evidence of actual market failure is there?

Meanwhile, since we're on the subject of general insurance, the New Zealand Initiative has an excellent report on the insurance system following the Christchurch and Kaikoura earthquakes. You can find the report at this link, but here are three summary recommendations as they apply to private insurers:

  1. Government should follow through with proposed changes to insurance that make private insurers the first port of call for claimants in major events, but strengthen audit procedures appropriately;
  2. Government should quickly seek declaratory judgments in key test cases arising after a major disaster; and
  3. Government should consider mechanisms like the Reserve Bank’s OBR for failed insurers.
 

More Surgical Mesh Injuries Denied ACC Cover

Jo Spod has lost his jobs and contemplated suicide after excruciating pain from a surgical mesh complication after a hernia repair procedure. "No-one disputes that Mr Spod is in pain, but ACC cannot cover pain without an identified physical injury and the external opinions provided to ACC could not identify any injury causing his pain." said an ACC spokesperson.

This article from NZ Herald states that in the last year alone, the decline rate of mesh injury claims jumped from 17 per cent to 28 per cent – with 43 of 152 claims turned down. 


Cerebral palsy teen loses appeal to have treatment covered by ACC

A teenage boy with cerebral palsy has lost a decade-long court case against ACC to cover the cost of his treatment. Jeremy was deprived of oxygen to the brain during his premature birth by emergency caesarean section and as a consequence has suffered from cerebral palsy all his life. This from the article by Mike Watson, on Stuff:

"The High Court was correct to find that a failure to treat cannot occur in circumstances where there are no indications for a different treatment course.

"In Mr Adlam's circumstances there was no suggestion prior to the emergency caesarean section that there should have been medical intervention of any kind."

As a result there was no entitlement to cover treatment under the Act and the appeal was dismissed.

In essence, they are saying that this wasn't an 'accident' and therefore does not qualify. Although the limitations of ACC may appear horribly cruel, unless the scheme covered everything, there will always be borderline cases being tackled in the courts. Click here to read more.