Claims Focus 2014, No. 2
Issue: December 2014 |
By Mary Enslin, Associate Claims Specialist, Cape Town
Claire Henshall, Manager Claims, London
Fionna Kossmann, Claims Specialist, Cape Town
It is easy to lose focus. In the context of disability claims assessment for example, it is easy to emphasise the medical aspects at the expense of the occupation. While the clinical evidence is clearly important, Claire Henshall highlights that the work a claimant did prior to disability is actually what determines if their claim is valid. Analysing job demands shows claims managers where they should focus to help claimants get back to work.
Every year millions of people’s lives are changed irrevocably by traumatic brain injury. Their recovery is often blighted by lasting impaired motor and cognitive function and complex behavioural changes. Getting them back to work is a challenge. Managing disability claims to a successful conclusion means surmounting critical obstacles by blending rehabilitation services, emotional support, and therapist interventions with empathetic case management. Mary Enslin discusses the unique role claims assessors can play in managing the relationship between claimant, medical personnel and employer.
Writing pre-existing medical clauses into Income Protection policy conditions is one method to manage claims risk when little, or no, underwriting is done prior to policy issue. Fionna Kossmann describes the effect of these clauses in a claim scenario and highlights how important it is that claims assessors know their content, how they may be applied and their limitations.
Browse the Contents in this publication.