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 over 93% of all lodged claims on advised policies.
However, it’s cases like Helen’s – defined by medical conditions that are outside of the terms of the policy – that are the main reason we end up declining around 7%.
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.