Steph’s cancer claim
Article19 February 2024
It pays to stay covered
Steph reduced her cover just weeks before she was diagnosed with colon cancer, but she still received the higher amount.
Steph's trauma cover claim
Steph Davies* took out trauma cover to the amount of $162,000 with OnePath in 2002 as a healthy 38 year old woman.
As the primary carer of a young family, she wanted to ensure she was able to provide for her young children should something happen to her.
With peace of mind from having some protection in place, Steph was content with paying her annual premiums consistently for the next 18 years.
What happened...
When Steph applied for her insurance with the help from her adviser, she chose to pay a stepped premium. This means that the price of her policy is determined each year at her policy anniversary based on her age at that time. The likelihood of claims naturally increases as we get older, which is why stepped premiums increase over time.
What’s the difference between stepped and level premiums?
Experiencing an increasing price while never having claimed can leave people like Steph doubting whether the expense is justified. Uncertain of the value of her policy, she called OnePath to cancel her policy.
However, our claims statistics show that people tend to want to cancel their policies at the time when they need it most – it’s become more expensive because their likelihood to claim has increased.
During July 2020
After speaking with OnePath, Steph made the decision to reduce her level of cover to make her cover more affordable – rather than cancelling her cover altogether and not having any protection in place.
She decided to reduce her level of cover from $162,000 to $50,000.
In early August 2020
Steph experienced some significant cramping in her stomach. She contacted her doctor who decided to conduct some routine blood tests for further investigation. The next day, Steph’s histopathology report confirmed that she had colon cancer.
Later that same day she had emergency and life-saving surgery to remove a section of her bowel.
Our decision
Luckily Steph's insurance was still in place, so she was entitled to a benefit payment for the $50,000 she was covered for under her policy.
After working hand-in-hand with Steph to submit her claim, Steph's designated claims specialist James saw it reasonable that Steph had the cancer before she decided to reduce her sum insured.
He brought Steph’s case to the in-house Claims Review Forum recommending that – with consideration given to the short time between her policy change, diagnosis and surgery, and to all the wider circumstances of her claim – OnePath pay her claim for the full amount of $162,000 which she had originally been covered for only weeks before.
Thanks to the diligent work of James, and the human decision-making process that determines the claims we pay, we saw it as the right thing to do to honour Steph’s claim – as a loyal customer of 20 years, and pay her the previously insured amount of $162,000.
*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.
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.
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.
