Helen’s joint disease claim
Article29 September 2023
It's important to know what you're covered for
Trauma cover provides protection against many serious medical conditions. But when Helen was diagnosed with Spondyloarthropathy, a joint disease of the vertebral column, she unfortunately wasn't eligible to make a claim.
Helen's trauma cover claim
Helen took out a trauma cover policy with OnePath in 2010 at the age of 31.
As a single parent of two young children, Helen wanted certainty that if something were to happen to her, she would be able to provide for her children.
What happened...
With the support of an adviser, Helen went through her insurance options and decided that Trauma Premier was the best cover for her needs. Together, they went through the details of her policy and submitted an application.
Four years later, Helen was diagnosed with Spondyloarthropathy – a joint disease of the vertebral column. She lodged a claim on her trauma policy in 2018, but while her policy covered her for many serious conditions, hers was not one of them. The assessors attempted to determine whether she qualified for Rheumatoid arthritis (a similar condition which was covered by the policy) but she did not meet the criteria to claim.
Our decision
Unfortunately, on this occasion, Helen’s claim was declined because her circumstances did not meet the terms for payment of her condition, or under the definition of Rheumatoid arthritis.
In informing Helen, the claims consultant Peter clearly explained the reason for the decision, listing the evidence Helen had provided to support her claim, explaining the conditions of her policy under which she was claiming, and inviting Helen to call him to explain the decision reached.
At OnePath, we’re in the business of paying claims that our customers are covered for, and it is our mission to be there for customers when they need us most. In fact, we pay 9 out of 10 of all lodged claims on advised policies.
For us at OnePath, to offer affordable protection to our customers, policies are priced based on a calculation of the future risks our customers face of suffering a set of clearly defined diseases and illnesses included in their policy. Although it would be our wish to cover customers for every risk they would ever face, this cannot be feasibly done. So taking out a policy means paying a regular premium to be covered for a set of diseases, illnesses and conditions set out in the terms of the policy.
At OnePath, we have the top-rated claims team in the country, and are proud to be there for our customers when they need us most.
Source: In 2022, OnePath paid 92% of lodged advised claims
Whilst the names have been changed to protect the individual claimant, this case study is based on the actual circumstances of the claimant. This is for illustrative purposes only, and claims will be assessed based on the specific circumstances of each individual case.
Zurich Australia Limited, trading as OnePath Life (ABN 92 000 010 195, AFSL 232510) (Zurich or OnePath) issues OneCare including OneCare External Master Trust and OneCare SMSF.
Brighter Super Trustee (ABN 94 085 088 484, AFSL 230511, RSE L0000178) (Trustee) is the trustee of Brighter Super (ABN 23 053 121 564, RSE R1000160) (Fund) and the issuer of OneCare Super. Zurich is the administrator and insurer for OneCare Super.
This information does not take into account your personal objectives, financial situation or needs. You should consider these factors and the appropriateness of the information to you. Consider seeking advice specific to your individual circumstances from an appropriate professional. You should also consider the relevant Product Disclosure Statement (PDS) for the product available at OneCare Policy Terms | OnePath or by calling us on 133 667 in deciding whether to acquire or continue to hold the product. Furthermore, some relevant products have been designed to meet certain objectives, financial situations and needs, which are described in its Target Market Determination available at Target Market Determinations | OnePath.
