The insurance claims process can be overwhelming for anyone, but for vulnerable customers, it can be particularly challenging. Vulnerability in this context can stem from various factors such as age, disability, mental health conditions, financial hardship, or language barriers. These challenges can make navigating the complexities of insurance even more difficult, often leading to increased stress and anxiety.
Understanding the emotional toll that the claims process can take is critical. It’s not just about the financial aspects; it’s about the mental and emotional strain that can arise when dealing with complex systems, lengthy processes, and, at times, unresponsive insurers. The process and communication from insurers can often be unclear and confusing, further complicating the situation for vulnerable customers. In this guide, we’ll explore how you can support yourself during this challenging time and ensure your insurer remains accountable.
It’s important to note that most people will only go through an insurance claim once or twice in their lifetime. Learning the language of the insurance industry to progress your claim can be a huge burden on anyone, especially when you’re already dealing with a difficult situation.
The Impact of the Claims Process on Vulnerable Customers
The stress of managing an insurance claim can exacerbate existing vulnerabilities. The uncertainty of not knowing whether your claim will be accepted, the financial strain, and the burden of constant follow-ups can all contribute to a decline in mental health and wellbeing. This is particularly true when you are displaced in alternative accommodation with no clear view on when you can move back into your home and return to normality. The time commitment required to stay on top of your claim and navigate the insurer’s process and language can be overwhelming.
Many insurers have teams that specialise in supporting customers with vulnerabilities. However, these efforts are often misguided, focusing on offering mental health support through counselling and urgent payments. While these services can be helpful, insurers often fail to appreciate the impact that the actual claims experience, management of the claim, confusing processes, and unclear communication have on vulnerable customers. It is often the claims experience itself that affects a customer’s mental wellbeing and their sense of peace of mind in navigating the process independently.
Additionally, when counselling services are employed by the insurer, it can feel unsettling for customers who are already struggling with the claims process. Feeling safe in a therapeutic session is crucial to the therapeutic process, and it can feel at odds with an unclear, delayed, and confusing claims experience.
Many insurers also lack a clear plan and strategy to bring the claim to resolution, which they can articulate to the customer. This lack of clarity and uncertainty around claim resolution timeframes can make the process seem overwhelming.
When you notice the impacts these behaviours from the insurer are having on you or your loved ones, here are some practical steps you can take.
Practical Steps to Support Yourself and Hold Insurers Accountable
Here are some practical strategies to help you manage the claims process and advocate for your rights effectively:
- Be Clear About Your Desired Resolution
- From the outset, know what you want from the claims process. Whether it’s a specific settlement amount, timely repairs, or alternative accommodation, having a clear goal will help you stay focused and articulate your needs to the insurer. This helps avoid confusion and keeps the insurer’s attention on resolution. It also helps you feel clear about your desires and keeps the process focused when it can often seem very confusing and cumbersome.
- Follow Up in Writing
- After every phone call or meeting, follow up in writing. Summarise what was discussed, agreed actions, who is responsible, and set clear expectations and timeframes. This creates a record of your interactions and ensures there is no misunderstanding about the next steps.
- Request Written Confirmations
- Always ask the insurer to confirm phone conversations in writing, including agreed actions, action owners, and due dates. This not only holds the insurer accountable but also helps you keep track of the process.
- Avoid Excessive Contact
- While it can be frustrating when your claim isn’t progressing as expected, it’s important to avoid excessive contact with the insurer. Repeated calls and emails can lead to confusion and overwhelm, both for you and the insurer. Insurers can become lost in the volume of requests and contacts, making it harder for them to focus on resolving your claim. This can also blur the clarity of your desired resolution. Instead, consolidate your concerns and queries into fewer, more comprehensive communications. This approach helps maintain clarity and ensures your requests are clearly understood and actionable. We recommend maintaining a running list of outstanding actions and requests. Remember, claim staff are often time poor so making it easier for them will assist in them actioning your requests.
- Ask for a Clear Plan Forward
- Request that the insurer provides a clear plan for how they intend to handle your claim. This plan should include key milestones, timelines, and who to contact at each stage. Knowing what to expect can significantly reduce anxiety and help you prepare for any upcoming decisions.
- Request a Copy of Your File
- Ask the insurer for a copy of your claim file. This will give you access to all the information they have on your case, ensuring you are fully informed and can identify any discrepancies or missing information.
Advocacy Services
If you feel that your insurer is not treating you fairly or if you’re struggling to navigate the claims process, there are advocacy services available to help you:
- Consumer Advocacy Groups: Reach out to consumer advocacy groups or organisations that specialise in assisting people with insurance issues. These groups can provide advice, support, and potentially advocate on your behalf. They can also help you understand your rights and the steps you can take if you’re dissatisfied with the way your claim is being handled. Claims Hero offers a free initial consultation for home and contents claims. We also have a number of blogs on our website that may be helpful – https://claimshero.au/blog/.
- Legal Aid Services: If you believe your rights are being ignored or violated, consider seeking legal advice. Legal aid services can offer free or low-cost legal support, particularly if you’re facing financial hardship.
Lodging a Complaint and the AFCA Process
If you have tried to resolve issues directly with your insurer but are still not satisfied, you can lodge a formal complaint with the Australian Financial Complaints Authority (AFCA). AFCA is an independent organisation that offers free dispute resolution services for consumers. AFCA’s decisions are binding on insurers.
Additional Support Available
Many insurers now offer additional support services to help vulnerable customers, and you are entitled to ask for these. These can include:
- Counselling Services: Some insurers provide access to counselling services to help customers manage the stress and emotional impact of the claims process. It’s important to understand that there are often some limitations in these providers, so it’s good to ask upfront what is/isn’t provided. For example, these providers are often unable to provide a report for the purpose of your insurance claim (i.e. demonstrating the impact the claim has had on you).
- Urgent Payments: If you’re facing financial hardship, ask your insurer about the possibility of receiving an urgent payment to help cover immediate needs. There are specific obligations contained in the General Insurance Code of Practice that the insurers must meet if you tell them you’re in financial hardship. We recommend familiarising yourself with these obligations and ensure that you reference them when requesting support.
- Other Urgent Requests: You can also ask the insurer for other urgent assistance depending on your circumstances. For example, extending alternate accommodation outside of the define policy benefits if there has been delays on the claim.
Public Mental Health Support Services
In addition to what your insurer may offer, there are public mental health support services available:
- Beyond Blue: Offers support for anxiety, depression, and suicide prevention.
- Lifeline: Provides 24/7 crisis support and suicide prevention services.
- Headspace: A service designed to help young Australians manage their mental health.
Financial Hardship Help Services
If you are experiencing financial hardship, there are several services that can provide assistance:
- National Debt Helpline: Offers free financial counselling to help you manage debt and negotiate with creditors, including insurance companies.
- Financial Counselling Australia (FCA): Provides free, independent, and confidential advice from professional financial counsellors. They can help you understand your rights, organise your finances, and advocate on your behalf.
- Good Shepherd Australia New Zealand: Offers a range of financial programs and services, including financial counselling, no-interest loans, and support for people in financial distress.
- Utility Relief Grant Scheme (URGS): Available for eligible households struggling to pay utility bills, which can help alleviate financial pressure and free up funds for other essential expenses.
Navigating the insurance claims process can be stressful, especially for vulnerable customers. However, by being proactive, clear, and organised, you can reduce some of this stress and ensure that your insurer is held accountable for providing the support you deserve. Remember, you have the right to an honest, fair, and transparent process, and there are resources available to help you through it.
Supporting vulnerable customers is not just a regulatory requirement for insurers; it’s a moral obligation. By following these steps, you can empower yourself to manage the claims process more effectively and protect your mental health along the way.